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30 Cards in this Set

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How long do all ADs require to take clinical effect?
How long can they be maintained?
2-6 wks
12 mo
TCAs vs SSRIs
longer history?
proven efficacy in severe depression?
better side effect profile?
much less toxic?
patient acceptance?
first line ADs for most physicians?
longer hx- TCA
proven efficacy- TCA
better side effects- SSRI
less toxic- SSRI
patient acceptance- SSRI
first line AD- SSRI
What type of TCA has lower incidence of side effects?
Secondary amines (nortriptyline)
Give an example of a different side effect profile that may inc pt. acceptance
buproprion has lower incidence of sexual side effects- inc's acceptance
If poor response, consider "5 D's"...what are they?
Dose
Duration
Diagnosis
adjunct Drugs
Different tx
What's your best bet with atypical depression (agitation, wt gain, somnolence)
MAOIs
For severe depression unresponsive to pharmacotherapy, or for psychotic depression, what is recommended?
ECT and psychotherapy
What two classes of drugs are used to treat acute manic episodes?
antipsychotics
and
anticonvulsants
What are the classic and more recent antipsychotic drugs used to treat acute manic episodes?
classic- haloperidol
recent- olanzapine (Zyprexa)
What are the classic and more recent anticonvulsant drugs used to treat acute manic episodes?
classic- bezodiazepines (lorazepam, clonazepam, diazepam)
recent- valproic acid (Depakote), carbamazepine (Tegretol)
What classes of drugs are used for maintenance of manic depression (mood stabilizers)
Lithium
Antidepressants
Anticonvulsants
Do most patients require AD?
no, severely depressed might
-precipitation of mania can occur in minority of patients
What are the common anticonvulsants used for maintenance of bipolar affective disorder?
valproic acid (aka divalproex sodium- Depakote)
carbamazepine (Tegretol)
What are two theories of mechanism of action of lithium?
1. interferes with metabolism of inositol phosphates
2. inhibits glycogen synthase kinase 3
Give three uses of lithium
1. long-term maintenance of bipolar disorder
2. adjunct in unipolar depression
3. adjunct in schizoaffective disorder
NOT EFFECTIVE IN ABATING ACUTE MANIC EPISODE
Name neurologic/psychiatric adverse effects of lithium
tremor (tx w/ beta blockers)

also ataxia, hyperactivity, aphasia, sedation, fatigue
Name glandular adverse effects of lithium
edema from inc aldosterone secretion

also mild hypothyroidism
Name Renal adverse effects of lithium
polydipsia, polyuria- nephrogenic diabetes insipidus (responds to amiloride)

also degenerative and infl changes in nephron
Name GI adverse effects of lithium
GI irritation

also diarrhea, and wt gain in some
What can lithium do to skin?
exacerbate skin problems- psoriasis, acne, folliculitis
Does lithium have a high or low TI?
low
Name signs of lithium overdose
mental confusion, aphasia
ataxia, hyperactivity, bizarre motor movements
hypotension, arrhythmias
convulsions, coma
How do you treat lithium overdose
supportive
osmotic diuretic
dialysis
lithium is absorbed (poorly/well)
distributed in ...
and _% is excreted in urine
well
total body water
5%
What percentage of filtered lithium is reabsorbed?
What can change that?
80%
Na levels and age
What is the implication of lithiums short t1/2 and low TI?
must give in divided doses or controlled-release form
How do you know if you reached your lithium target of .5-1 mEq/L
blood levels must be determined
What drugs will increase lithium toxicity?
sodium depleting diuretics that decrease Li excretion- especially THIAZIDES, also furosemide; ACE inhibitors, NSAIDS
What can decrease Li levels from increased excretion?
mannitol
acetazolamide
theophylline
Which of the following anticonvulsants is used only as an adjunct to lithium?
carbamazepam
clonazepam
valproate
clonazepam

*the others may be used alone in milder forms of disease*