Pino: Antidepressants and mood stabilizers

_____ are the 1st choice antidepressants

SSRIs

what is a washout period and why do we need one?

a washout period is the waiting time you need when switching an antidepressant to avoid serotonin syndrome

What 3 major things is depression associated with?

problem with neurotransmitters (most drugs try to increase these neurotransmitters), thyroid problems, and atrophy in the hippocampus and cortex

What are the tricyclic antidepressants? (7)

clomipramine, imipramine, desipramine, amitriptyline, nortriptyline, doxepin and amoxapine

What drugs MOA is NE and 5-HT reuptake inhibitor that also inhibits NET and SERT?

tricyclic antidepressants

(clomipramine, imipramine, desipramine, amitriptyline, nortriptyline, doxepin and amoxapine)

_____ is a TCA that also can be used for bed wetting

imipramine

_____ is the least anticholinergic TCA

desipramine

What TCA is also used for OCD?

clomipramine

What TCA is also used for neuropathic pain and migraines?

amitriptyline

What TCA also has some D2 blockade which can lead to parkinsonism

amoxapine

What TCA has the most H1 blockade?

doxepin

What is the antidote for a TCA overdose? what are the signs of a TCA overdose?

sodium bicarbonate

3Cs: coma, convulsion, and cardiotoxicity

adverse effects: antimuscarinic (mydriasis, dry mucous membranes, etc.)

orthostatic hypotension (alpha 1 block)

sedation and weight gain (histamine block)

serotonin syndrome

tricyclic antidepressants (TCAs)

_____ added to naltrexone helps with weight loss

buproprion

MOA: reuptake inhibition of DA and NE; noncompetitive antagonist at nicotinic receptors

buproprion

What antidepressant also has some potential for smoking cessation?

buproprion

_____ is combined with dextromethorphan (DM- antitussive) as a drug for major depression

buproprion

adverse effects: lowers seizure threshold so caution in bulimic pts, does not cause sexual dysfunction

buproprion

What drug MOA is alpha 2 block, increased NE and 5-HT release

opposite of clonidine’s MOA

causes weight gain, sedation, no sexual dysfunction, no nausea, and is anxiolytic

mirtazapine

MOA: 5-HT and NE reuptake inhibitors (SNRI)

duloxetine, venlafaxine, desvenlafaxine, and milnacipran

What drug(s) can be used to treat major depression as well as chronic pain, fibromyalgia, and neuropathic pain

are like the TCAs but no blockade of H1, alpha1, or M receptors

duloxetine, venlafaxine, desvenlafaxine, and milnacipran

What are the 3 drugs for depressed pregnant pts? which one is safest?

fluoxetine, citalopram, and sertraline

citalopram is safest

What drugs MOA is selective serotonin reuptake inhibitor (SSRI)?

fluoxetine, fluvoxamine, citalopram, paroxetine, sertraline, and escitalopram

_____ is the SSRI with the longest t1/2 and the least withdrawal

fluoxetine

adverse effects: insomnia, headache, bleeding abnormalities, impotence, and discontinuation syndrome (need to taper dose)

the SSRIs

fluoxetine, fluvoxamine, citalopram, paroxetine, sertraline, and escitalopram

What drug(s) are used to treat major depression, anxiety, panic, OCD, PTSD, PMDD, bulimia, and social phobias?

the SSRIs

fluoxetine, fluvoxamine, citalopram, paroxetine, sertraline, and escitalopram

MOA: serotonin reuptake inhibitor and blocker (SARI), alpha1 and H1 receptor blockade

trazodone and nefazodone

Which one is hepatotoxic? trazodone or nefazodone

nefazodone

What drug is associated with priapism (sustained erection) and is a medical emergency?

trazodone

MOA: partial 5-HT1a agonist

good for depression and anxiety

vilazodone

MOA: partial 5-HT1a agonist that also inhibits NET and SERT

vortioxetine

What drug(S) are associated with hypertensive crisis due to tyramine-containing foods (wine and cheese effect)

the MAOI-As

phenelzine, tranylcypromine, and isocarboxazid

MOA: NMDA receptor blockade

has to be administered by a healthcare professional

esketamine

what do we use to treat treatment-resistant depression?

esketamine

What do we use for postpartum depression that is administered IV for 30 days (has to be done at a facility with healthcare professional)

brexanolone

MOA: GABA modulator at both pre and post-synaptic receptors

is a derivative of progesterone

brexanolone

_____ was a 5-HT2c agonist used for weigh loss (not anymore)

locaserin

weight gain is most prominent with _____

olanzapine

MOA: 5-HT2a and also D2,3,and 4 block

used for bipolar, schizophrenia, and irritability in autism

risperidone (or paliperidone which is the active metabolite)

What drug(s) adverse effects include increased prolactin (the drug is used to treat bipolar)

risperidone or paliperidone

_____’s MOA is blockade of 5-HT2a (and some others) and is approved in combination with fluoxetine for mania

olanzapine

_____ and ____ in combo are used to treat mania

Olanzapine and fluoxetine

used for bipolar, schizophrenia, tourette’s and irritability in autism

aripiprazole

_____ shows less weight gain than the other atypical drugs for mood disorders

aripiprazole

MOA: blocks 5-HT and NE reuptake, also alpha1 and H1 block

A/E: skin reactions, eosinophilia, sedation, and orthostasis

ziprasidone

MOA: blocks NE adenylyl cyclase signaling, decrease IP3 and DAG

lithium

treats bipolar disorder, has a narrow therapeutic index, pts taking diuretics can has adverse effects, can also see tremors, polyuria and polydipsia, hypothyroidism, and ebstein anomaly

lithium

what drug is associated with ebstein anomaly (baby born with heart defect)

lithium

see spinal bifida, neural tube defects, and autism, also weight gain and hepatitis

valproate and valproate syndrome

A/E: SIADH, hyponatremia, aplastic anemia, teratogen (neural tube defect) and SJS (HLA variant)

carbamazepine