Slattery- Antidepressants/Drugs for Manic Disorders Flashcards Preview

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Flashcards in Slattery- Antidepressants/Drugs for Manic Disorders Deck (17)
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1
Q

2 hypotheses for mood disorders

A

1) Amine Hypothesis
Depression is due to changes in 5HT and NE signals in the brain
Depression occurs with bad receptors or decreased synthesis, storage, or release

2) Neurotrophic hypothesis
Brain-derived neurotrophic factor (BDNF) is important for neural plasticity, resilience, and neurogenesis
BDNF prevents apoptosis and makes new neurons
Depression = loss of BDNF

2
Q

Antidepressant drug subtypes

A

Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
Dual-mechanism drugs

3
Q

Mood stabilizers subtypes

A

Lithium carbonate
Anticonvulsants
Atypical antipsychotics

4
Q

MOA of TCAs

A

Block the reuptake of NE and/or 5-HT by nerve terminals –> Results in higher concentration of the neurotransmitters at their receptors

5
Q

Desipramine (Norpramin)

A
Type: 
Tricyclic Antidepressant (NE selective)

MOA:
Blocks the reuptake of NE by nerve terminals resulting in higher concentration of the neurotransmitters at their receptors

Uses:
Depression, insomnia

Adverse effects:
Antimuscarinic effects (in parasymps): glaucoma, constipation, confusion
orthostatic hypotension –> Blockade of α adrenoreceptors
weight gain → block histamine
tachycardia and risk of arrhythmia → block Na channels

Disadvantages:
Makes you drowsy, so taken before bed
Low therapeutic index (5-10)→ risk of OD, only can give in 7 day supplies
Metabolized by CYP2D6 → potential for many drug interactions

6
Q

Imipramine (Tofranil)

A
Type:
Tricyclic Antidepressant (NE/5HT mixed selective)

MOA:
Blocks the reuptake of NE and 5HT by nerve terminals resulting in higher concentration of the neurotransmitters at their receptors

Uses:
Depression, insomnia

Adverse effects:
Antimuscarinic effects (in parasymps): glaucoma, constipation, confusion
orthostatic hypotension –> Blockade of α adrenoreceptors
weight gain → block histamine
tachycardia and risk of arrhythmia → block Na channels

Disadvantages:
Makes you drowsy, so taken before bed
Low therapeutic index (5-10)→ risk of OD, only can give in 7 day supplies
Metabolized by CYP2D6 → potential for many drug interactions

7
Q

Phenelzine (Nardil)

A

Type:
Monoamine oxidase inhibitor (MAO)
MAO-A (NE and 5HT) and MAO-B (DA) –> irreversibly blocks

MOA:
Irreversibly blocks the intra-neuronal breakdown of monoamines, resulting in increased levels of these neurotransmitters at their receptors

Uses:
Depression

Disadvantages:
Low therapeutic index
If switching to an SSRI, wait 14 days after stop with MAOI and vice versa
Serotonin syndrome –> Results from overactivation of 5HT-2A (can cause hyperthermia, confusion, irritability, coma or death)

***Must avoid concurrent ingestion of tyramine

8
Q

Fluoxetine (Prozac), Sertraline (Zoloft), Escitalopram (Lexapro)

A

Type:
SSRI

MOA:
Selective inhibition of serotonin reuptake by CNS neurons; very complex with several receptor subtypes (clinical effect is in the 5HT 2a receptor).
Specific enough that it has no muscarinic, histaminergic, or α adrenergic receptors

Uses:
Depression, anxiety disorders

Advantages:
are not sedating like TCAs or atypical antidepressants

Disadvantages
Nausea, diarrhea and weight loss (so many will discontinue tx)
Sexual dysfunction
Black box warning

***Do not use alone in bipolar disorder! Need to include a mood stabilizer to prevent rapid mood swings

9
Q

Venlafaxine (Effexor, Effexor XR)

A

Type:
Dual Action Antidepressant

MOA:
Is a serotonin AND norepinephrine reuptake inhibitor (SNRI)

Uses:
Depression, OCS, panic, PTSD, phobias

Advantages:
Doesn’t affect:
Adrenergic receptors (sympathetics) –> So no increased heart rate, etc
Histaminergic receptors
Cholinergic receptors (muscarinic/parasymps) –> So will be able to poop!
All equals less side effects

10
Q

Mirtazapine (Remeron)

A

Type:
Dual Action Antidepressant

MOA:
Blocks presynaptic α2 receptors:
On adrenergic neurons (Autoreceptors)
-Autoreceptor → block OWN NT if sense too much in the cleft)
On serotonergic neurons (heteroreceptors)
-Heteroreceptors → Sense NE levels from neighboring synapse and inhibits 5HT release from its own neuron
This combination increases NE and 5HT levels

Uses:
Depression

Advantages:
Fewer side effects than TCA drugs

11
Q

Buproprion (Wellbutrin)

A

Type:
Dual Action Antidepressant

MOA:
Blocks both NE and DA reuptake
May also involve presynaptic release of NE and DA

Uses:
Depression

Adverse effects:
Stimulation –> agitation, anorexia and insomnia)

***often used in combination with SSRI (no real reason why though)

12
Q

Ketamine

A

Type:
injectable anesthetic

MOA:
NMDA antagonist

Uses:
Procedures where you need to be unconscious
Depression

Advantages:
Give 1 dose and within 2 hours get improved depression, however only lasts 1 week

Adverse effects
nightmares and hallucinations

13
Q

Lithium Carbonate (Eskalith)

A

Type:
Manic Bipolar Phases

MOA:
Unknown
Best guess: Most likely involves effect on postsynaptic rather than presynaptic neuron

Uses:
Bipolar disorder
Prevention of mood swings

Adverse effects:
Fatigue, weakness, ataxia, slurred speech, and tremor
Causes nephrogenic diabetes insipidus (increased thirst and urination) –> Lithium blocks antidiuretic hormone
Tolerance develops to some sx but never develops for tremor and the constant urination/drinking

SUPER SMALL therapeutic index (toxic dose = 2)
can lead to coma

14
Q

Valproic acid (Depakene) or sodium valproate (Depacon)

A

Type:
Anticonvulsant

MOA:
Unknown; good for non-rapid cycling bipolar disorder (superior to Lithium)

Uses:
Anticonvulsant and antidepressant; may work well for acute manic episodes

**can combine with lithium if pts don’t respond to either alone

15
Q

Carbamazepine (Tegretol)

A

Type:
Anticonvulsant

MOA:
Unknown; good for non-rapid cycling bipolar disorder (superior to Lithium)

Uses:
Prophylaxis of Bipolar disorder

16
Q

Lurasidone (Latuda)

A

Type:
Atypical Antipsychotic

MOA:
Central DA and 5HT receptor antagonists (maybe) but exact mechanism is unknown

Uses:
Bipolar depression

17
Q

Wake Therapy

A

What: Keep people awake during the night and don’t let them sleep during the day –> This will alleviate signs of depression

Adverse effects
Relapse as soon as they go to bed

Advantages:
May “jump start” the antidepressant drugs you give them