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mp
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TCA -- Amitriptyline (Elavil) -- moa
5-HT and NE reuptake inhibitor
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TCA -- Imipramine (Tofranil) -- moa
5-HT AND NE reuptake inhibitor
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TCA -- Desipramine (NORpramin) -- moa
NE reuptake inhibitor
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TCA -- Nortriptyline (Aventyl) -- moa
5-HT and NE reuptake inhibitor
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SSRIs -- selectively inhibits reuptake of serotonin
- Fluoxetine (Prozac),
- Paroxetine (Paxil),
- Sertraline (Zoloft),
- Fluvoxamine (Luvox),
- Citalopram (Celexa),
- Escitalopram (Lexapro)
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Serotonin Syndrome
- CNS agitation, hallucinations
- confusion anxiety
- fever
- hyperreflexia
- sweating
- tremor
- 2-72 hrs (quick)
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S/NRIs -- serotonin and NE reuptake inhibitors
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
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Venlafaxine (Effexor)
- low dose -- SSRI
- higher dose -- NE RI
- little cholinergic, H1 or alpha-1 blockade
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Duloxetine (Cymbalta)
S/NRI, weak DA inhibition
- labeled for Fibromyalgia and Gen Anxiety DO
- relieves pain of diabetic peripheral neuropathy
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Heterocyclics: 2nd Generation
- Amoxapine (Asendin)
- Maprotiline (Ludiomil)
- Trazodone (Desyrel)
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Amoxapine (Asendin)
some DA receptor antagonism
EPS and amenorrhea-galactorrhea
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Maprotiline (Ludiomil)
- block NE re-uptake
- alpha receptor blockade
- high dose causes seizures
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Trazodone (Desyrel)
5-HT2a antagonist
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3rd generation heterocyclic antidepressants
- Venlafaxine (Effexor) -- SNRI
- Nefazodone (Serzone)
- Mirtazapine (Remeron)
- Bupropion (Wellbutrin)
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Nefazodone (Serzone)
- 5-HT2a antagonist
- fewer adverse sexual SE
- rare but dangerous hepatoxicity
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Mirtazapine (Remeron)
5-HT2a and alpha receptor antagonism
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Bupropion (Wellbutrin)
- Stimulant and suppresses appetite -- no weight gain
- Not as much affect on serotonin, cholinergic, or histamine
- "Happy, horny, skinny pill"
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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
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MAOIs -- drugs
tranylcypromine, phenelzine -- MAO-A
Selegiline -- MOA-B -- lower risk of hypertensive crisis
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Drug Therapy for BPD
- Mood stabilizers -- Lithium and Valproic acid (AEDs)
- Antipsychotics -- given during manic episodes
- Antidepressants -- given during depression phase
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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
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Lithium P. kinetics
- Sodium deficiency -- lithium levels are increased from decreased Na
- Plasma level -- 0.6-1.4 mEq/L
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Valproic acid (Depakene)
- very effective
- has replaced Li in many pts
- fewer SE than Li
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Carbamazepine and oxcarbazepine
- reduces symptoms
- protects against recurrence of mania and depression
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Lamotrigine
- long-term maintenance
- used alone or in combo
- fewer SE than carbamazepine
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