Drugs PDF

Drugs Anti-Depressant SSRI Pure SSRI Escitalopram QT Prolongation Omeprazole/Esomeprazole (CYP2C19 inhibitor) = ↑ Drug’s Conc. 5-HT2C antagonist Slight NE reuptak...

Drugs Anti-Depressant SSRI Pure SSRI Escitalopram QT Prolongation Omeprazole/Esomeprazole (CYP2C19 inhibitor) = ↑ Drug’s Conc. 5-HT2C antagonist Slight NE reuptake inhibition Take in AM Fluoxetine less likely withdrawal Tamoxifen CYP inhibit SSRI M1 Antagonist NET Blocker Paroxetine NO2 Synthase (-) ↑ HIGHER WITHDRAWAL RISK - AVOID IN CHILDREN (lower half life kasi Tamoxifen CYP inhibitor ↑ Sexual Dys (anticholinergic kasi) for coronary heart disease take in AM Sertraline slight DA reuptake inhibition α1 binding SSRI σ1 agonist Fluvoxamine OCD CYP (-) - (↑↑Clozapine, ↑Melatonin) Smoking decrease Drug SSRI Dapoxetine for premature ejaculation Rapid Absorption, Onset SNRI Neuropathic Pain Venlafaxine not for children (coz of short hald life = higher withdrawal + manic switch unless may narcolepsy) CI w/ uncontrolled angle-closure glaucoma SNRI CI w/ uncontrolled angle-closure glaucoma Desvenlafaxine QT Prolongation Higher rate of withdrawal Financially Toxic  SNRI Duolexetine preferred for neuropathic pain rare liver s/e Multimodal MDD Vortioxetine Rare angioedema Less Sexual Dysfunction Noradrenergic and Specific Serotonergic Antidepressant (NaSSA) α2 receptor antagonism → release of 5-HT Sedation (frequent) Weight Gain Mirtazapine Anticholinergic effects ↑ Cholesterol Less Sexual Dysfunction CI - Serotonin Syndrome Melatonergic Antidepressant GAD Agomelatine CI - hepatic impairment s/e - Less SERT Side effects (GI, sex) Hepatotoxicity Glutamatergic Antidepressant NEEDS S2 Dangerous Drug Esketamine Slow Onset (22 days) lethargy, sedation, dissociation, addiction potential TCA AntiDepressant has more potent SERT blockade Clomipramine Na+ channel blockade (cardiotoxicity) Anticholinergic + NET blockade combo also enhances cardiotoxicity TCA AntiDepressant Has more NET blocker indications Amitriptyline Na+ channel blockade (cardiotoxicity) Anticholinergic + NET blockade combo also enhances cardiotoxicity Lithium Aripiprazole Adjuncts to Antidepressants (4) Brexpiprazole Olanzapine Mood Stabilizer Most effective drug narrow therapeutic index + financial toxicity Lithium 1st line Bipolar disorder, manic and depressive phases CI - cardiac, renal disease + Na depletion (monitor creatinine and thyroid) 1-3 weeks onset  Mood Stabilizer DO NOT CHANGE Divalproex - Specific ratio of sodium valproate and valproic acid. Valproic Acid - unionized Sodium Valproate - Ionized mania, mixed episodes ADR: Pancreas, Liver, Mitochondrial + valproate-induced hyperammonemic encephalopathy (VHE) Valproate Antidote: L-carnitine CI: Pregnancy, women of childbearing potential (unless no alternatives) let women decide what they shud or shud not receive May weight gain coz of genetics Drugs I: Lamotrigine - decrease concentration of drug Topiramate - rare hyperammonemia Mood Stabilizer BIPOLAR DEPRESSION ONLY not mania VERY MINIMAL WEIGHT GAIN Na + channel blocker & increases brain GABA Pathway: voltage-gated channels -> ↑ Glu -> Glu bind to Glu and NMDA recep -> entry of Ca (toxic sa CNS = neuron death) Lamotrigine SJS-TEN - basta rash Titrate dose VERY SLOWLY pricey other CI: hormone pill (decrease efficacy) least risk for pregnant Kinetic Interaction: substrate of uridine glucuronosyltransferase (UGT) → IF (-) → increase levels of the drug Mood Stabilizer Adenosine-1 receptor antagonists -> long-term -> upregulation of receptors -> block Ca2+ influx via NMDA receptor -> no apoptosis Bipolar Mania w/ fast Carbamazepine 1st line for benign occipital epilepsies Positive test for HLA-B*1502 allele = SJS TEN (no w/ paracetamol) but ADR ang SJS TEN ADR: hepatotoxicity, bone marrow suppression, hyponatremia (bind to ihi receptor = no pee) + CYP (+) drug interactions: anticonvulsants, antidepressants, antipsychotics, warfarin + valproate Mood Stabilizer Haloperidol for Mood cheap kaya ginagamit but can cause mania switch Bipolar Mania ADHD Drug Indication: ADHD, Narcolepsy (daytime sedation ONLY, not for cataplexy) BLACK BOX: dependence and addiction Methylphenidate take this w/o ADHD = increase BP GI: Loss of Apetite -> anorexia cannot be interchanged coz of kinetic differences addiction risk Atomoxetine 2nd Line ADHD  Onset: 4-6 wks - last whole day GI: lesser appetite effects expensive Alzheimer’s ADR': CV - bradycardia + mortality - if mayron stop na, nakakamatay toh - GI: ulcer + GI bleed (Take w/ food) Donepezil + insomnia Rivastigmine MOA: block acetylcholinesterase -> increase acetycholine -> bind to M1 -> DUMBBELLS restart dose if you stop Indication: dementia lewy bodies Alzheimer’s low affinity uncompet NMDAR antagonist -> stop Ca from coming -> no apoptosis Memantine Adjunct to alzheimers (mod to severe) s/e: raise in urine pH and reduce elimination of urine - Psychoeducation - detection and managing prodromes - Cognitive Behavioral Therapy - changing maladaptive thought Psychotherapy - Family Focused Therapy - improve relationship - Interpersonal and Social Rhythm Therapy - disengage from maladaptive processes - Peer Support - don't promote viewpoints against adherence or for substance use Anxiolytics For: Insomnia (acute/short-term use only) not a cure CI: Ineffective and potentially harmful in PTSD and phobias Narrow-angle glaucoma Myasthenia gravis Respiratory disorders Hepative Pregnancy Benzodiazapines Toxicity Antidote: Flumazenil (not for seizure patients coz it will withdrawal seizure) S2 license in the pH onset: disrupt sleep (more light sleep) Dependence: Anxiety disorders: