Page 618 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat

574 sEctiON iii Psychiatry ` Psychiatry—PharMacology Psychiatry ` Psychiatry—PharMacology

Lithium
MEchaNisM Not established; possibly related to inhibition of LiTHIUM:
phosphoinositol cascade. Low Thyroid (hypothyroidism)

cliNical UsE Mood stabilizer for bipolar disorder; treats acute Heart (Ebstein anomaly)
manic episodes and prevents relapse. Insipidus (nephrogenic diabetes insipidus)
Unwanted Movements (tremor)
aDVErsE EFFEcts Tremor, thyroid abnormalities (eg,
hypothyroidism), polyuria (causes nephrogenic
diabetes insipidus), teratogenesis. Causes
Ebstein anomaly in newborn if taken by
pregnant mother. Narrow therapeutic window
requires close monitoring of serum levels.
Almost exclusively excreted by kidneys; most
is reabsorbed at PCT via Na channels.
+
Thiazides, NSAIDs, and other drugs affecting
clearance are implicated in lithium toxicity.

Buspirone
MEchaNisM Stimulates 5-HT receptors. I get anxious if the bus doesn’t arrive at one, so
1A
cliNical UsE Generalized anxiety disorder. Does not I take buspirone.
cause 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
MAOIs
- -
Metabolites MAO MAO Metabolites

NE 5-HT
α 2 (autoreceptor)
adrenergic
receptor
-
-
TCAs, SNRIs, - Mirtazapine TCAs, SSRIs,
bupropion - SNRIs, trazodone
NE reuptake 5-HT reuptake

5-HT receptor
NE receptor

POSTSYNAPTIC NEURON

FAS1_2019_13-Psych.indd 574 11/7/19 5:28 PM