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27 Cards in this Set

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Name some of the tricyclic antidepressants. Which ones are tertiary amines and which are secondary?
Tertiary = Clomipramine, Amitriptyline, Trimipramine, doxepin
Secondary = Nortriptyline, Protriptyline, desipramine
*CAT NaP - tertiary amines cause sedation, secondary barely do
Name some of the heterocyclic antidepressants. Which are second generation and which are third?
Second gen: Bupropion, Amoxapine, Trazodone
Third gen: Mirtazapine, Nefazodone, Venlafaxine
*BAT MaN Van - TMN block 5-HT2 receptors
buproprion = wellbutrin
effexor XR = venlafaxine HCl
How do tricyclic and heterocyclic antidepressants work?
they inhibit the reuptake of NE or 5HT
What receptors do they block that cause side effects?
muscarinic, histamine, alpha-1, amine reuptake transporters
What side effects may result?
anticholinergic, sedation, postural hypotension, tremor/insomnia
What are the effects of overdosing on a tri/heterocyclic antidepressant?
convulsions, severe arrhythmias, respiratory depression
Amoxapine can cause side effects similar to what class of drugs? Why?
antipsychotics; it is a dopamine receptor antagonist
What are the uses of tricyclic and heterocyclic antidepressants?
unipolar and bipolar depression, enuresis, pain syndromes, prophylaxis of migraine, bulimia, diabetic neuropathy, phobias
*i've seen trazodone used for sedation only (tx insomnia)
Name some SSRIs.
*h for common names
FLUoxetine, FLUvoxamine, PAroxetine, Sertraline, Citalopram
*ok this is dumb but... Flu! Flu! PASs the vitamin C!
paroxetine = paxil
sertraline = zoloft
citalopram HBr = Celexa
escitalopram oxalate = Lexapro
What are the uses of SSRIs?
depression, panic disorders, OCD, PTSD, bulimia
What are the side effects of SSRIs?
behavioral changes, sexual dysfunction, nervousness, nausea, dyspepsia, insomnia, headache
What is serotonin syndrome and how is it caused?
hyperthermia, muscle rigidity, myoclonus, rapid changes in vitals and mental status; SSRIs + MAOIs
How do MAOIs work?
They increase NE and 5HT by inhibiting their metabolism, resulting in down-regulation of their receptors.
What do MAOIs have to do with tyramine??
MAO breaks down dietary tyramine and circulating epinephrine. If someone on MAOIs eats tyramine, it won't be metabolized and could cause severe hypertension and stroke.
Name three MAOIs.
phenelzine, tranylcypromine, L-deprenyl (aka seligiline.. MAO-B only)
What inactivates phenelzine?
When are MAOIs used?
depression when tricyclics don't work; phobias, narcolepsy, panic attacks
What are the side effects of MAOIs?
restlessness, insomnia, dizziness; orthostatic hypotension at start of tx, constipation, urinary retention, etc
Our teacher says MAOIs (phenelzine, tranylcypromine, seligiline) are irreversible; which two are reversible?
moclobemide, clorgyline
What should you NOT take if you're on an MAOI?
anything that increases NE (tyramine, tcas, l-dopa, alpha agonists)
anything that increases 5HT (ssri)
*all of these can be FATAL!!
How does lithium work?
prevents recycling of phosphoinositides, so no PIP2, so no IP3 or DAG; this diminishes the effects of excess catecholamines or serotonin
Loss of what ion increases lithium in the body?
sodium (Na+)
*this means diuretics will increase lithium
When is lithium used?
acute mania, prevention of manic and depressive episodes in bipolar patients, and alternative to antidepressant therapy
What are the toxicities of lithium?
acute intoxication leads to nausea, vomiting, and tremors; late toxicity includes convulsions, coma, and death
When is lithium contraindicated?
in pregnancy and breastfeeding
How is lithium excreted?
by the kidneys
What side effects may lithium cause?
thyroid enlargement, polydipsia, polyuria, and fatigue