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22 Cards in this Set
- Front
- Back
Imipramine
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3o TCA more potent in inhibiting S uptake
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Amitriptyline
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3o TCA more potent in inhibiting S uptake
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Desipramine
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- desmethyl imipramine
- 2o TCA more selective inhibitors of NE uptake |
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Nortriptyline
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- desmethyl amitriptyline
- 2o TCA more selective inhibitors of NE uptake |
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TCA SE's
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- narrow theraputic range
– CV (arrhythmias, long QRS) - small quantities prescribed to minimize use in suicide - muscarinic blockade – a-blocaide (orthostatic hypotension) – 5) H blockade (Sedation, Weight gain) |
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MAOI mechanism
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- both A and B vital to inactivation of S, EPI, NE, D, and phenethylamine
- classic MAOIs inhibit both |
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MAOI SE's
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– potentiate symp amines
– potentiates Tyramine, in wine and cheeses, which means hypertensive crisis - Strong CNS stimulation, convulsions, and coma ( serotonin syndrome) w/ MAOIs + TCAs, SSRIs – wait 2 wks to switch (4 w/ fluoxetine b/c long ½ life) – dont use w/ meperidine (Demerol) |
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Phenelzine
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MAOI
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SSRI action
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- Selectively inhibit serotonin (5-HT) reuptake
- most do not manifest noradrenergic or D effects – little affinity for muscarinic receptors |
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SSRI SE's
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- altered GI motility, nausea, agitation, anxiety, sleep disturbance, tremor, and HA
- sexual dysfunction |
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Fluoxetine
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SSRI
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Sertraline
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SSRI
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Paroxetine
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SSRI
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Citalopram
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SSRI
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Venlafaxine
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- SNRI devoid of antiH, antiCh, and antiadrendergic effects
– effective in depressed inpatients and outpatients, and relatively rapid therapeutic response – SE’s like SSRI’s, but Idiopathic HTN may occur at higher doses |
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Bupropion
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- noradrenergic uptake inhibitor
– doesn’t affect sexual function – Zyban for smoking – small risk of seizures – not ok if hx seizures, head injury, or eating disorder |
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Mirtazapine
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- enhances central noradrenergic and S neurotransmission
– Block presynaptic a2 R’s increased 5-HT and NE release – 5H2 and 5HT3 antagonist – net effect is selective increase in 5HT1A fcn – H1 blocker at lower doses – Side effects wt gain, sedation, none sexual |
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Trazodone
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– mixed 5-HT agonist/antagonist
– Weak 5-HT reuptake – significant a1 blocker and H1 blocker -> orthostatic hypotension and sedation – small doses as a hypnotic - Priapism |
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Valproate
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– anticonvulsant for acute manic episodes in BPD
– less effective in acute bipolar depression – may decrease catabolism and turnover to increase GABA and increases GABAB-R density – few SE’s compared to lithium, but include GI distress, benign elevations in hepatic transaminases, sedation, tremor, wt gain – rare but serious are hepatic failure, pancreatitis, and thrombocytopenia |
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Lamotrigine
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– anticonvulsant for bipolar depression and BPD maintenance
– no evidence of “switching” – if used w/ carbamazepine, double dosage b/c of enzyme induction – if used w/ valproic acid, it must be halved b/c of enzyme inhibition |
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Carbamazepine
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– Extended-release anticonvulsant for BPAD manic and mixed episodes
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Atypicals for acute mania
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Olanzapine, Quetiapine
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