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17 Cards in this Set
- Front
- Back
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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?
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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. |
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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 |
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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. |
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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 |
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Response and relapse rates on Schizophrenic meds?
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30% get a good response
relapse- 10-20% while on meds 80-90% when NO meds |
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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 |
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What is a common mood stabilizer for bipolar disorder? what side effects? how prevent?
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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 |
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What is valproate, lamotrigine, and carbamazepine used to treat?
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bipolar disorder
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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?
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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 |
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Depression: SNRIs? What receptors? What major side effects?
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block alpha 1 receptors in the locus ceruleus
Side effects- dizziness, drowsiness, orthostatic hypotension and sexual dysfunction |
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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 |
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What is the only class of anti-depressants with minimal sexual side effects? What side effect must you be weary of with this class?
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D2 antagonists- increase prolactin resulting in huge breasts
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Side effects of anticholinergics?
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Dry mouth, constipation, can't urinate, blurred vision, delirium
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Side effects of antihistamines? (benadryl)
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H1 antagonists lead to wt gain, hypotension, and sedation
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which antidepressant would you take if you wanted your patient to gain wt?
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antihistamines or TCAs
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TCA's as antidepressants? (NRI/SNRI) Side effects of this class? Interesting metabolism? OD potential?
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wt gain, impotence, CV issues, anticholinergic effects...
Metabolized by p450 so many drug-drug interactions which make dosing tricky High OD potential. |
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#1 side effects of MAOI's?
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dietary restrictions from the beer, wine and cheese phenomenon including tyramine displacing toxic quantities of norep into bloodstream
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