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17 Cards in this Set

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Antidepressants as part of anxiolytic therapy? How do SSRI's compare to TCAs or MOAI's? SSRI's vs. Benzos in the treatment of panic disorders and GAD? Relapse after stopping meds?
SSRI's good anxiolytics , but takes long time for effects to kick in 3-8 weeks. SSRIs better than benzos for PD but worse for GAD. TCAs and MAOIs are ok but too many side effects.
60-90% after 1 yr.
Benzos hit two GABA receptors: BZ1 and BZ2? WHat each for? How do Benzos vary (2 factors impt for dosing)?
DO patients experience BENZO withdrawal/addicition?
BZ1- hypnotic/sleep inducing
BZ2- anxiety, cognition, motor control

Either short, intermediate, or long acting. ALso vary on liver metabolism; some heavily metabolized and some not.
50% experience benzo withdraw when going cold turkey... want to taper them over time
Hypnotic agents; what GABA receptor do they act on and why?
Why good for dosing purposes?
BZ1 because they induce sleep only, don't reduce anxiety/psychoses.

T1/2 range from 2-6 hrs so effects wear off when wake up, but sleep architecture is semi messed up.
What receptors do typical antipsychotics bind to?
Side effects of high, mid, and low potency agents? anticholinergic/antihistaminergic?
D2 (DOPA) ANtagonists;
High- extrapyramidal symptoms, tardive dyskinesia (involuntary, purposeless movements), akathisia (internal feeling of restlessness), and menstrual irregularities
Mid= anticholinergic and antihistaminergic (dry mouth, blurred vision, nausea/vomiting, urinary retention?
LOW- anticholinergic- mostly sedation
Response and relapse rates on Schizophrenic meds?
30% get a good response
relapse- 10-20% while on meds
80-90% when NO meds
Atypical antipsychotics activate 5HT-2A receptors; result on DOPA? Make sense of this in light of how typicals work? Net result...
FDA warning on atypicals?
Increase DOPA (agonist), compete with antagonistic typical D2 guys. Net: partial agonist in the 20-40% D2 binding range (see graph)
FDA- increased risk of diabetes and hyperglycemia
What is a common mood stabilizer for bipolar disorder? what side effects? how prevent?
Lithium- major concern is it reaching toxic levels..Drink lots of H20 and do IV fluids..small therapuetic window
slurred speech, muscle twitches, seizure, coma, death
What is valproate, lamotrigine, and carbamazepine used to treat?
bipolar disorder
Depression; SSRI's? What two receptors for ser and what major side effects of each receptor? How do the many SSRIs differ from each other?
they act on many different receptors
5-HT2- sexual dysfunction and insomnia
5-HT3- nausea, vomiting, and diarrhea

SSRI's differ in side effect profiles, half lives/potency (dosing), metabolism, and drug-drug interactions
Depression: SNRIs? What receptors? What major side effects?
block alpha 1 receptors in the locus ceruleus
Side effects- dizziness, drowsiness, orthostatic hypotension and sexual dysfunction
Depression; D2 antagonists? where are receptors in brain?
Side effects?
Nigra-striatal pathway-
Side effects= extrapyrimadal side effects, Prolactin increase (huge breasts), flattened affect, slowed cognition
What is the only class of anti-depressants with minimal sexual side effects? What side effect must you be weary of with this class?
D2 antagonists- increase prolactin resulting in huge breasts
Side effects of anticholinergics?
Dry mouth, constipation, can't urinate, blurred vision, delirium
Side effects of antihistamines? (benadryl)
H1 antagonists lead to wt gain, hypotension, and sedation
which antidepressant would you take if you wanted your patient to gain wt?
antihistamines or TCAs
TCA's as antidepressants? (NRI/SNRI) Side effects of this class? Interesting metabolism? OD potential?
wt gain, impotence, CV issues, anticholinergic effects...
Metabolized by p450 so many drug-drug interactions which make dosing tricky
High OD potential.
#1 side effects of MAOI's?
dietary restrictions from the beer, wine and cheese phenomenon including tyramine displacing toxic quantities of norep into bloodstream