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PHARMACOLOGY > 15-Drugs for Mood Disorders > Flashcards

15-Drugs for Mood Disorders Flashcards

1
Q

3 major classes of neurotransmitters and an example of each.

A
  1. small molecule neurotransmitters (dopamine)
  2. neuropeptides (substance P)
  3. neurotransmitter gases (nitric oxide)
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2
Q

Three classes of small molecule neurotransmitters.

A
  1. acetylcholine
  2. monamines
  3. amino acids
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3
Q

Which neurotransmitter is connected with Alzheimer’s Disease?

A

acetylcholine

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4
Q

Which neurotransmitter is connected with schizophrenia and parkinson’s disease?

A

Dopamine

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5
Q

Which neurotransmitters are connected with depression and bipolar disorder?

A

Norepinephrine (NE), Epinephrine (E), Serotonin (5-HT)

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6
Q

Which neurotransmitters are amino acids?

A

Glutamate and GABA

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7
Q

Which neurotransmitters are monoamines?

A

Dopamine, Norepinephrine, Epinephrine, Serotonin

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8
Q

Which neurotransmitter is the messenger of the noradrenergic system?

A

Norepinephrine

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9
Q

Noradrenergic system:

  1. neuronal placement
  2. receptors
  3. role
  4. metabolism
A
  1. neurons originating from the locus ceruleus project to limbic system & cerebral cortex
  2. Alpha and Beta Adrenergic receptors
  3. Maintains emotional tone (mood, arousal, wakefulness & reward)
  4. Metabolized by MAO (monoamine oxidase)
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10
Q

Why is depression a side/adverse effect of adrenergic drugs?

A

Because adrenergic drugs can cross the blood-brain barrier (depending on solubility) and implicate mood.

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11
Q

Which neurotransmitter is the messenger of the serotonergic system?

A

Serotonin

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12
Q

Serotonergic system:

  1. neuronal placement
  2. receptors
  3. role
  4. metabolism
A
  1. neurons originate in raphe nuclei and project to the limbic system and cerebral cortex (co-localized with NE system)
  2. Many receptor classes: 5-HT1 to 5-HT7 with subtypes for each
  3. maintains sleep-wake cycle, emotion tone & sensory perceptions (e.g. pain); lack of adequate serotonin in the CNS can lead to depression
  4. metabolized by MAO (monoamine oxidase)
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13
Q

Why do people with depression experience more physical pain? Why are antidepressants prescribed for the purpose of treating pain?

A

Serotonin has inhibitory effect of substance - P.

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14
Q

Major depressive disorder symptoms

A

lack of energy; sleep disturbances; abnormal eating patterns; feelings of despair, guilt or hopelessness

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15
Q

What is the most common mental health disorder of older adults?

A

Major Depressive Disorder

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16
Q

Mood disorder: definition

A

Persistent disturbance in mood that impairs a person’s ability to effectively deal with normal activities of daily living

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17
Q

MDD (major depressive disorder) diagnostic criteria

A

5 or more of the following symptoms present & documented during the same 2 week period nearly every day.

At least one of:
- depressed mood most of the day; or
markedly diminished interest or pleasure in all or almost all activities (anhedonia)

Other symptoms:

  • significant weight loss when not dieting or weight gain
  • insomnia or hyperinsomnia
  • psychomotor agitation or retardation
  • fatigue or loss of energy
  • feelings of worthlessness or excessive or inappropriate guilt
  • diminished ability to think or concentrate, or indecisiveness
  • recurrent thoughts of death, recurrent suicidal ideation

AND
- the episode is NOT attributable to the physiological effects of a substance/drug or to another medical condition (e.g. oral contraceptives, vit B deficiency)

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18
Q

4 different depressive disorders and their cause.

A
  1. Major Depressive Disorder: biological cause, family history
  2. Situational depression: short-lasting; often reactive as a result of circumstances
  3. post-partum depression: presents 2 weeks to 6 months after childbirth
  4. seasonal affective disorder: associated with dark winter months & lower levels of natural light
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19
Q

For what disorders are antidepressants used to enhance mood?

