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22 Cards in this Set

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Imipramine
3o TCA more potent in inhibiting S uptake
Amitriptyline
3o TCA more potent in inhibiting S uptake
Desipramine
- desmethyl imipramine
- 2o TCA more selective inhibitors of NE uptake
Nortriptyline
- desmethyl amitriptyline
- 2o TCA more selective inhibitors of NE uptake
TCA SE's
- narrow theraputic range
– CV (arrhythmias, long QRS)
- small quantities prescribed to minimize use in suicide
- muscarinic blockade
– a-blocaide (orthostatic hypotension)
– 5) H blockade (Sedation, Weight gain)
MAOI mechanism
- both A and B vital to inactivation of S, EPI, NE, D, and phenethylamine
- classic MAOIs inhibit both
MAOI SE's
– potentiate symp amines
– potentiates Tyramine, in wine and cheeses, which means hypertensive crisis
- Strong CNS stimulation, convulsions, and coma ( serotonin syndrome) w/ MAOIs + TCAs, SSRIs
– wait 2 wks to switch (4 w/ fluoxetine b/c long ½ life)
– dont use w/ meperidine (Demerol)
Phenelzine
MAOI
SSRI action
- Selectively inhibit serotonin (5-HT) reuptake
- most do not manifest noradrenergic or D effects
– little affinity for muscarinic receptors
SSRI SE's
- altered GI motility, nausea, agitation, anxiety, sleep disturbance, tremor, and HA
- sexual dysfunction
Fluoxetine
SSRI
Sertraline
SSRI
Paroxetine
SSRI
Citalopram
SSRI
Venlafaxine
- SNRI devoid of antiH, antiCh, and antiadrendergic effects
– effective in depressed inpatients and outpatients, and relatively rapid therapeutic response
– SE’s like SSRI’s, but Idiopathic HTN may occur at higher doses
Bupropion
- noradrenergic uptake inhibitor
– doesn’t affect sexual function
– Zyban for smoking
– small risk of seizures
– not ok if hx seizures, head injury, or eating disorder
Mirtazapine
- enhances central noradrenergic and S neurotransmission
– Block presynaptic a2 R’s  increased 5-HT and NE release
– 5H2 and 5HT3 antagonist
– net effect is selective increase in 5HT1A fcn
– H1 blocker at lower doses
– Side effects wt gain, sedation, none sexual
Trazodone
– mixed 5-HT agonist/antagonist
– Weak 5-HT reuptake
– significant a1 blocker and H1 blocker -> orthostatic hypotension and sedation
– small doses as a hypnotic
- Priapism
Valproate
– anticonvulsant for acute manic episodes in BPD
– less effective in acute bipolar depression
– may decrease catabolism and turnover to increase GABA and increases GABAB-R density
– few SE’s compared to lithium, but include GI distress, benign elevations in hepatic transaminases, sedation, tremor, wt gain
– rare but serious are hepatic failure, pancreatitis, and thrombocytopenia
Lamotrigine
– anticonvulsant for bipolar depression and BPD maintenance
– no evidence of “switching”
– if used w/ carbamazepine, double dosage b/c of enzyme induction
– if used w/ valproic acid, it must be halved b/c of enzyme inhibition
Carbamazepine
– Extended-release anticonvulsant for BPAD manic and mixed episodes
Atypicals for acute mania
Olanzapine, Quetiapine