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Medical Studies 2A > 6.3 Pharmacology > Flashcards

6.3 Pharmacology Flashcards

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USMLE® Step 1 flashcards
1
Q

Outline the pharmacological mechanism of antidepressants

A
  • Exact mechanism not well understood
  • Operates off monoamine theory of depression, so we aim to increase them
  • BUT: actual effect takes 2-4 weeks, so there are obviously some other things at play…
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2
Q

What happens to adrenergic and serotonergic receptors in response to SNRI/SSRI use? How does this effect efficacy?

A

Density increases. Increases efficacy, since more serotonergic/noradrenergic transmission can occur.

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3
Q

Give some examples of SSRIs

A
  • Citalopram
  • Escitalopram
  • Sertraline
  • Fluoxetine
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4
Q

Give some examples of SNRIs

A
  • Duloxetine
  • Venlafaxine
  • Desvenlafaxine
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5
Q

What are some contraindications for SSRIs/SNRIs?

A
  • May precipitate mania in bipolar patients
  • These drugs lower sodium; contraindicated for those with hyponatremia

(SS = Sodium Sucking)

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6
Q

What do we communicate to patients when prescribing SNRIs/SSRIs?

A
  • Take a few weeks to become effective
  • May experience other symptoms (better/worse), incl. adverse effects
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7
Q

What are some adverse effects of SSRIs?

A
  • GI (nausea, diarrhoea, anorexia); get better with time
  • Headaches
  • Agitation, insomnia, tremor
  • Sexual dysfunction (long term)
  • Bleeding risk
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8
Q

SNRI adverse effects

A
  • Same as SSRIs (sexual dysfunction, GI, agitation, insomnia, bleeding risk, headaches)
  • Plus: palpitations, hypertension, orthostatic hypertension
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9
Q

Mechanism of tricyclic antidepressants

A
  • Inhibit serotonin and noradrenaline reuptake
  • BUT: also antagonise histamine receptors (sedation, weight gain), alpha adrenergic receptors (orthostatic hypotension), and muscarinic (anticholinergic effects)
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10
Q

What are the effects of tricyclic antidepressants on the heart?

A
  • QT prolongation (depolarisation-repolarisation)
  • Other effects on cardiac function
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11
Q

Effect of tricyclic antidepressants on seizure threshold

A

Decrease

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12
Q

Give some examples of tricyclic antidepressants

A
  • Amitryptyline
  • Dosulepin
  • Doxepin
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13
Q

Tricyclic antidepressants contraindications

A
  • Overdose risk
  • Can precipitate manic episode
  • Heart failure/LBBB
  • Elderly
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14
Q

Adverse effects tricyclic antidepressants

A
  • Sedation
  • Cardiac effects
  • Postural hypotension
  • Muscarinic effects
  • Anticholinergic effects

Depends on patient before you.

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15
Q

Mirtazapine mechanism

A
  • Blocks post-synaptic serotonin 2 and 3 receptors
  • Also acts on H1 receptors (which can help with sleep -> insomnia)
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16
Q

Contraindications for mirtazapine

A
  • Bipolar disorder
  • Serotonin-elevating drugs (serotonin syndrome)
17
Q

Adverse effects of mirtazapine

A
  • Sedation
  • Increased appetite
18
Q

What are some considerations when deprescribing antidepressants?

A
  • Address underlying symptoms
  • Watch for withdrawal effects
19
Q

What are some SSRI withdrawal effects?

A

Dizziness, nausea, paraesthesia, anxiety, agitation, tremor, sweating

(Some of which are similar to initial causes…)

20
Q

A patient has an inability to produce GABA. Should we give Alprazolam (AKA Xanax) for depression?

A
  • No, you fool.
  • They have no GABA; allosteric increase of GABA receptors is meaningless
21
Q

Describe the mechanism of action of Benzos

A
  • Allosterically bind to GABA receptors
  • Increase GABAergic activity
  • Hyperpolarises neurons, leading to widespread CNS depression
22
Q

Give some examples of benzodiazepines

A
  • Diazepam
  • Oxazepam
  • Nitrazepam

(-pam, -lam, -zam = probably benzo)

23
Q

Benzodiazepine contraindications

A
  • Existing CNS depression
  • Liver failure
  • Respiratory depression
  • History of dependence
24
Q

What do we communicate to patients when prescribing benzodiazepines?

A
  • CNS sedation
  • Effect on vision and driving
  • Dependence/tolerance
  • Anterograde amnesia (cannot form new memories)
25
Q

Should you write a 6 month benzodiazepine script upon first encounter.

A
  • No
  • Not under any circumstances
  • Absolutely not
26
Q

Why do we want to deprescribe benzos ASAP?

A
  • Fall risk
  • Cognitive impairment
  • Risk of withdrawal (seizures etc.)
27
Q

How do we deprescribe benzodiazepines?

A

Need to provide treatment for underlying reason. (e.g. insomnia = sleep hygiene, anxiety = perhaps a psychologist or other coping strategies)

Medical Studies 2A (110 decks)

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