23.5 Pharm: Antidepressants Flashcards
What are some 1st gen antidepressants?
Tricyclic antidepressants, MAO inhibitors
What are some 2nd generation antidepressants?
SSRIs, SSNRIs
What are the 3rd gen antidepressant drugs?
‘Atypical’- novel monoaminergic, non-monoaminergic
How do tricyclics work?
Inhibit NA/5HT reuptake
Antagonists for His/Musc/a-adreno/5HT R’s
What can tricyclics do at high concentrations?
Block Na+ channels (membrane stabilising/anaesthetic, Quinidine like effects)
What drug are tricyclics structurally similar to?
Schozophrenia drugs
What are the pharmacokinetics of tricyclics?
Narrow therapeutic window, long half life
What are some side effects of tricyclics?
Sedation, anti-cholinergic, postural hypotension, weight gain
How do MAO inhibitors work?
Increase NA/5HT/DA
What reaction can occur with irreversible MAO inhibitors?
‘Cheese reaction’
Tyramine isn’t broken down (gut wall MAO usually does this)-in cheese/choc/wine/bananas
Tyramine releases NA (sympathomimetic effects)
What is a reversible MAO inhibitor selective for? What does this help with?
MAO A selective, less ‘cheese reaction’
How do SSRIs work?
What are some names?
Selective for serotonin
Fluoxetine, paroxetine, sertraline
What are the pharmacokinetics of SSRIs like?
Minimal toxicity alone, high therapeutic window
What are some side effects of SSRIs?
Nausea, decreased libido, weight change
Young people: increased anxiety and suicidal ideation
Why was an SSNRI developed?
For maintaining the serotonin:noradrenaline balance.
What are some atypical antidepressants? What has this shown us about treating depression?
Monoaminergic mechanisms, we’re moving towards targeting the receptors (not just focusing on NTM levels)
Also non-monoaminertic (e.g. opioids, supporting cell targets, herbal-St John’s Wort)
What drug is used in bipolar depression?
Lithium carbonate
How does lithium carbonate work?
Intracellularly, 2nd messenger calcium regulation
What are side effects of lithium carbonate?
What are the pharmacokinetics?
Nausea, renal/thyroid/neurological problems
Low therapeutic index so need to monitor plasma
