Lithium And Antidepressants

Front 1

what 4 things is serotonin involved in?

Back 1

1. mood
2. food intake
3. sleep
4. sex/libido

Front 2

what happens when you increase serotonin levels?

Back 2

1. elevated mood
2. decrease food intake
3. increase sleep
4. decrease libido

Front 3

what is the MOA of tricyclic antidepressants?

Back 3

bind to the amine pumu and block pre-synaptic reuptake of 5HT and NE

Front 4

which receptors do tricyclic antidepressants bind to ?

Back 4

alpha-1 : orthostatic hypotension and syncope
2. histamine receptors : cause sedation
3. muscarinic receptors: anti SLUDE

Front 5

what are the two main differences between tertiary amines and secondary amines?

Back 5

tertiary amines : long acting, more selective at blocking 5HT reuptake
secondary amines : short acting, more selective at blocking NE reuptake

Front 6

name 5 tertiary amines?

Back 6

ACID T
amitryptyline, clomipramine, doxepin, imipramine, trimipramine

Front 7

name 5 secondary amines?

Back 7

DAMPN
amoxapine, desipramine, maprotiline, nortryptyline, protryptyline

Front 8

what would you give a sleepy depression patient? secondary or tertiary?

Back 8

secondary, it will increase NE more than 5 HT

Front 9

Name six SSRIs?

Back 9

citalopram, escitalopram,fluoxetine, fluvoxamine, paroxetine,sertraline ( SC PEFF)

Front 10

Name three SNRI's ?

Back 10

duloxetine, milnacipran, venlafaxine (DMV)

Front 11

what are the five atypical drugs?

Back 11

bupropion ( increases incidence of seizures), nefazodone , mirtazapine (sedation is an adverse effect due to blocking histamine receptor, also blocks 5HT2A, alpha1 and alpha2, reboxetine, trazadone( no cardiac or anticholinergic side effects

Front 12

what is tyramine? why cant you take tyramine when you are on MAOi?

Back 12

tyramine is a releaser of stored monoamines. if you block MAO and take tyramine you release all the stored NTs which can cause a hypertensive crisis and a patient can stroke out.

Front 13

what is the MOA for lithium?

Back 13

it gets in the way of sodium so action potential cannot start. that gives you a generalized neuronal dampening.

Front 14

state 8 side effects of lithium?

Back 14

1. arrhythmias
2. polyuria and polydipsia
3. nausea and vomiting
4. drug abuse ( place them on SSRI, MAOi, SNRI)
5. insomnia
6. weight gain
7. thyroid enlargement
8. increase in circulating PMNL ( reversible)

Front 15

what are the three drug interactions for lithium?

Back 15

1.use osmotic diuretic or acetazolamide for detoxification ( increased excretion of lithium)
2.loop diuretic or thiazide decrease excretion of lithium and can lead to toxicity.never use them.
3. NSAIDs indomethacin, naproxen, ibuprofen can diminish clearance and increase plasma levels leading to lithium toxicity.

Front 16

which are the other three drugs used to treat bipolar depression?

Back 16

1. lamotrigine ( blocks sodium channels and causes generalized neuronal dampening)
2. carbamazepine (anti convulsant, blocks Na channel)
3. valproic acid( anti convulsant, blocks Na channel)

Front 17

what is tyramine? why cant you take tyramine when you are on MAOi?

Back 17

tyramine is a releaser of stored monoamines. if you block MAO and take tyramine you release all the stored NTs which can cause a hypertensive crisis and a patient can stroke out.

Front 18

what is the MOA for lithium?

Back 18

it gets in the way of sodium so action potential cannot start. that gives you a generalized neuronal dampening.

Front 19

state 8 side effects of lithium?

Back 19

1. arrhythmias
2. polyuria and polydipsia
3. nausea and vomiting
4. drug abuse ( place them on SSRI, MAOi, SNRI)
5. insomnia
6. weight gain
7. thyroid enlargement
8. increase in circulating PMNL ( reversible)

Front 20

what are the three drug interactions for lithium?

Back 20

1.use osmotic diuretic or acetazolamide for detoxification ( increased excretion of lithium)
2.loop diuretic or thiazide decrease excretion of lithium and can lead to toxicity.never use them.
3. NSAIDs indomethacin, naproxen, ibuprofen can diminish clearance and increase plasma levels leading to lithium toxicity.

Front 21

which are the other three drugs used to treat bipolar depression?

Back 21

1. lamotrigine ( blocks sodium channels and causes generalized neuronal dampening)
2. carbamazepine (anti convulsant, blocks Na channel)
3. valproic acid( anti convulsant, blocks Na channel)

Front 22

to which class do first generation antipsychotics belong to? what is their MOA?

Back 22

phenothiazines, they are D2 receptor antagonists.

Front 23

what are the three subclasses of phenothiazines? what are their D2 receptor affinities?

Back 23

1. aliphatics ( weakly selective)
2. piperdines ( intermediate selectivity)
3. piperazides ( highly selective)

Front 24

name three aliphatic phenothiazines?
what is the main side effect?

