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Pharm3 > Affective Disorder Drugs > Flashcards

Affective Disorder Drugs Flashcards

1
Q

Neurotropic hypothesis for depression

A

-BDNF is critical for regulation of neuroplasticity.
-Depression is associated with loss of neurotrophic support.
- antidepressants increase neurogenesis/connectivity

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2
Q

Monoamine hypothesis for depression

A

-Depression is related to deficiency in 5-HT, NE, and DA
-antidepressants increase these immediately.
-antidepressive effects delayed for weeks.

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3
Q

Integrated hypothesis of depression

A

Glutamine and monoamines stimulate BDNF production.
-increased cortisol to hippocampus and HPA Steroid abnormalities inhibit BDNF production.
-Monoamines inhibit effect of HPA steroid abnormalities.

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4
Q

hypothesis behind therapeutic lag

A

BDNF protein synthesis products takes 2 weeks or longer.
- some is pharmacokinetic in nature
-delayed postsynaptic changes

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5
Q

General function of the 6 classes of antidepressants

A

Increase noradrenergic or serotonergic neurotransmission.

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6
Q

SSRI Blackbox warning:

A

Association between antidepressant treatment and suicide. (motivation related)

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7
Q

Effects of SSRI/SNRI discontinuation syndrome, and how to avoid

A

significant withdrawal symptoms: Sleep disruption, GI, Affective symptoms, sexual sensitivity, confusion(cognitive), sensory, somatic, disequilibrium.
- avoid by tapering off dose.

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8
Q

Describe Serotonin Syndrome and Tx

A

Caused by anything that increases serotonin.
-Increased 5HT receptor activation
-increased NE release
-Thermogen, Tremor, Rigidity, increased BP, Increased HR

Tx: Mild- observe for 6hrs, benzodiazepines

Moderate- Hospitalize, Cardiac monitoring, Cyproheptadine

Life Threatening- Intensive Care, Esmolol, nitroprusside, cooling measures, ventilator.

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9
Q

Describe Steven Johnson Syndrome and Tx

A

Blisters, mucosal/epidermal detachment from full-thickness epidermal necrosis in absence of dermal inflammation. <10% surface area.
more is called SJS/TEN

Need early diagnosis and discontinuation of drug (i.e. TCAs). Need intensive supportive care.

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10
Q

Describe MAOIs and TCAs affect on adrenergic/dopaminergic signaling, and the side effects expected

A

TCA: alpha blocking effects, orthostatic hypotension, anticholinergic symptoms(dry mouth)

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11
Q

MAOIs food restrictions

A

Hypertensive Crisis with: tyromine containing foods:
Aged cheese/meat, banana peel, bean pods, marmite, sauerkraut, soy sause, draft beer.
Moderation of: wine, bottled/canned beer no more than two 12-oz

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12
Q

Why caution antidepressants in pt with bipolar disorder

A

induce switch to manic/hypomanic episode if monotherapy

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13
Q

SSRI Uses

A

Firstline Major depression and generalized anxiety.
Also for Panic disorder, PTSD, OCD, Social Anxiety, but all combined with behavioral therapy.

Fluoxetine and Sertraline for PMDD

Fluoxetine for Bulimia
(EFSPC)

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14
Q

SSRI Drugs Names

A

Effective For Sadness, Panic, Compulsions:
Escitalopram
Fluoxetine, Fluvoxamine
Sertraline
Paroxetine
Citalopram

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15
Q

SSRIs MOA etc.

A

MOA: Highly selective blockade of serotonin transporter (SERT)

AE: Sex dys
serotonin syndrome risk with MAOIs
GI (postpone procedures until tolerance)

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16
Q

Fluoxetine risk

A

prolongs duration of action of certain benzodiazepines leading to prolonged sedation

17
Q

SNRI Drugs

A

Venlafaxine
Duloxetine
(vexed and depressed)

18
Q

SNRI Uses

A

Major Depression and chronic pain disorders.
fibromyalgia, perimenopausal symptoms

Chronic joint and muscle pain, postherpetic neuralgia, chronic back pain

19
Q

SNRI MOA etc.

A

MOA: Moderately selective blockade of SERT and NET
-Also adrenergic synaptic activity

AE: Anticholinergic, sedation, hypertension (venlafaxine)

Interactions: vasoconstrictors or tramadol may increase CV side effects.

20
Q

5HT receptor modulator

A

Trazadone’s primary metabolite is a 5HT receptor antagonist.
Black box: hepatotox

AE: Modest alpha blockade (orthostatic hypotension)
and H1 blockade (sedation, weight gain, hypnosis)

Addon to SSRIs, for Major depression
(inferior to SSRI/SNRIs)

TRAZADONE for INSOMNIA (off-label)

21
Q

TCA Drugs

A

Amitriptyline
Nortryptyline
(tryptylines)

22
Q

TCA Uses

A

depression that is unresponsive to common commonly used antidepressants
(NOT commonly prescribed currently)
Overdose is lethal ( a weeks worth of doses at once)

-chronic pain

23
Q

TCA MOA, etc.

A

MOA: Mixed and variable blockade of NET and SERT

AE: Significant blockade of autonomic Alpha receptors (anticholinergic) and Histamine receptors (Sedation, weight gain)
arrythmias

  • worse withdrawals than SSRI/SNRIs
    -cholinergic rebound
24
Q

Tetracyclics, Unicyclics

A

Tetracyclic: Mirtazapine
Unicyclic: Bupropion

25
Q

Tetracyclics, Unicyclics Uses

A

Major Depression

Mirtazapine: Sedation

Bupropion: Smoking Cessation (as effective as nic patch)

26
Q

Tetracyclics, Unicyclics MOA etc.

A

Mirtazapine:
MOA: Increase release of NE and 5HT
AE: sedation, weight gain (H1 block)

Bupropion: Increase NE and DA
AE: Lowers seizure threshold.
-!!! Stevens-Johnson syndrome !!! (stop immediately)
-OD causes hypertension, tachycardia, arrhythmia, death

27
Q

MAOI Drugs

A

Phenelzine
Selegiline

Rarely used b/c tox and lethal food/drug interactions

28
Q

MAOI MOA etc.

A

Phenelzine:
MOA: irreversibly and nonselectively binds MAO-A and B

Selegiline:
MOA: MAO-B selective irreversible inhibition.
(low dose)

AE: Hypotension, insomnia, very slow elimination,
-Serotonin Syndrome!!! deadly. Libby Zion Laws

29
Q

MAOI Uses

A

Major depression unresponsive to other drugs.

Selegiline: parkinsons

30
Q

Esketamine

A

Tx resistant unipolar Antidepressant, S enantiomer. Inhibits NMDA receptors. Short term Tx of suicidal ideation.
AE: Long term use addiction, neuro, hepato, bladder toxicity

31
Q

Zuranolone

A

Post partum depression. (PPD caused by neuroactive steroid allopregenenolone).

GABA-A receptor positive modulator
AE: drowziness dizzy, fatigue, diarrhea, NO DRIVING, no hazardous activities

Pharm3 (7 decks)

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