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Neuropharmacology (mood stabilizers (lithium (uses (px&tx of mania,…

- - - - px&tx of mania, bipolar, unipolar depression
      - bipolar manic depression
      - schizoaffective disorder
      - combo w/ neuroleptic drugs but additional side effects
    - - cerebellar effects - ataxia
      - nephrogenic diabetes insipidus - lose water instead of sugar
      - renal failure even at therapeutic doses
    - - dose to plasma concentration
      - renal elimination - but reabs (ddi w/ diuretics)
      - narrow therapeutic window
      - long duration of action
- - - - Modality
        
        fluoxetine
        
        escitalopram
        
        paroxetine
      - efficacy similar to TCA but safer than TCA and MAOI
      - most commonly prescribed antidepressants
      - AE
        
        n/i
        
        sexual dysfunction
        
        sedating but less than TCA
        
        anticholinergic effects
        
        serotonin syndrome (hyperthermia, muscle rigidity, CV collapse) w/ MAOI
        
        suicidality is a risk
    - - most are nonselective and irreversible
      - modality
        
        isocarboxazid
        
        selegiline
        
        safest in class
        
        TD for antidepressant
        
        low dose PO target type B - for parkinson's
      - MOA
        
        MAO control concentrations in synapse from NT release or leaking
        
        block MAOI metabolism so monoamine NT accumulate in vesicle and cytosol increase
        
        irreversible, LA - need 2 weeks to recover
      - AE
        
        orthostatic hypotension
        
        tyramine abs from gut and taken up by sympathetic nerves and stored in vesicle instead of NE but less efficacious so can't regulate BP
        
        hypertensive crisis - cheese reaction
        
        atropine-like effects
        
        weight gain
        
        CNS stimulation
        
        restlessness
        
        insomnia
        
        hepatotoxicity
        
        neurotoxicity - rare
        
        convulsion with acute overdoses
      - DDI
        
        anesthetics
        
        alcohol
        
        OTC decongestants - cheese reaction (tyramine < NE in maintaining BP)
        
        serotonin syndrome w/ SSRI, SNRI, TCA, meperidine, tramadol, opioids
    - - modality
        
        duloxetine
        
        venlafaxine
      - similar to TCA except no major receptor blocking action, fewer side effects (less cv risk, safer in OD)
    - - Modalities
        
        Amitriptyline
        
        Imipramine
        
        Nortriptyline
      - Characteristics
        
        derivative of phenothiazines - can be deadly
        
        Similar nonselective receptor blocking w/ phenothiazine
        
        most are long acting
        
        converted to active metabolites
      - MOA --> AE
        
        H1 receptor blocking
        
        Sedation
        
        alpha adrenergic blocks
        
        orthostatic hypotension
        
        muscarinic receptor blockade
        
        xerostomia, blurred vision, constipation, mania, convulsion
        
        potassium channel blockade
        
        torsades de point
        
        OD --> confusion, mania, arrhythmia
        
        assess suicide risk before using
      - DDI w/ alcohol, anesthetics, hypotensive drugs, NSAID, MAOI
      - Uses
        
        mod/severe endogenous depression
        
        panic, obssessional, phobic disorders
        
        neuropathic pain
        
        short term nocturnal enuresis
    - - modality
        
        bupropion
        
        trazdone
        
        mirtazapin
      - MOA
        
        increase MAO release
        
        varying toxicity but less than TCA