Pharm II (mood disorders) 1b

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Pharm II (mood disorders) 1b
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2011-02-06 13:00:21
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Pharm II mood disorders 1b
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Pharm II (mood disorders) 1b
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  1. What would appear with SSRI discontiuation?
    • After 1 to 3 days would experience:
    • Dizziness, Nausea, Headache, Anxiety/agitation
    • Sensory disturbances
  2. Name the Serotonin Norepinephrine reuptake inhibitors (SNRI)
    • venlafaxine
    • desvenlafaxine
    • duloxetine
  3. What is Venlafaxine?
    What else does it do?
    What are its indications?
    • It is a SNRI
    • It is a weak inhibitor of DA reuptake
    • Has NO AFFINITY FOR
    • Muscarinic, H1 or Alpha adrenergic receptors.

    Indications: Depression, GAD, Social Anxiety disorder
  4. What are some Velafaxine Adverse effects?
    Short half-life

    Abrupt discontinuation may lead to SSRI discontinuation syndrome

    Extended release formulation reduces this somewhat

    *at low doses it have more Adrenergic affects, at high doses it has more seritonin effects
  5. What are some Venlafaxine interactions?
    • -Do NOT combine with MAOI
    • -Wait 2 weeks after MAOI is stopped before giving starting this drug
  6. What is Devenlafaxine?
    • -It is a SNRI
    • -It is the major active metabolite of Venlafaxine
    • -Not broken down by cyt P450
    • -Side effects are similar to Venlafaxine
    • -Does not undergo extensive hepatic metabolism
  7. What is Duloxetine?
    What is it indicated in?
    What is an adverse effect?
    It is a SNRI

    • -Depression
    • -GAD
    • -Neurologic pain management
    • -Management of chronic musculoskeletal pain

    Potential interaction with MAOI, as with other antidepressants.
  8. Name some other Antidepressents
    • Dupropion
    • Mirtazapine
    • Trazodone
    • Nefazodone
  9. Bupropion
    It is an antidepressent with Dual monoamine reuptake inhibitor

    • NE>DA (not as effective for seratonin)
    • -Aid to smoking cessation
    • -Can be used in treatment of ADHD
  10. Bupropion has the Absence of.......


    and compared to other Antidepressents, Bupropion has...
    • Absence of:
    • Sedation, Cardio effects (mild increased BP), sexual dysfunction, Anticholinergic effects.

    • Carparativly:
    • -Reduced risk for “switching” to mania/hypomania
  11. What are the adverse effects of Bupropion???

    What are some interactions that can occure?
    • -Activation (insomnia, agitation)
    • -Decrease in Appetite
    • -Lowers seizure threshold (remember that the Seizures are dose related)

    • Interactions with:
    • -MAOI
    • -Antiparkinson drugs (increase dopamine)
  12. What is Mirtazapine?
    -It is an antidepressent that is NOT a reuptake inhibitor.

    • -It is a potent Alpha 2 antagonist( blocks 5-HT2/3)
    • -Therea are minimum effects on Monoamine reuptake
  13. What is Mirtazapines mech of action?

    What does it have Low/ High effinity for?
    • Blockade of presynaptic alpha-2 Autoreceptors ➨ ⇧NE release
    • -Blockade of alpha-2 heteroreceptors on 5-HT neurons ➨ ⇧ 5-HT releas
    • - Low affinity for Muscarinic Cholinergic and Dopamine recepters
    • -High affinity for H1 (Sedation at low dose, Increase NE at higher dose)
  14. What is Trazodone?

    What is its mech of action?
    It is a weak 5-HT reuptake inhibition

    The active metabolite, m-chlorophenyl piperazine (m-CPP) is a 5-HT agonist

    • -Weak blocker of presynaptic alpha-2 receptors
    • -Potent post-synaptic alpha-1 antagonist
    • Causes Orthostatic hypotension
  15. What are the Drug interations of Trazodone?
    • -Potentiates other CNS depressants
    • -Potentiates antihypertensives
    • -Potentiates other serotoninergic drugs
  16. What was Nefazodone withdrawn for?
    Due to increased risk of Hepatic failure
  17. -What are the Antipsychotic drugs approved as adjunctive treatment?

    -Fluoxetine + Olanzapine are fixed combinations that are approved for?
    • 1. Quetiapine
    • 2. Aripiprazole
    • ___________________
    • 1. Treatment resistant depression
    • 2. Bipolar Depression
  18. Children and Antidepressants, what are they at increased risk for?

    What are the ones approved for childrens use?
    -Increased risk of Suicidal thinking and behavior

    - Fluoxetine and Escitalopram
  19. TREATMENT OF BIPOLAR DISORDER
    • Mood stablizers
    • -llithium
    • -lvalproic acid
    • -lcarbamazepine
    • -llamotrigine

    • Antidepressant drugs
    • Antipsychotic drugs
  20. Depression treatment (both acute and prophylaxis)


    Mania treatment (noth acute and prophylaxis)
    Depression: Antidepressents Mood Stablizers

    Mania: Mood stablizers(and antipsycotic drugs) mood stablizers

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