A

phobias; OCD; panic attacks; generalized anxiety; PTSD

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20
Q

Other than mood enhancement, what are antidepressant drugs prescribed for?

A

Psychological and physical effects of pain (e.g. mood problems associated with debilitating chronic pain conditions such as fibromyalgia) and childhood enuresis.

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21
Q

What is important to monitor for in the pediatric (under 25) population with antidepressant drugs.

A

Suicidal ideation (especially SSRIs)

22
Q

Four drug classes of antidepressant drugs.

A
  1. selective serotonin reuptake inhibitors (SSRIs)
  2. atypical antidepressants (including SNRIs)
  3. tricyclic antidepressants (TCAs)
  4. Monoamine oxidase inhibitors (MAOIs)
23
Q

Monoamine Oxidase Inhibitors (MAOIs):

  1. mechanism of action
  2. effect
  3. side effects
  4. interactions
A
  1. inhibits MAO
  2. increased NE, serotonin and dopamine
  3. orthostatic hypotension (hypertensive crisis with tyranine); headache; insomnia; diarrhea
  4. Tyrosine; many over-the-counter and prescription drugs
24
Q

Tricyclic Antidepressants:

  1. mechanism of action
  2. effect
  3. side effects
  4. interactions
A
  1. inhibit NE, serotonin and dopamine reuptake
  2. increased NE, serotonin and dopamine
  3. anticholinergic effects; sweating; sedation; orthostatic hypotension
  4. MAO inhibitors
25
Q

Selective Serotonin Reuptake Inhibitors (SSRIs):

  1. mechanism of action
  2. effect
  3. side effects
  4. interactions
A
  1. inhibits serotonin reuptake
  2. increased serotonin
  3. nervousness; insomnia; sexual dysfunction; weight gain; nausea, headache; restlessness; sleep disturbances; suicidal ideation in pediatric pop.
  4. MAOIs; warfarin
26
Q

NE and Dopamine reuptake inhibitors:

  1. mechanism of action
  2. effect
  3. side effects
  4. interactions
A
  1. inhibits NE and dopamine reuptake
  2. increased NE and dopamine
  3. increased appetite
  4. MAOIs
27
Q

Serotonin and NE reuptake inhibitors (SNRIs):

  1. mechanism of action
  2. effect
  3. side effects
  4. interactions
A
  1. inhibit serotonin and NE reuptake
  2. increased serotonin and NE
  3. nausea; headache; nervousness; hypotension
  4. MAOIs
28
Q

What are classified as typical antidepressants? What are classified as Atypical antidepressants?

A

Typical - MAOIs, TCAs, SSRIs

Atypical - NDRIs, SNRIs

29
Q

What happens to the sensitivity of the pre and post synaptic neurons with SSRIs?

A

Inhibition of serotonin reuptake into the presynaptic neuron. Presynaptic 5HT receptors become less sensitive, postsynaptic receptors become more sensitive.

30
Q

What is the preferred drug class of antidepressants and why?

A

SSRIs - reduced side effect profile; exert a therapeutic effect more quickly than TCAs

31
Q

Why do SSRIs have an improved side-effect profile?

A

They have no affinity for histamine, alpha adrenergic or muscarinic receptors.

