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JG Year 1 > 123 Depression > Flashcards

123 Depression Flashcards

1
Q

Name 2 TCAs

A
  • amitryptyline
  • imipramine
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2
Q

What is the MOA of antidepressants?

A

Inhibits the reuptake of NA and -HT by competing at the binding site at the presynaptic terminal

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3
Q

Name 4 contraindications of prescribing TCAs

A
  1. prostatism
  2. recent MI
  3. narrow angle glaucoma
  4. heart block
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4
Q

What are the anti-muscarinic effects of TCAs?

(4 listed)

A
  • blurred vision
  • dry mouth
  • consipation
  • urinary retention
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5
Q

Name 2 types of sedaive drugs which would interact with TCAs

A
  • alcohol
  • opiates
  • antihistamines
  • anxiolytics
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6
Q

Why should TCAs like amitripyline not be prescribed with e.g. amiodarone?

A

Both have a risk of prolonging QT interval

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7
Q

What drug class do the following belong to?

  • phenelzine
  • isocarboxazid
  • tranylcypromine
A

MAOIs

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8
Q

Which MAO receptor is targetted in drug therapy due to having a preference for 5-HT?

A

MAO-A

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9
Q

Name 4 possible SE of MAOIs

(6 listed)

A
  1. postural hypotension
  2. atropine-like side effects
  3. weight gain
  4. CNS stimulation
    • restlessness
    • insomnia
    • hallucinations
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10
Q

What effect do tyramine-containing products have when taken with MAOIs?

A

Severe hypertension

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11
Q

Which drug class do the following belong to?

  • fluoxetine
  • citalopram
  • paroxetine
  • setraline
A

SSRIs

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12
Q

Name 3 of the SE’s of SSRI’s?

A
  • hyponatraemia
  • GIT bleeding
  • QT prolongation
  • serotonin syndrome
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13
Q

What is serotonin syndrome?

A

Excess serotonergic activity on the CNS due to OD of certain therapeutic drugs e.g. SSRIs

S&S:

  • headaches
  • confusion
  • shivering
  • sweating
  • hyperthermia
  • tachycardia
  • D&V
  • hyperreflexia
  • myoconus
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14
Q

What is the mechanism of SSRI induced hyponatraemia?

A
  • causes SIADH
  • more ADH is released causing retention of water
  • low sodium (hyponatraemia) due to increased fluid vol
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15
Q

Which drugs should be avoided with SSRIs given the increased risk of GIT bleeding?

A

Antiocoagulants, warfarin and NSAIDs

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16
Q

Name 3 common SEs of SSRIs

(5 listed)

A
  • nausea
  • anorexia
  • insomnia
  • GI disturbances
  • loss of libido and failure to orgasm
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17
Q

When are SSRIs contraindicated?

A

In people under 18 years - increased risk of self harm and suicidal thoughts

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18
Q

What is the risk of prescribing MAOIs and SSRIs together?

A

Drug interaction - may precipitate serotonin syndrome

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19
Q

Which drug has a short half life and can therefor be stopped suddenly?

A

Fluoxetine

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20
Q

What type of antidepressants are Mirtazepine and Trazodone?

A

Non selective serotonin receptor blocker

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21
Q

Which drug has a sedative effect as it blocks H2 receptors?

  1. mirtazapine
  2. trazodone
A
  1. Mirtazapine
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22
Q

Which one has an action similar to TCAs?

  1. Mirtazapine
  2. Trazodone
A

Trazodone

(Mirtazapine increases the release of NA and 5-HT)

23
Q

Which TCA has a very narrow therapeutic index? (i.e. increased risk of death upon OD)

  • Amitriptylin
  • Imipramine
  • Dusolepin
24
Q

At which dose does Vanlafaxine inhibit the reuptake of NA as well as serotonin?

25
Which group of antodepressants should be given to treat major/severe depressive disorders?
Non selective serotonin inhibitors * venlafaxine * duloxetine
26
When should cross-tapering of antidepressant be done?
When swapping antidepressants
27
Name 2 substances used to augment the effect of antidepressants
* lithium * antipsychotics * more antidepressants * benzos
28
What are the following e.g's of? * aripipralone * olanzapine * quetiapine * risperidone
Anipsychotics
29
What are benzos used to treat?
Insomnia/anxiety
30
What type of benzos are the following? * temazepam * nitrazepam * zopiclione * zolpidem * zaleplon
Hypnotics - to treat insomnia
31
What type of benzos are the following? * diazepam * chlordiazepoxide * lorazepam * oxazepam
Anxiolytics
32
What is the MOA of benzos?
* binds to GABAA receptor * --\> opens chloride chanel * --\> increases the inhibitory effect if GABA * = sedation
33
What are the indications for use of benzos?
When the anxiety is severe and disabling
34
Why should benzos only be used short term?
Problem with dependence and tolerance - difficult to reduce the dose due to the withdrawal symtpoms
35
Name 3 SE's of benzos | (5 listed)
* drowsiness and falls * impaired judgement and dexterity * increased risk of RTAs * forgetfulness/confusion/irritability * aggression and parodoxical dis-inhibition
36
Which is the main exitatory NT in the CNS?
Glutamate
37
What is the effect when glutamate receptors are blocked in the CNS?
Sedation
38
What is the main inhibitory NT in the CNS?
GABA
39
Which enzymes are involved in converting mopped up GABA into glutamine in the glial cells? GABA --\> Glutamate --\> glutamine
* Gaba transaminase * Glutamine synthetase
40
What are the effects when GABA receptors are enhanced e.g. by lorazepam?
sedation
41
Where in the CNS does glycine act mostly?
* brainstem * spinal cord
42
Is glycine exitatory/inhibitory?
inhibitory
43
Where in the CNS is serotonin produced?
Raphe nuclei in the brainstem
44
Which receptor does the antiemetic ondansetron block?
5HT3
45
Where outside the CNS is there a vast storage of serotonin?
* enterochromaffin cells in the GIT * excess causes D&V
46
Where in the CNS is the vomit centre found?
Area postrema in the base of the 4th ventricle
47
Which NT acts upon the vomit centre?
Serotonin
48
Why do people tend to feel nauseous during chemo?
* enterochromaffin cells in the GIT are sensitive to the chemo and lyse which releases their contents --\> release of serotonin * increased serotonin picked up in the vomit centre in the area postrema in the base of the 4th ventricle
49
Where in the brain is ACh synthesised?
* basal forebrain * brainstem tegmentum
50
What is the main NT of the ANS?
ACh
51
Where is dopamine produced (apart from substantia nigra)?
Ventral tegmental area
52
Which is the main exitatory NT in the CNS?
glutamate
53
What is effect of blocking glutamate receptors?
sedation

JG Year 1 (27 decks)

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