Pharm - Antidepressants And Lithium

Front 1

Antidepressants
General

Back 1

therapetuci resposne may take weeks
no therapeutic diff between classes

Front 2

Antidepressants
Main Indications
4

Back 2

MDD
bipolar
anxiety - SSRI, SNRI (long term)
post traumatic stress - not benzos
OCD - not benzos
neuropathic pain SNRI

Front 3

Antidepressants
Other Indications

Back 3

smoking - Bupropion
premenstrual dysphoric disorder - SSRI
ADHD - TCA
bulimia - fluoxetine

Front 4

Antidepressants
Mech

Back 4

all inc levels of NE and 5-HT
monoamine hypothesis - block neuronal pre--jxnal membrane transport into NE and 5-Ht

Front 5

Antidepressants
monoamine hypothesis -

Back 5

block neuronal pre--jxnal membrane transport into NE and 5-Ht

Front 6

Antidepressants
neurotrophic hypothesis

Back 6

brain derived neurotrophic factors inc neurogenesisi and plasticity
in depression vol loss and decreased BDNF

Front 7

SSRI
Mech

Back 7

block serotonin reuptake

Front 8

SSRI
Advantage

Back 8

minimal sedation/hypotension/anticholinergic effects
no cardiotoxicity or lethality with overdose

Front 9

SSRI
Side E

Back 9

headache
sex dysfxn!
wt changes
anxiety
rebound effect (shorter half life more likely, paroxetine)

Front 10

SSRI
Toxicity

Back 10

Sertonin syndrome - severe agitation; sweating, diarrhea, hyperpyrexia, coma/death
inc risk with MAOI or another agent

Front 11

SSRI
Fluoxetine

Back 11

least specific
long half life of metabolite (norfluoxetine, 14 days)
inhibit liver microsomal enz

Front 12

SSRI
drugs

Back 12

Fluoxetine
Seratraline
Paroxetine

Front 13

Atypical Antidepressants
Hypericum (St. John's Wort)3
features

Back 13

treats mild depression
affects liver metab of other drugs for HD, depression, seizures

Front 14

Atypical Antidepressants
Amoxapine (TCA)
Features

Back 14

blocks DA,
hyperprolactinemia, EPS

Front 15

Serotonin 5TH2 antagonists
Drugs

Back 15

Trazodone
nefazodone

Front 16

Serotonin 5TH2 antagonists
nefazodone

Back 16

moderate sedation
liver failure

Front 17

Serotonin 5TH2 antagonists
Trazodone

Back 17

severe sedation

Front 18

Serotonin 5TH2 antagonists
Trazodone
nefazodone
Side E

Back 18

nausea/vomiting
priapism
hypotension

Front 19

Serotonin 5TH2 antagonists
Trazodone
nefazodone
ADV

Back 19

mild hypotensive
mild GI/sexual
safter than TCA in overdose

Front 20

Serotonin NE RI (SNRIs)
Drugs

Back 20

Venlafaxine
Duloxetine

Front 21

Serotonin NE RI (SNRIs)
Venlafaxine
Duloxetine
indication

Back 21

MDD when SSRIs don't work
neuropathic pain/fibromyalgia

Front 22

Serotonin NE RI (SNRIs)
Venlafaxine
Duloxetine
Side E

Back 22

seizures;more than SSRI

Front 23

AD
Bupropion
Features

Back 23

less side E; (sedation, hypotensive, sexual, antiach)
smoking cessation
lowers seizure threshold

Front 24

AD
Bupropion
Side E

Back 24

agitation/insomnea
seizures

Front 25

AD
Maprotiline
Mech

Back 25

Blocks NE uptake
no adv over TCA

Front 26

AD
Maprotiline
Side E

Back 26

wt gain
seizures
lethal in overdose

Front 27

AD
Mirtazapine
mech

Back 27

blocks prejxnal alpha 2 receptors thus inc NE and 5-HT
blocks serotonin receptors

Front 28

AD
Mirtazapine
Side E

Back 28

fewer than SSRIs
sedation and wt gain main ones
minimal sexual

Front 29

AD
Clomipramine
Features

Back 29

OCD
moderate Side E
hihg seizures

Front 30

TCA
Mech

Back 30

block reuptake of catacholamines into prejxnal endings

Front 31

TCA
Properties

Back 31

lipid sol. with long half life (days)
2 rings - 2ndary or tertiary amine side chains
metabolized by ring hydroxylation and glucuronide conjgation
can be made into active metabolite

Front 32

TCA
Side E - general

Back 32

antagonit at alpha, M, and H receptors

Front 33

TCA
Side E
CNS

Back 33

sedation - H
confusion/delirium - cholinoceptor block
seizure; mania
tremor - propranolol
amoxapine - movement (EPS) (dopamine antag)

Front 34

TCA
Side E
CV

Back 34

post hypoT - alpha1
tachycardia

Front 35

TCA
Side E
Periph activity

Back 35

dry mouth, blurred vision, constipation, urinary retention

Front 36

TCA
Side E
Others
3

Back 36

Wt gain
sexual dysfxn
rebound

Front 37

TCA
Overdose

Back 37

M and alpha antag. activity
excitement, seizures
slowed conduction (quinidine-like effect)
supportive treatment - respiration
benzos for seizures

Front 38

TCA
Drug Interactions

Back 38

alcohol
block antihypertensive (clonidine)
block antihistamines
MAOIs - serotonin syndrome

Front 39

TCA
Drugs

Back 39

Imipramine
Amitriptyline
Nortriptyline
Desipramine

Front 40

MAOI
Phenelzine
Mech

Back 40

inhib MAO A and B
suicide inhib; knocks enz out until more is made - weeks
actaully has short half life but works for longer

Front 41

MAOI
Phenelzine
Indications

Back 41

no response to TCAs and SSRI

Front 42

MAOI
Phenelzine
Side E

Back 42

hypotension
headache, dry mouth sex, wt gain
CNS stim

Front 43

MAOI
Phenelzine
Interactions

Back 43

serotonin syndrome
CNS depressant, sympathomimetic amine

Front 44

MAOI
Phenelzine
Interactions
Tyramine

Back 44

Tyr releases NE
is in many foods
typically broken down but when MAO is deficient, leads to nausea and vomiting
leads to inc in NE release = arrhythmias, HTN crisis, subarachnoid bleeding, stroke

Front 45

Lithium
Indications

Back 45

mania or bipolar
onset is 2-3 weeks

Front 46

Lithium
Mech

Back 46

pict. in notes
inhib phospholipid turnover, and therefore lowers amt PIP2, IP3 and DAG

Front 47

Lithium
excretion

Back 47

amt in blood determine efficacy
elminated unchanged by kidney, 80% reab in prox tubule
competes with tubule
low TI

Front 48

Lithium
Side E

Back 48

low plasma levels .5-.9 normal
0.9-2.5 more severe
nausea, fine tremore, polyuria,polydipsia
wt gain/ rash/thyroid
fetal malformation

Front 49

Lithium
Side E - high dose

Back 49

confusion first sign of toxicity
collapse coma
treat with hemodialysis and anticonvulsants

Front 50

Lithium
Interactions

Back 50

sodium depletion (thiazide diuretics)
renal clearance dec by NSAIDs - not aspirin or acetaminophen

Front 51

Valproic acid
Carbamazepine

Back 51

treat mania and bipolar with or without lithium