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54 Cards in this Set
- Front
- Back
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MAOIs
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-MAO breaks down excess catecholamines
-MAOIs bind irreversibly to MAO -efficient antidepressant and anti-anxiety agents -rarely used today b/c of serious SE |
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MAOI types
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1. Nardil
2. Parnate 3. Marplan 4. EmSam: no dietary restriction on lower doses because it avoids "first pass" |
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MAOIs SE
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1. hypertensive crisis: caused by eating tyramine-containing foods, with increase NE in the body such as:
-alcohol, foreign cheeses, excess caffeine or chocolate -smoked or fermented meats -avacados, raisins, figs 2. Serotonin syndrome: AMS, hyperpyrexia, muscle rigidity 3. Sympathomimetic syndrome: HTN, tachy, anxiety -WAIT 2 WKS WHEN SWITCHING FROM AN MAOI TO ANOTHER ANTIDEPRESSANT |
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Tricyclic antidepressants (TCAs)
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-bind to reuptake pumps and block reuptake of serotonin and NE
-antidepressants and antianxiety agents -SECOND LINE because of SE's |
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TCAs types
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1. Elavil
2. Anafranik 3. Norpramin 4. Pamelor 5. Tofranil |
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TCA SE
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1. Serotonine: GAS
-GI upset -Arousal -Sexual: dec libido, erectile dysfunction 2. NE: -inc BP, tachy, tremor -anxiety, incomnia, HA -dec appetite, nausea 3. Anticholinergic: dry mouth, constipation, drowsiness, confusion, urinary retention, blurred vision |
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TCA SE cont
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4. Alpha 1: orthostatic hypptension, syncope, dizziness
5. Cadiac: prolongs QT interval -use caution in pts with conduction disorders! |
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SSRIs
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-inhibit presynaptic reuptake of serotonin only
-antidepressant and antianxiety agents -good for premenstrual syndrome and PMDD -first line antidepressant because of MILD SE profile! -not all alike! -relatively safe in OD -may inc levels of other antidepressants! |
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SSRI types
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1. prozac
2. paxil 3. zoloft 4. luvox 5. celexa 6. lexapro |
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SSRI SE
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1. N/D
2. vomiting 3 anorexia 4 anxiety 5 insomnia 6. sedation 7. dec libido, erectile dysfunction -may dec plt function! -may inc INR in combo with coumadin -w/drawal syndromes: Dizziness, GI distress, fatigue, anxiety palpitations |
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Serotonin-2 Antagonistd
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-increased serotonin leads to:
5HT-1 - Decreased depression and anxiety 5HT-2 - Anxiety, decreased libido, dysorgasmia 5HT-3 – Nausea, vomiting 5HT-4 – Abdominal cramping, diarrhea |
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serotonin-2 antagonists- basics
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-Block Serotonin at the postsynaptic Serotonin-2 receptor, where many unwanted side effects occur, such as anxiety and sexual dysfunction
-results in dec depression and anxiety, with fewer sexual SE -most commonly used to treat insomnia -Desyrel |
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serotonin-2 antagonists SE
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1. sedation
2. wt gain 3. orthostatic hypotension 4. dizzines 5. sedation -priapism in 1/10,000 male pts! |
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SNRIs
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-inhibits presynaptic reuptake of serotonin and NE
-may be more effective than SSRIs alone -good for depression, anxiety, pain disorders 1. Effexor XR 2. Pristiq 3. Cymbalta |
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SNRIa SE
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1. anxiety, jitteriness, insomnia, sedation
2. N/D. vomiting, anorexia 3. dec libido 4. inc BP, tachy, tremor 5. HA |
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Dopamine-NE reuptake inhibitors (NDRIs)
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-inhibit presynaptic reuptake of NE and DA
-lower sexual SE and wt gain potential than other antidepressants! -good for depression, seasonal affective disorder, smoking cessation and ADHA -no indication fo anxiety disorders 1. Welbutrin, Welbutrin SR, Welbutrin XL |
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NDRIs SE
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1. inc BP, tachy, tremor
2. anxiety, insomina, HA 3. decreased appetitie, nausea 3. increased libido -increased seizure risk! -paranois, psychosis! |
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Alpha-2 Antagonists
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-inhibit presynaptic alpha-2 activity
-increase levels of synpatic serotonin and NE -Remeron |
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alpha-2 antagonists SE
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1. aniexty, agittion, insomnia, sedation
2. N/D 3/ dec libido 4. inc BP, tachy, tremor 5. HA 6. sedation 7. wt gain |
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Lithium
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-acts on ion channels to "desensitize" the CNS
-good for mania and bipolar -effective in decreasing recurrences of mania -NOT metabolized by liver -excreted through kidneys |
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Lithium SE
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1. sedation
2. N/V/D 3. acne 4. alopecia 5. tremor, seizures 6. wt gain 7. hypothyroidism 8. polyuria, polydipsia 9, benign EKG changes, arrhythmia 10, leukocytosis |
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lithium- cautin
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-narrow TI
-Toxicity; N/V, abd pain, lethargy, ataxia -CAT D -labs: BUN/Creat, lytes, TFTs, CBC, U/A, EKG, HcG -f/u every 6 months |
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Antoconvulsants
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-act on ion channels to "desensitize the CNS
Depakote: for acute mania only Equetro: Bipolar Disorder Lamictal: long-term treatment of Bipolar Disorder. |
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Depakote SE
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1. GI upset
2. sedation 3. tramor 4. wt gain 5. alopecia 6. thrombocytopenia, inc LFTs 7. hepatotoxicity Lab: CBC, plts, LFTs |
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Equetro SE
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1. sedation
2. GI distress 3. dec appetite 4. hepatitis 5. leukopenia, thrombocytopenia 6. inc LFTs 7. agranulocytosis, aplastic anemia Labs: CBC, plts, LFTs, HCG |
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Lamictal SE
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1. sedaiton
2. GI 3. exfoliative dermatitis 4. SJS -Depakote + Lamictal increases levels of both medications and the risk of Stevens-Johnsons Syndrome, |
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Antopsychotics
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-lower DA in CNS
-used in acute and maintenance tx of mania -all can cause varying degrees of sedation, dry mouth, constipation, lightheadedness |
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When treating anxiety disorders...