Back 24

chlorpromazine, promazine, trifluopromazine.
these drugs give autonomic side effects.

Front 25

which receptors do aliphatic phenothiazines bind? what are the effects?

Back 25

alpha 1 , histamine, muscarinic.
blocking alpha 1 results in orthostatic hypotension.
blocking histamine- sedation
blocking muscarinic- anti SLUDE

Front 26

name two major drugs from the piperdine class?

Back 26

mesoridazine and thioridazine.

Front 27

what is the SE of piperdine class of drugs?

Back 27

black box warning for cardiotoxicity, long QT interval which slows the heart.

Front 28

name three drugs for the piperazide class? what are the SE of this class of drugs?

Back 28

fluphenazine, perphenazine, trifluoperazine
extrapyramidal side effects, parkinson like SE,tardive dyskinesia and neuroleptic malignant syndrome.

Front 29

what are butyrophenones?

Back 29

its haloperidol, they have intermediate to high affinity for D2 receptors and thus have increased risk of extrapyramidal side effects.

Front 30

name two thioxanthenes?

Back 30

Chlorprothixene and thiothixene.

Front 31

what are the advantages of second generation antipsychotics? whom are the atypicals meant for?

Back 31

they have little or no D2 antagonism, hence no tardive dyskinesiaand drug induced parkinsonism. they are meant for patients with negative symptoms.

Front 32

which are the three general atypicals? which one is not used much?

Back 32

clozapine- not used much because of agranulocytosis.
Olanzapine and loxapine are other atypicals

Front 33

what is the SE of piperdine class of drugs?

Back 33

black box warning for cardiotoxicity, long QT interval which slows the heart.

Front 34

name three drugs for the piperazide class? what are the SE of this class of drugs?

Back 34

fluphenazine, perphenazine, trifluoperazine
extrapyramidal side effects, parkinson like SE,tardive dyskinesia and neuroleptic malignant syndrome.

Front 35

what are butyrophenones?

Back 35

its haloperidol, they have intermediate to high affinity for D2 receptors and thus have increased risk of extrapyramidal side effects.

Front 36

name two thioxanthenes?

Back 36

Chlorprothixene and thiothixene.

Front 37

name three 5HT2A receptor antagonists?

Back 37

Risperidone, Ziprasidone and Paliperidone

Front 38

name three other heterocyclic antipsychotics?

Back 38

Molindone, Pimozide and Quetiapine

Front 39

which class of drugs will you give for hallucinations

Back 39

5HT2A antagonists.

Front 40

name a partial dopamine receptor agonist? what is it used for? what are its SE?

Back 40

Aripriprazole. used to treat mania
may have some alpha 1 receptor antagonist activity and thus can cause orthostatic hypotension.

Front 41

what are the 8 strategies used to treat parkinson disease?

Back 41

1. direct replacement
2.dopamine releasers
3. MAO type B inhibitors
4. muscarinic antagonist
5. post synaptic DA receptor agonist
6. Vit E
7. COMT inhibitors
8. adjunct therapy

Front 42

which drug combination is used for dopamine replacement?

Back 42

Carbidopa / Levodopa

Front 43

name a dopamine releaser?

Back 43

Amantadine

Front 44

Name a MAO type B inhibitor and its MOA?

Back 44

Selegiline - blocks the action of MAO-B and causes more dopamine to be available. its metabolites are amphetamine and methamphetamine

Front 45

name 2 muscarinic antagonists?

Back 45

1. Trihexlphenidyl- inhibits Ach activity in key excitatory pathways
2. Benztropine - centrally acting anti-muscarinic

Front 46

Name 4 dopamine receptor agonists? and their specificities?

Back 46

Bromocriptine(D2 and partial D1), Pergolide (D2 and D1), Pramipexole ( highly selective D2), Ropinirole(highly selective D2).

Front 47

name 2 COMT inhibitors and their drawback?

Back 47

1. Entacapone
2. tolcapone
Black box warning for hepatotoxicity

Front 48

name 3 drugs used in adjunct therapy

Back 48

1. diphenhydramine ( for anticholinergic effects)
2. Ethopropazine ( for anticholinergic properties)
3. Procyclidine ( again anticholinergic, atropine like)

Front 49

what 2 drug interactions do we keep in mind when treating parkinson's disease?

Back 49

1. MAOI can lead to acute hypertensive episode and stroke
2. High Vit B6 increases GI dopa decarboxylase activity.

Front 50

which is the drug of choice to treat huntington? what is its MOA? which drug is supplementary addition?

Back 50

Baclofen, its a GABA B agonist. GABA B is found presynaptically that control the release of excitatory NTs.

Front 51

which is the main drug for ALS treatment? what is its MOA?

Back 51

Riluzole, its a glutamate antagonist and also causes decrease in release of glutamate.

Front 52

Which other drugs are used for ALS apart from Riluzole?

Back 52

Baclofen and muscarinic receptor antagonist like Dicyclomine, Flavoxate, Oxybutynin, Oxyphencyclimine, Trihexylphenidyl. muscarinic antagonist cause anti-SLUDE