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54 Cards in this Set

  • Front
  • Back
What are the symptoms of Depression?
-depressed mood
-loss of interest
-loss of enjoyment
-Altered sleep
-altered eating
-suicidal thoughts
What is the etiology of Depression?

What is the Pathophysiology?
Unknown but may arise spontaneously or be triggered by life events

May involve deficits in Noradrenergic or Serotonergic neurotransmission
Define "Bipolar Disorder"
periods of depression alternating with periods of mania or hypomania
Bipolar Disorder treatment:
-Acute depression?
-Acute Mania?
Depression = Antidepressants

Mania = Antipsychotics
What effect should Anti-depressants have in normal people?
should NOT elevated mood
What are the 4 major classes of Antidepressants?
1. Monoamine Oxidase Inhibitors

2. Tricyclics (TCA's)

3. Selective Serotonin Reuptake Inhibitors (SSRI's)

4. Miscellaneous
What is the hypothesized mechanism of Antidepressants?
increased synaptic availability of NE &/or Serotonin
What 3 things may the ultimate effect of Antidepressants be due to?
1. secondary changes in receptors - e.g. downregulation of Alpha-2 & Beta receptors

2. increase in brain-derived neurotrophic factor (BDNF) in the Hippocampus

3. Cognitive changes
What are the 2 MOAI's?

What is the mechanism of Phenelzine & Tranylcypromine?
-increase synaptic availability of Norepinephrine & Serotonin by blocking their catabolism

-irreversible inhibit MAO-A (NE & 5-HT) and MAO-B (DA = Dopamine)
What are the side effects of MAOI's?
1. Dry mouth
2. Constipation
3. Headache
4. Drowsiness
5. Postural Hypotension
6. Weight gain
7. Sexual dysfunction
8. Sleep disturbances
Overdose with MAOI's is unsusual, but what can it cause?
1. Seizures
2. Shock
3. Delerium
4. Hyperthermia
What can MAOI's potentiate the action of?
Other Sedatives such as alcohol
What could happen if MAOI's & Tyramine are taken at the same time?
Hypertensive Crisis

**Tyramine is a compound found in many foods, displaces NE from neuronal storage vesicles
What drugs in combination with MAOI's may produce "Serotonin Syndrome"? What are the symptoms?
Meperidine & SSRI's

Muscle rigidity
How long does it take for the effects of MAOI's to wear off?
2 weeks due to irreversible inactivation of MAO

**So don't give SSRI's or Meperidine until after discontinuing MAOI's for 2 wks
List the Tricyclic Antidepressants

What is the mechanism of action of the TCA's?
inhibit the reuptake of NE &/or Serotonin

*relative proportion of Serotonin/NE activity varies for each drug
TCA's are also potent antagonists at various receptors including...

Histaminergic = sedation

Alpha-adrenergic = hypotension
What are the side effects of the TCA's?
1. Sleepiness
2. Sympathomimetic effects = tremor or insomnia
3. Anticholinergic effects
4. Arrhythmias
5. Seizures
6. Weight gain
7. Sexual dysfunction
What are the life-threatening side effects of TCA overdose?
1. Coma
2. Respiratory depression
3. Delirium
4. Seizures
5. Hyperpyrexia
6. Bowel & Bladder dysfunction
7. Cardiac effects = arrhythmias
What class of drugs do TCA's have adverse interactions with?
List the Selective Serotonin Reuptake Inhibitors (SSRI's)
1. Fluoxetine
2. Sertraline
3. Paroxetine
4. Fluvoxamine
5. Citalopram
6. Escitalopram
What is the mechanism of action of the SSRI's?
Inhibit Serotonin reuptake

*can inhibit reuptake of NE at higher doses
List the side effects of the SSRI's
1. Acute anxiety
2. Insomnia
3. Sleepiness
4. Fatigue
5. Tremor
6. GI symptoms
7. Rashes
8. Weight loss or gain
9. decreased libido
10. Sexual dysfunction
What class of drugs do SSRI's have adverse interactions with?

Serotonin Syndrome
-Muscle rigidity
-CV collapse
T or F: SSRI's have a high risk of fatal overdose
Explain the SSRI Discontinuation Syndrome
Flu-like &/or GI symptoms occurring within a week after stopping the drug

Most associated with drugs with short half-lives
Misc. Antidepressant that inhibits the reuptake of Serotonin & NE (5-HT > NE)
Selective Norepinephrine Reuptake inhibitor (SNRI) with similar side effects as TCA's
Misc. antidepressant that increases 5-HT & NE release by blocking Alpha-2 receptors on nerve terminals
Misc. antidepressant that has anti-dopaminergic activity & is used in Psychotic depression; causes EPS & Tardive Dyskinesia

"A Morning Pine Ox" inhibits Dopamine & does not have Psychotic Depression anymore; gets EPS & Tardive Dyskinesia
Misc. antidepressant that inhibits Serotonin reuptake; is very sedating & is used as a hypnotic & pre-anesthetic; can cause priapism

"alca-TRAZodone inhibits Serotonin reuptake, makes you sleepy, and gives you Priapism
Misc. antidepressant that blocks Dopamine reuptake

Side effects: dizziness, sweating, aggravation of psychosis, seizures
Misc. antidepressant that has a similar mechanism to TCA's (inhibits Serotonin, NE, & Dopamine reuptake) but with improved Side Effect profile

Can cause SSRI discontinuation syndrome
Most antidepressants have long half-lives, which 3 do not?



**unless in time-release formulations
**TVB have short half-lives
What is the route of administration for the Antidepressants?
Which 2 antidepressants are CYP2D6 inhibitors?
Fluoxetine & Paroxetine

F is 6th letter in alphabet, Paroxetine has same ending
Antidepressants used for Panic Disorders?


Antidepressants used for Obsessive-Compulsive disorder
Antidepressants used for Enuresis (bedwetting)
TCA's = esp. Imipramine
Antidepressants used for Chronic pain, esp. neuropathic
Antidepressants used for Eating disorders
Antidepressant used for Smoking Cessation
Antidepressant used as a Sedative
Antidepressant used for ADHD
List the 4 Mood Stabilizing agents
1. Lithium

2. Carbamazepine

3. Valproic Acid

4. Lamotrigine
What is Lithium's mechanism of action?
may affect Ion transport, the serotonin system, or the PI cascade
Describe the pharmacokinetics of Lithium
1. Absorbed rapidly but accumulates slowly in the brain
2. Therapeutic levels reached in 6-10 days
3. >95% excreted in the urine
List the side effects of Lithium (8)
1. Tremor = most common
2. Thyroid enlargement -> hypothyroidism
3. Polydipsia & Polyuria = ADH antagonist
4. EEG alterations
5. Leukocytosis
6. Edema
7. Acne
8. Teratogenesis

"Nathan Bell was bipolar so he took Lithium. As a result he got Tremors, Thyroid Enlargement, & Pee'd alot. He also had alot of Acne, Leukocytosis, Edema, & EEG abnormalities"
If a patient gets tremors while taking Lithium, what do you give to treat?
What are the symptoms of Lithium overdose?
1. Tremor
2. NVD
3. Sedation
What are the symptoms of overdose of Lithium in severe cases?
1. Ataxia
2. Confusion
3. Coma
4. Arrhythmias
5. Hypotension
6. Albuminemia
7. Death
When is Lithium contraindicated?
1. Renal or Cardiovascular disease

2. Pregnancy = Teratogenic