Antidepressants/BPD

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mp
ID:
205130
Filename:
Antidepressants/BPD
Updated:
2013-03-05 21:08:59
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Pharmacology II Antidepressants BPD
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Antidepressants/BPD
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  1. TCA -- Amitriptyline (Elavil) -- moa
    5-HT and NE reuptake inhibitor
  2. TCA -- Imipramine (Tofranil) -- moa
    5-HT AND NE reuptake inhibitor
  3. TCA -- Desipramine (NORpramin) -- moa
    NE reuptake inhibitor
  4. TCA -- Nortriptyline (Aventyl) -- moa
    5-HT and NE reuptake inhibitor
  5. SSRIs -- selectively inhibits reuptake of serotonin
    • Fluoxetine (Prozac),
    • Paroxetine (Paxil),
    • Sertraline (Zoloft),
    • Fluvoxamine (Luvox),
    • Citalopram (Celexa),
    • Escitalopram (Lexapro)
  6. Serotonin Syndrome
    • CNS agitation, hallucinations
    • confusion anxiety
    • fever
    • hyperreflexia
    • sweating
    • tremor
    • 2-72 hrs (quick)
  7. S/NRIs -- serotonin and NE reuptake inhibitors
    • Venlafaxine (Effexor)
    • Duloxetine (Cymbalta)
  8. Venlafaxine (Effexor)
    • low dose -- SSRI
    • higher dose -- NE RI
    • little cholinergic, H1 or alpha-1 blockade
  9. Duloxetine (Cymbalta)
    S/NRI, weak DA inhibition

    • labeled for Fibromyalgia and Gen Anxiety DO
    • relieves pain of diabetic peripheral neuropathy
  10. Heterocyclics: 2nd Generation
    • Amoxapine (Asendin)
    • Maprotiline (Ludiomil)
    • Trazodone (Desyrel)
  11. Amoxapine (Asendin)
    some DA receptor antagonism

    EPS and amenorrhea-galactorrhea
  12. Maprotiline (Ludiomil)
    • block NE re-uptake
    • alpha receptor blockade
    • high dose causes seizures
  13. Trazodone (Desyrel)
    5-HT2a antagonist
  14. 3rd generation heterocyclic antidepressants
    • Venlafaxine (Effexor) -- SNRI
    • Nefazodone (Serzone)
    • Mirtazapine (Remeron)
    • Bupropion (Wellbutrin)
  15. Nefazodone (Serzone)
    • 5-HT2a antagonist
    • fewer adverse sexual SE
    • rare but dangerous hepatoxicity
  16. Mirtazapine (Remeron)
    5-HT2a and alpha receptor antagonism
  17. Bupropion (Wellbutrin)
    • Stimulant and suppresses appetite -- no weight gain
    • Not as much¬†affect on serotonin, cholinergic, or histamine
    • "Happy, horny, skinny pill"
  18. MAOIs -- overall
    • 2nd or 3rd choice
    • as effective as TCAs or SSRIs but more dangerous side effects
    • hypertensive crisis -- tyramine rich foods
    • DOC of atypical depression
  19. MAOIs -- drugs
    tranylcypromine, phenelzine -- MAO-A

    Selegiline -- MOA-B -- lower risk of hypertensive crisis
  20. Drug Therapy for BPD
    • Mood stabilizers -- Lithium and Valproic acid (AEDs)
    • Antipsychotics -- given during manic episodes
    • Antidepressants -- given during depression phase
  21. Lithium
    • Most effects via inhibition of 2nd messengers -- IP3 and DAG
    • neuorprotective and neurotropic effects
    • initial treatment¬†for euphoric mania
    • effect seen in 5-21 days
  22. Lithium P. kinetics
    • Sodium deficiency -- lithium levels are increased from decreased Na
    • Plasma level -- 0.6-1.4 mEq/L
  23. Valproic acid (Depakene)
    • very effective
    • has replaced Li in many pts
    • fewer SE than Li
  24. Carbamazepine and oxcarbazepine
    • reduces symptoms
    • protects against recurrence of mania and depression
  25. Lamotrigine
    • long-term maintenance
    • used alone or in combo
    • fewer SE than carbamazepine

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