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Psychiatry Week 1 2018/19 > 5: Pharmacology of antidepressants and mood stabilisers > Flashcards

5: Pharmacology of antidepressants and mood stabilisers Flashcards

1
Q

Are antidepressants only given for depression?

A

No

eating disorders, anxiety, chronic pain as well

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2
Q

What is dysthymia?

A

Persistent low-grade depression

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3
Q

What are some examples of monoamine neurotransmitters?

A

Noradrenaline (excitatory)

Dopamine (excitatory)

5-HT / Serotonin (inhibitory)

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4
Q

What is 5-HT?

A

Serotonin

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5
Q

NA, 5-HT and dopamine are examples of ____ neurotransmitters.

A

monoamine

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6
Q

Serotonin is widely distributed in the brain.

What are its functions

a) superiorly
b) at the nucleus raphe magnus?

A

a) Mood, sleep, appetite, perception

b) Analgesia

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7
Q

What effects does NA produce in the brain specifically?

A

Arousal

Emotional response

fight or flight in the brain

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8
Q

Which part of the brain releases NA in response to signals from the periaqueductal grey?

What general effect does this cause?

A

Locus caeruleus

Analgesia

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9
Q

Which enzyme metabolises monoamine neurotransmitters to clear them out of the pre-synaptic terminal?

A

Monoamine oxidase

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10
Q

What happens if you inhibit monoamine oxidase?

A

Neurotransmitter isn’t cleared up

It sticks around in the synapse for longer

Increased excitation

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11
Q

What are two examples of monoamine oxidase inhibitors?

A

Phenelzine (irreversible)

Moclobemide (reversible)

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12
Q

Which monoamine oxidase inhibitor is

a) reversible
b) irreversible?

A

a) Moclobemide

b) Phenelzine

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13
Q

What is a major side effect, involving diet, of monoamine oxidase inhibitors?

A

If you eat products containing lots of tyramine e.g cheese, gravy you’ll have a hypertensive crisis

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14
Q

Why aren’t monoamine oxidase inhibitors e.g phenelzine, moclobemide widely used?

A

Side effects

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15
Q

What are some side effects of monoamine oxidase inhibitors?

A

Hypertensive crisis w/ high tyramine diet

Postural hypotension

Peripheral oedema

Insomnia

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16
Q

How do tricyclic antidepressants work?

A

Block re-uptake of monoamine neurotransmitter into pre-synaptic terminal

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17
Q

What are some examples of tricyclic antidepressants?

A

Imipramine

Dosulepin

Amitriptyline

Lofepramine

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18
Q

What are some side effects of TCAs?

A

Anticholinergic effects - reduce smooth muscle activity; blurred vision (can’t accomodate), dry mouth, constipation, urinary retention

Cardiovascular problems - tachycardia, postural hypotension, (fatal) arrhythmia

Sedation

Weight gain

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19
Q

What are some anticholinergic effects of TCAs?

A

Dry mouth and eyes

Blurred vision (failure of accommodation)

Constipation

Urine retention

20
Q

What are some cardiovascular side effects of TCAs?

A

Postural hypotension

Tachycardia

Arrhythmia (fatal in overdose)

bad for the heart in general

21
Q

What can patients suffer if they overdose on TCAs?

A

Fatal arrhythmias

22
Q

How do SSRIs work?

A

Same action as TCAs, prevent reuptake of monoamine neurotransmitter into pre-synaptic terminal

but act selectively on 5-HT

23
Q

SSRIs act selectively on ___.

A

5-HT (serotonin)

24
Q

What are some examples of selective serotonin reuptake inhibitors?

A

Fluoxetine

Citalopram

Sertraline

25
Q

What are some side effects of SSRIs?

A

N&V (opposite: anti-emetics which INHIBIT a type of 5-HT)

Headache (opposite: triptans which INHIBIT a type of 5-HT)

Sweating

Sexual dysfunction

26
Q

The nausea and headache typically caused by SSRIs is ___.

A

transient

meaning it goes away after a while

27
Q

Which symptoms are

a) 5-HT1
b) 5-HT3

receptors responsible for?

A

a) Headache (antagonists are the -triptans, for migraine)

b) Nausea (antagonists are -setrons, or anti-emetics)

28
Q

SSRIs may initially ___ the symptoms of anxiety or depression.

A

worsen

especially in young people

29
Q

In young people, what do SSRIs increase the risk of?

A

Thoughts of self-harm / suicide

30
Q

Why shouldn’t SSRIs be given to patients under 25?

A

Increase in thoughts of self-harm / suicidal ideation

31
Q

SSRIs can cause a degree of ___ dysfunction.

A

sexual dysfunction

32
Q

Which class of antidepressant has a similar mode of action to SSRIs but less side effects?

A

SNRIs

duloxetine

blocks uptake of NA AND 5-HT

33
Q

Which antidepressant can be added alongside an SSRI to block its nausea and headache side effects?

A

Mirtazapine

look at receptors to see why

34
Q

In the treatment of depression, you don’t combine drugs because you get more side effects without more benefit.

What is the one exception to this?

A

Addition of mirtazapine to SNRI (duloxetine) therapy to reduce side effects

35
Q

What is the onset of action of antidepressants?

A

2 - 6 weeks

36
Q

What should you ask about in the drug history of someone with a mood disorder?

A

Drugs they’ve been on previously

They may help again

37
Q

The more severe a patient’s depression is, the (more / less) effective antidepressants tend to be.

A

more severe > more effective

38
Q

Which mood stabiliser is the gold standard treatment for bipolar disorder?

A

Lithium

39
Q

Lithium has a narrow ___ ___.

A

narrow therapeutic index

effective dose is v close to toxic dose

40
Q

Lithium has a lot of ___ side effects.

A

renal

41
Q

Lithium may cause renal impairment when given with which class of drug?

A

NSAIDs

42
Q

Which mood stabiliser is toxic when given in high doses?

A

Lithium

43
Q

Which class of antidepressant can cause fatal arrhythmias when an overdose occurs?

A

TCAs

imipramine, amitriptyline, dosulepin

44
Q

Which drugs, used in epilepsy, can also be given to stabilise mood in bipolar disorder?

A

Anticonvulsants

sodium valproate

lamotrigine

carbamazepine

remember sodium valproate is teratogenic and carbamazepine makes myoclonic epilepsy worse

45
Q

Which class of antidepressant drug can cause a fatal hypertensive crisis when the patient eats mature cheese?

Why?

A

Monoamine oxidase inhibitor (phenelzine, moclobemide)

Tyramine is a substrate of monoamine oxidase, accumulation causes noradrenaline release - BP skyrockets > pulmonary oedema, palpitations, subarachnoid haemorrhage

Psychiatry Week 1 2018/19 (9 decks)

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