Antidepressants, Antipsychotics, and Mood Stabilizers

What are the MAOIs?

- phenelzine

- selegine

- isocarboxazid

- tranylcypromine

- procarbazine

- furazolidone

What is the main contraindication to MAOIs?

Pheochromocytoma

Why are MAOIs not used much anymore?

risk of hypertensive crisis

What causes this hypertensive crisis in MAOIs?

tyramine containing foods

When do stimulants (MAOIs) need to be given?

in the morning

What do the TCAs end in, and what are the two additional drugs?

- -ipramine

- -iptyline

- trazodone

- doxepin

What are the ADRs of TCAs?

- anticholinergic

- orthostatic hypotension

- sedation

- cardiac arrhythmias

What kind of metabolism do TCAs undergo?

34A metabolism

What cannot be take within 14 days of TCAs?

MAOIs

What are the first-choice medications for depression?

SSRIs

What are the SSRIs?

- fluoxetine

- sertraline

- citalopram

- escitalopram

- paroxetine

- fluvoxamine

- vilazodone

What effects are SSRIs also known to have that we need to be cautious with?

mild antiplatelet effect (problematic if the patient is already on another anticoagulant)

What is a caution with starting all antidepressants in a new patient that we need to be aware of?

- there is a risk of hypomania/exacerbation of mania

- cut back on the dose if this is the case

- start low and go sloe

What is escitalopram (SSRI) an active metabolite of?

Citalopram

What SSRIs are LEAST likely to have DDIs?

Citalopram and Escitalopram

What SSRIs are MOST likely to have DDIs?

Fluvoxamine

What is special about citalopram?

it has a really long half life

What do ALL SNRIs and SSRIs have a risk for?

Serotonin syndrome

Do antidepressants ever completely remove the risk of suicide?

No

What are the SNRIs?

- Duloxetine

- Venlafaxine

- Desvenlafaxine

What are the ADRs of duloxetine?

- neuropathic problems

- depression

What are the atypical antidepressants?

- vortioxetine

- buproprion

- nefazodone

- vilazodone

- mirtazapine

What is a special indication for bupropion?

smoking cessation

What is the main indication for mirtazapine (besides an antidepressant)?

weight loss

What is the MOA of mirtazapine at low doses?

- H1 blocker

- sedating/appetite stimulating

What is the MOA of mirtazapine at high doses?

alpha-adrenergic effects

What are the low-potency, 1st generation antipsychotics?

- chlorpromazine

- thioridazine

What are the high-potency, 1st generation antipsychotics?

- fluphenazine

- haloperidol

- perphenazine

- prochloroperazine

- thiothixene

- trifluoperazine

What are the 2nd generation antipsychotics?

- aripiprazole

- lurasidone

- olanzapine

- quetiapine

- risperidone

- ziprasidone

- lumateperone

- pimavanserin

- brexpiprazole

- clozapione

What are the 1st generation antipsychotics used to treat?

positive symptoms (hallucinations, delusions, "sterotypical symptoms)

What are 2nd generation antipsychotics used to treat?

BOTH negative and positive symptoms, plus negative affect, social isolation, and illogical thinking

How are antipsychotics administered?

Given IM monthly

What generation of antipsychotics are used less frequently because of a higher risk for EPS and tardive dyskinesia?

1st generation

How do 1st generation antipsychotics cause EPS and tardive dyskinesia?

block dopamine

What is the BBW for 2nd generation antipsychotics?

increased mortality in elderly/dementia related schizophrenia psychosis

What is the long term concern with 2nd generation antipsychotics?

development of metabolic syndrome and diabetes

What is the special indication for pimavaserin?

it is an atypical antipsychotic for patients who develop schizophrenia related to parkinson's disease

psychosis

What is the special indication for clozapine?

refractory psychosis

Which atypical antipsychotic has a REMS requirement?

Clozapine

What are EPS?

dystonia and parkinson like akathisia due to disruption of dopamine

What are neuroleptic malignant syndrome?

muscle rigidity, fever, MS change, autonomic instability, and myoglobinemia

What are tardive dyskinesia?

involuntary body movements

What is AIMS testing used for?

determine the level of dyskinesia

What are the overall ADRs of atypical antipsychotics?

- serotonin syndrome

- QT prolongation

- EPS

- tardive dyskinesia

- neuroleptic malignant syndrome

What is bipolar d/o?

cyclical phases of mania and depression

What is the mainstay for the treatment of bipolar d/o?

mood stablizers

What are the mood stablizers?

- divalproe

- lamotrigine

- lithium (not used much anymore)

What is the OG drug used for bipolar d/o, with a narrow therapeutic index?

Lithium

What is the issue with litium?

notable CNS toxicity

What are the DDIs for lithium?

- NSAIDs

- TZD

- ACE inhibitors

- Verapamil

- Fluoxetine

What is the 1st mood stabilizers most commonly used for bipolar d/o?

divalproe or lamotrigine