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Starting dose is lower than for Depression
Therapeutic dose is often higher than for Depression Side Effects are more common than in Depression Rule of Thumb: “Start low, go slow, end high.” |
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Benzodiazepines
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-GABA attaches to the GABA receptors of the Cl channel, allowing Cl ions to pass
-the greater the number of Cl ions, the greater the inhibition of the CNS -benzos attach to the benzo receptor of the Cl channel -in the presence of GABA, more Cl ions are to pass through -without GABA benzos are useless! |
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Benzos- basics
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-enhance GABA activity
-Sedative-hypnotics: 1. in lower doses, the reduce anxiety 2. in higher dose, the induce sleep -NOT first line tx, due to TOLERANCE, DEPENDENCE, WITHDRAWAL AND SEDATION |
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Long acting benzos
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1. Klonopin 6-10 hr duration
2. Valium 6-10 hrs |
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intermediate acting benzos
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1. Xanax 4-5 hrs
2. ativan " |
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short acting benzos
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1. Halcoin 1-2 hrs
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Benzo SE
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1. sedation
2. confusion 3. impaired memory 4. ataxia 5. behavioral disinhibition 6. resp depression -caution: hass additvie effect with alcohol -may lead to death in pts with impaired respt function! |
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Primary tx for insomnia is
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-non-benzodiazepine hypnotics
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Non-Benzodiazepine Hypnotics
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- bind to a receptor site NEAR benzo receptors to increase GABA activity
-benefits over benzos: 1. rapid onset, short duration 2. less rebound, witdrawal, dependence and loss of efficacy 3. less confusion, memory impairment and ataxia |
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non benzo hypnotics types
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1. Ambien (shortest half life)
2. Sonata 3. Lunesta 4. Restoril (longest half life) |
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Melatonin agonists
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-Rozerem
-increases activity at the MT-1 and MT-2 receptors -no evidence of dependence or tolerance! -may take up to 2 wks to work -SE: depression, possible dec test and increase prolactin |
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second line tx for insomnia
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1. short-acting benzos
2. sedating antidepressants: TCAs, Trazadone, Remeron 3. 1st gen antihistamines 4. natural supps: melatonin |
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Hypersomnolence txs
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1. sleep if primary cause is sleep deprivation
2. caffeine: adenosine receptor antagonist. DA and NE agonist -Adenosine is a by-product of ATP metabolism. As it builds up in your system, it increases your sleep drive. |
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Psychotimulants
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-Ritalin, Adderal
-MOA: block Da and NE reuptake. May relase DA and NE as weel -SE: inc BP, tachy, anxiety, insomnia, HA, dec appetite, wt loss |
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Histamine Agonist
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-Provigil
-increases histamine release in the "sleep/wake" center of the brain -increased alertness with dec sympathetic SE -dec potential for tol and dependence -dec potential for abuse |
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antipsychotics affect 4 major areas of the brain:
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1) Mesolimbic Pathway – Positive Symptoms
2) Mesocortical Pathway – Negative and Cognitive Symptoms 3) Nigrostriatal Pathway – Body Movement 4) Tuberoinfundibular Pathway - Prolactin Release |
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Haldol SE
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1. dystonia
2. ESPEs 3. TD 4. prolactinemia |
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Clozapine SE
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-2nd gen
1. agranulocystosis 2. seizures 3. leukopenia |
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Risperdal SE
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-2nd gen
1. hyperprolactinemia |
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Zyprexa SE
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-2nd gen
1. hyperglycemia 2. hyperlipidemia |
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Seroquel Se
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-2nd gen
-sedation |
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Geodon SE
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-2nd gen
-QTC prolongation |
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Abilify Se
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-3rd gen
-Akathesia |
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Acetylcholinesterase inhibitors
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-block the enzyme that breast down Ach
-slowing in the degenerative course of Alzheimers |
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Ach inhibitor types
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1. Aricept: N/V/D
2. Exelon: GI upset 3. Razadyne 4. Cognex: heptatotoxicity- 2nd line |
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NMDA antagonists
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-Namenda
-tx moderate ot severe alzheimers -inhibits excess NMDA and NMDA-induced neurodegeneration -should inhibit disease progression |
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ADHD tx
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1. psychostimulatns: first line!
2. non-stimulants: increase levels of NE in the brain -SE: anxiety, insomnia, sedation, dry mouth, constipation, urinary retention |
