Lithium PDF - Psychiatry Pharmacology

592 SEC TION III PSYCHIATRY ` PSYCHIATRY!PHARMACOLOGY Lithium MECHANISM Affects neurotransmission (!excitatory, LiTHIUM: !inhibitory) and second messenger systems...

592 SEC TION III PSYCHIATRY ` PSYCHIATRY!PHARMACOLOGY Lithium MECHANISM Affects neurotransmission (!excitatory, LiTHIUM: !inhibitory) and second messenger systems Low Thyroid (hypothyroidism) (eg, G proteins). Heart (Ebstein anomaly) CLINICAL USE Mood stabilizer for bipolar disorder; treats acute Insipidus (nephrogenic diabetes insipidus) manic episodes and prevents relapse. Unwanted Movements (tremor) ADVERSE EFFECTS Tremor, hypothyroidism, hyperthyroidism, mild hypercalcemia, polyuria (causes nephrogenic diabetes insipidus), teratogenesis (causes Ebstein anomaly). Narrow therapeutic window requires close monitoring of serum levels. Almost exclusively excreted by kidneys; most is reabsorbed at PCT via Na+ channels. Thiazides, ACE inhibitors, NSAIDs, and other drugs affecting clearance are implicated in lithium toxicity. Buspirone MECHANISM Partial 5-HT1A receptor agonist. I get anxious if the bus doesn’t arrive at one, so CLINICAL USE Generalized anxiety disorder. Does not cause I take buspirone. sedation, addiction, or tolerance. Begins to take effect after 1–2 weeks. Does not interact with alcohol (vs barbiturates, benzodiazepines). Antidepressants NORADRENERGIC SEROTONERGIC AXON AXON MAO - inhibitors - MAO Metabolites Metabolites MAO NE 5-HT α2 (autoreceptor) adrenergic receptor - - TCAs, SNRIs, - Mirtazapine TCAs, SSRIs, bupropion - SNRIs, trazodone NE reuptake 5-HT reuptake 5-HT receptor NE receptor POSTSYNAPTIC NEURON