Behavorial Sciences

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Author:
malikos87
ID:
65008
Filename:
Behavorial Sciences
Updated:
2011-02-08 15:20:03
Tags:
Psych
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Description:
Mood Disorders- Pharm 2
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  1. Antidepressants

    also Mood Stabilizers
    • SSRIs
    • Tricyclic antidepressants
    • MAOIs(mono amine oxidase inhibitors)
    • others

    can take 2-3 wks for antidepressants to have an effect
  2. SSRIs
    • Serotonin-specific reuptake inhibitors
    • No effects on NE or dopamine
    • most widely used antidepressants-fewer/less severe side effects
    • Maybe used for tourette syndrome or OCD
  3. SSRI's ADR
    • GI distress
    • SEXUAL DYSFUNCTION
    • Anorgasmia
    • serotonin syndrome w/ MAOI: HTN, hyperthermia, muscle rigidity, CVS collapse
  4. SSRI clinical use
    • OCD
    • Depression
  5. SSRI drugs
    • FLUOXETINE
    • SERTRALINE
    • PAROXETINE
    • Citalopram
  6. TCAs
    • Tricylic antidepressants
    • blocks reuptake of both NE and serotonin
    • used in depression
    • can block the alpha-q adrenergic, histamine, and muscarinic receptors
  7. TCAs ADR
    • Seuxal: impotence, anorgasmia
    • Anticholinergic: tachycardia, UR
    • CNS: sedation/drowsiness, insomnia, disorientation/confusion
    • CVS: more common in the elderly, tachycardia, orthostatic hypotension
    • TRI C's: convulsion, coma, cardiotoxicity(arrthymia)
    • HAM= histamine-blocks it which leads to drowsiness, alpha trypsin-blocks bronchoconstriction, muscarinic-m1/m2/m3- dry mouth, eyes
  8. TCA drugs
    • Imipramine: desipramine-strongly anticholinergic
    • Amitripyline: nortripyline-strongly anticholinergic
    • Clomipramine
    • Doxepin
    • Amoxapine
  9. Random uses
    • Imipramine: Enuresis, which is bedwetting
    • Amitriptyline: chronic pain

    • imipramine also treats panic disorder
    • fluoxetine, clomipramine: treats OCD
  10. Other considerations
    • Not first line for pt's with resp diff's
    • lower seizure threshold
    • may impair driving
    • avoid in first trimester
    • withdrawal symptoms
  11. MAOIs
    • inhibits the enzyme that metabolizes serotonin, epinephrine, and NE
    • seleginine, phenelzine
  12. MAOI's ADR
    • MAOI with TYRAMINE=hyptertensive crisis!!!
    • occipital headaches, stiff neck, N/V, CP, dilated pupils, nosebleed, elevated BP
    • stop the drug, give phentolamine(alpha blocker)
    • fyi: tyramine is found in cheese and fish
    • DO NOT GIVE MAOI WITH SSRIs
  13. Other Antidepressants
    • BUPROPION
    • TRAZODONE
    • venlafaxine
    • mertazipine
    • maprotiline
  14. Bupropion
    • aka Wellbutrin
    • mech not well understood, NE
    • used for smoking cessation
    • NO SEXUAL SIDE EFFECTS
    • toxicity: tachycardia, insomnia, headache, lowers seizure threshold
    • DO NOT USE IN EATING DISORDERS OR ALCHOLICS
  15. Venlafaxine
    • used also in generalized anxiety disorder
    • inhibits catacholamine reuptake
    • toxicity: stimulant effects, nausea, constipation, increase BP, impotence
  16. Mirtazapine
    • Alpha 2 antagonist(increase the release of NE and serotonin)
    • toxicity: sedation, increase appetite(good for depression in eating disorders)
    • dry mouth
  17. Maprotiline
    • Blocks NE reuptake
    • ADR: sedation, orthostatic hypotension
  18. Trazodone
    • Inhibits serotonin reuptake
    • toxicity: sedation(can improve sleep quality), nausea, Priapism(contant boner), postural hypotension
  19. Mood Stabilizers
    • Lithium
    • Valproic acid
    • Carbamazepine
  20. Lithium
    • Mech is not well understood
    • Long term control and Px of Bipolar disorder, migraine cluster headaches, chronic aggression, combined with tricyclics for resistant depression
    • when you hear lithium think BIPOLAR!!
  21. Lithium ADR
    • L: Lithium
    • M: metalic taste in mouth or movement (tremor)
    • N: Nephrogenic diabetes insipidus
    • O: HypOthyroidism
    • P: Teratogenic-epstein anomaly
    • Note: narrow therapeutic window requiring close monitoring of serum levels
  22. Valproic Acid
    • Acute mania, bipolar, seizures, rapid mood changes
    • augments the GABA receptor in the CNS
    • monitor blood levels
    • hepatoxic (don't use if Liver fnc. test are impaired)
    • TERATOGENIC-NTD
    • agranulocytosis
  23. Carbamezepine
    • Also an anitconvulsant: can be used to treat seizures as well.
    • ADR: aplastic anemia, agranulocytosis

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