Wellbutrinzyban mirtazapine remeron venlafaxine

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(Wellbutrin,Zyban), Mirtazapine(Remeron), Venlafaxine (Effexor), Reboxetine (Vestra), Duloxetine (Cymbalta)Psychopharmacology antidepressants :- Antidepressants (1958) Tofranil (from CPZ) ---+ Tricyclics, MAOIs, SSRIs, Others-Depressive D/Os- Enuresis (urinary incontinence)- Eating D/Os- Anxietv D/OsDepression is caused by reduced quantity ordurationResponse is several weeks for target Sx.'First Break' : 6-12 months. 2no: vears - lifetime.TricyclicsSSRIsMAOIsf SedationNausea./HA,/ DiznrTyramine Rest. Diet+wt. GainAnorexia/ drowsy+wt. GainConstipation/Anti Cholinergic SESweating/ +AnxietySexual DysfunctionSuicide Risk after 2ndweekSexual DvsfunctionInsomniaCardioToxicSome EPSHTN Crisis/ Ortho HTN
TRICYCLIC ANTIDEPRESSANTS :- Serum levels: needed to titrate these drug- ^SE: orthostasis, sedation, anticholinergic effects (careful in glaucoma and prostatichypertrophy), slowed cardiac conduction (contraindicated in heart block), erectiledysfunction, priapism- I*: increased anticholinergic SEs with other anticholinergic drugs like phenothiazines;increased sedation with CNS depressants and antihistamines; SSRIs inhibit tricyclicmetabolism; hypertensive crisis with MAOIs; added hypotension with diuretics andantihypertensivesSSRIs:- SE: no cardiac toxicity; little or no anticholinergic effects; little or no sedation; maycause insomnia if taken at bedtime; yawning; delayed ejaculation; decreased libido- SSRIs (except for citalopram) inhibit one or more of the cytochrome P450 enzymes inthe liver and can interfere with metabolism of many drugs; cimetidine inhibits themetabolism of paroxetine and sertralinATYPICAL ANTIDEPRESSAIITS :Wellbutrin (buproprion) increases DA in synapses; marketed to help quit smoking too +Zyban: lowers the seizure threshold; decreases appetiteEffexor (venlafaxine) affects both NE and 5-HT reuptake; can increase blood pressureDesyrel (trazodone) rather sedating and useful in treating insomnia (non-habit forming)MOOD STABILIZERS:- LITHIUM: Eskalith (lithium carbonate)- fNote: Depakote (valproic acid) and Tegretol (carbamazepine) also used as rnoodstabilizers but discussed under seizure medication section]- Uses: treatment of bipolar disorder or to augment antidepressant medication- MOA: the leading theory is that lithium acts intracellularly to depletephosphatidylinositol bisphosphate (PIP,) especially when neurons are firing rapidly thusdampening their ability to respond to any further stimulation- Lithium has a narrow therapeutic index and requires blood levels to titrateeffectively; blood levels of 0.6-1.2 mEq/L are therapeutic- SE: nausea/vomiti'lrg, anorexia" dianhea, abdominal p^ain; antagonizes ADH leading topolyuria; rare renal toxicity; lethargy, fatigue, weakness, and tremor; interferes withd other dermatologicabsorption of lithjLum;- AnticonvulsantsCarbamazepine (needs levels) (Tegretol)Valproic acid (needs levels) (Depakote)Topiramate (Topamax)Gabapentin (Neurontin)Lamotrigine (Lamictal)
Lithium0.6-1.2 rnEq/LValproic Acid50-100 mcgimlCarbamazepine4-l2mcg/mlNauseaTremor/AtaxiaConfusionKidney damageNarrow Tx.

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