32
Q

Serotonin Syndrome (SES):

  1. What is it
  2. Symptoms
  3. Cause
  4. Treatment
A
  1. extreme increase in serotonin levels
  2. mental status changes (confusion, anxiety, restlessness); hypertension; tremors; sweating; hyperpyrexia; ataxia
  3. co-administration of drugs that increase serotonin. SSRIs + MAOIs, TCAs, Lithium, St. John’s Wart, Fentanyl, Meperidine. MDMA (ecstasy)
  4. SSRIs should be discontinued and supportive care implemented. In severe cases mechanical ventilation and muscle relaxants may be necessary
33
Q

SNRIs:

  1. Why might they be preferred to other antidepressants?
  2. What else are they effective in managing?
  3. what do they increase the risk of?
A
  1. they may cause symptoms to improve earlier than other drugs
  2. management of neuropathic pain characteristic of fibromyalgia and diabetic neuropathy (Duloxetine)
  3. may increase the risk of post-partum hemorrhage
34
Q

NDRIs:

  1. why might they be preferred over SSRIs?
  2. what else are they prescribed for?
  3. Contraindications.
A
  1. less likely to induce sexual dysfunction, weight gain or insomnia
  2. smoking cessation (Zyban - same as Wellbutrin)
  3. seizure disorders
35
Q

What other receptors do TCAs have an affinity for? What side effects result from this?

A

Histaminergic, muscarinic and Alpha 1 receptors.

Sedation, blurred vision, dry mouth, urinary retention, constipation, tachycardia, orthostatic hypotension.

36
Q

How are adverse effects of TCAs minimized?

A

By slowly increasing the dose over 2-3 weeks.

37
Q

What is the albumin binding of TCAs?

A

90%

38
Q

When are TCAs used?

A

They are used to treat depression in refractory cases (when no other medications are working) as well as neuropathic pain and childhood enuresis.

39
Q

What is the role of MAO?

A

Deaminates dopamine, norepinephrine and serotonin.

40
Q

Why are elevated levels of tyramine associated with hypertensive crisis?

A

If tyramine isn’t metabolized it becomes NE which causes vasoconstriction.

41
Q

Other than elevated tyramine, what is hypertensive crisis associated with?

A

Serotonin Syndrome

42
Q

Why should you be cautious in prescribing MAOIs to diabetics.

A

They potentiate the hypoglycemic effects of insulin & antidiabetic drugs.

43
Q

When are MAOIs prescribed?

A

As a last resort.

44
Q

Bipolar Disorder: definition and symptoms

A

Definition: alternating periods of depression and mania

Depressive Symptoms: same as MDD

Mania: symptoms >1 week

  • grandiose ideas; inflated self esteem
  • reduced need for sleep
  • increased talkativeness or pressure to keep talking
  • racing thoughts
  • distractibility or agitation
  • increased goal directed activity or psychomotor agitation
  • excessive involvement in pleasurable activities that have high potential for painful consequences
45
Q

Lithium:

  1. Use
  2. Mechanism of action
  3. co-administration
  4. Drug interactions
A
  1. effective for the treatment of mania and reducing the frequency and magnitude of mood changes
  2. inhibits the synthesis of PIP, decreasing the generation of IP3 and DAG
  3. antidepressants and benzodiazepines are often co-administered to improve outcomes
  4. Narrow therapeutic index - some drugs (indomethacin) decrease renal clearance and increase lithium levels
46
Q

What is the monitoring practice for a client on lithium?

A
  1. serum levels must be monitored for 5 days post any change in regimen
  2. 12 hours serum levels every 3 months
  3. creatinine, urinalysis every 3-6 months
47
Q

Why do you take lithium at bedtime?

A

To protect the kidneys from nephrogenic diabetes insipidus

48
Q

Why is it important to monitor lithium levels?

A

It has a narrow therapeutic index and is hard on the kidneys.

49
Q

What are symptoms of lithium toxicity?

A

muscle weakness; lack of coordination; vomiting; diarrhea; tremor; twitching; lethargy; mental confusion; polyuria

50
Q

Other than lithium, what other drugs are used to manage mania?

A

Antiseizure drugs and Atypical Neuroleptic drugs

51
Q

What are the adverse effects of antiseizure drugs?

A

dizziness, drowsiness, headache, nausea, blurred vision, sedation

52
Q

For what condition would atypical neuroleptic drugs be prescribed for (other than mania in Bipolar)?

A

Schizophrenia

PHARMACOLOGY (27 decks)

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