affective disorders Flashcards
describe tyramine toxicity
uptake of tyramine into the Adrenergic neuron via vmat into the synaptic vesicle where it displaces norepinephrine causing reverse transport of norepinephrine out of the neuron.
tyramine is an indirect sympathomimetic=HTN crisis
What are some adverse effects SSRIs- fluoxetine/Prozac escitalopram/Lexapro?
GI distress
sexual dysfunction
serotonin syndrome
Locus coeruleus is a target for PTSD. What receptors?
Locus coeruleus is a target for PTSD. What receptors?
Prazosin-a1
Clonidine a2
Dexmedetomidine a2
Decrease noradrenergic neurotransmission.
all loose tigers are dangerous, send signal of fear renewal/adaptive to amygdala
prelimbic cortex/prefrontal cortex
herb, used for treating depression, downregulation of beta receptors in the brain, probably increases norepinephrine, upregulate CYP enzymes, may cause photo sensitivity and neurotoxicity
Saint Johns wort
can also interact with prescription antidepressants and other drugs
name two selective serotonin reuptake inhibitors
fluoxetine/Prozac
escitalopram/Lexapro
Name two tricyclic antidepressant
Amitriptyline/Elavil
Desipramine/norpramin
Adverse effects include-block sodium channels in the heart in the CNS which can lead to lethal conduction delays and seizures?
TCA
Amitriptyline/Elavil
Desipramine/norpramin
Define affective disorder.
profound emotions without the appropriate situational context.
major depressive order
anxiety slash panic disorder
post-traumatic stress disorder
First line treatment for major depression and anxiety, very selective, decrease side effects
ssri
fluoxetine/Prozac
escitalopram/Lexapro
why don’t you mix SSRI MAOI and triptan(5HT agonist)
Serotonin syndrome-dangerous elevations in serotonin levels or serotonin neurotransmission causes hyperthermia muscle rigidity myoclonus and rapid fluctuations in vital signs
Which MAO metabolizes dopamine?
MAO B for brain
Serotonin-norepinephrine reuptake inhibitor
Cymbalta/duloxetine
Used to treat patients that don’t respond to SSRI, also used to treat fibromyalgia, chronic neuropathic pain, and hot flashes
serotonin norepinephrine reuptake inhibitor
Cymbalta/duloxetine
Major depressive disorder is likely due to decreased_______ and__________ while PTSD is likely due to increased________ and _______ with decreased ________.
major depressive disorder is likely due to decreased dopamine and norepinephrine
PTSD is likely due to increased norepinephrine and glutamate with decreased serotonin
How would you manage a TCA overdose
5
Acls Volume resuscitation treat the seizure treat cardiac arrhythmias with lidocaine and some bicarb because TCAs are weak bases
Blocks endocannaboid reuptake
Tylenol
Selective irreversible Mao B inhibiter used to treat Parkinson?
Selegiline(eldepryl)
CB1 receptor agonist, adjunct analgesics for neuropathic pain, anti emetic, appetite stimulant
Dronabinol/Marinol
Nabilone/cesamet
MAO-A is responsible for the metabolism of what?
3
Tyramine, serotonin, norepinephrine
name an A typical antidepressant
bupropion/Wellbutrin
Selective MAO A inhibitor, reversible, hops on and off enzyme
Moclobemide (amira, auroix, clobemix)
How does Wellbutrin/ bupropion work?
Wellbutrin/ bupropion
atypical
increases dopamine and serotonin extracellular levels by blocking transport DAT/SERT which displaces neurotransmitter from the nerve terminal
Management of affective disorders. Increases NE, 5HT in neurons and vesicles. Increases tyramine concentration in blood, MAO-I –non selective, irreversible inhibitor
Phenlizine/nardil
Phenlizine/nardil, iproniazid/marsilid, iprazid, ipronid are _______ _______ _____ _____ associated with tyramine toxicity
MAO-I –non selective, irreversible inhibitors
an adverse effect of tyramine toxicity
Phenlizine/nardil
these two drugs’ Adverse effects include blocking muscarinic receptors, histamine receptors and adrenergic receptors.
What signs and symptoms would blocking those receptors lead to
TCA
Amitriptyline/Elavil
Desipramine/norpramin
Muscarinic-dry mouth, blurred vision, confusion, tachycardia, urinary retention,
Histamine-sedation and confusion
Andrenergic-orthostatic hypotension, reflects tachycardia dizziness,
How do monoamine oxidase inhibitors work as antidepressants?
Increase norepinephrine and serotonin via increased plasma tyramine
Block norepinephrine and serotonin reuptake can also be used to treat chronic neuropathic pain, migraine, fatigue syndrome, not selective for transporters
TCA
Amitriptyline/Elavil
Desipramine/norpramin
can be used to treat PTSD insomnia, nightmares, and reduce daytime flashbacks
Dronabinol/Marinol
Nabilone/cesamet
How do TCA, SSRI, SNRI treat chronic pain?
Increase norepinephrine and serotonin neurotransmission in the dorsal horn
caged tigers are not dangerous, sends signal to amygdala to suppress expression of fear in a no longer dangerous situation
infralimbic cortex/prefrontal cortex
