Anti-depressant Flashcards
1
Q
Name MAO-A Inhibitor
A
- moclobemide
- clorgyline
-> selective and reversible
(unlike irreversible MAO-B I selegiline)
2
Q
Interaction of MAO-A inhibitor
A
- cheese reaction
- react with many food and drugs which contain large quantities of tyramine
- (beer, yeast, cheese, pickled meat)
- tyramine acts as catecholamine in MAO inhibited patient
-> vasoconstriction and hypertension
*-> less likely to produce cheese reaction in selective and reversible
3
Q
Advantage of moclobemide
A
- lacks adverse effects of TCAs
-> alternative option in elderly patients and those with heart disease
4
Q
Adverse effects of moclobemide
A
- nausea/ dizziness/ headache/ insomnia
- caution while co-prescribing pethidine, SSRIs and TCAs
5
Q
Name tricyclic antidepressants
A
- Amitriptyline (-> Nortriptyline)
- Imipramine (-> Desipramine)
6
Q
TCA antidepressant MOA
A
- inhibit NET (norepinephrine transporter) and serotonin transporter (SERT) at neuronal and platelet membrane
7
Q
Name side effects of TCAs
A
- anti cholinergic: dry mouth, constipation, urinary retention
- sedation
- increased appetite and wg
8
Q
TCAs interaction
A
- potentiate sympathomimetics amines -> avoid adrenaline containing amine
- potentiate CNS depressants
- concurrent MAOI -> hypertensive crisis
9
Q
Name SSRIs (selective serotonin reuptake inhibitor)
A
- fluoxetine
- citalopram
- paroxetine
- sertraline
10
Q
SSRIs general interaction
A
- serotonin syndrome
-> when concurrent use with serotonergic drugs: MAOI, tramadol, pethidine
11
Q
Fluoxetine
A
- longest acting SSRIs
- approved for use in children 7 y/o or older for depression/ OCD
12
Q
Setraline
A
juvenile depression efficacy
13
Q
Name SNRIs (serotonin and noradrenaline reuptake inhibitor) and prominent side effects
A
- venlafaxine
- nausea/ sweating/ anxiety/ withdrawal syndrome
14
Q
Name four atypical antidepressants
A
- trazodone
- mianserin
- mirtazapine
- bupropion
15
Q
Trazodone
A
- major drug target: 5HT2A receptor (acts as antagonists) -> directly involve in mood control
- less effective 5HT reuptake blocker, prominent adrenergic bloker -> hypotension
- metabolite strong 5HT2 blocker
- less prone to arrhythmia
- prolonged and painful penile erection
16
Q
Mianserin
A
- block presynaptic a2 receptors -> increase release and turnover of NA -> antidepressant effect
- not inhibit uptake of 5HT/ NA
- overdose seizure
- blood dyscrasias
17
Q
Mirtazapine
A
- block a2 receptors -> enhance NA and 5 HT release
- NA further increase serotonergic raphe neurons firing via a1 receptors
- selective enhancement of antidepressive 5HT1 receptor -achieved by concurrent blockade of 5HT2 and 3 receptors
18
Q
Bupropion
A
- inhibit DA and NA uptake -> excitant effect
- metabolize into amphetamine-like compound -> presynaptic release of DA and NA
- contraindicated in eating disorder and bipolar
- infrequently use - except with atypical features
19
Q
Treatment for severely depressed
A
Electroconvulsive therapy
20
Q
Bipolar disorder drug treatment x3
A
- anti epileptic drug
- lithium
- atypical antipsychotics (olanzapine, aripriprazole)
=> mood stabilizer
21
Q
Lithium effect
A
- calming effect/ mood stabilizer -> treat acute mania
- prophylaxis of recurrent manic and depressive episodes
- anti suicidal effect
22
Q
Lithium MOA
A
- dopamine pathway - decrease dopamine transmission
- glutamate pathway
- downregulate NMDA receptor
- modulate associated myoinositol second messenger system -> long term change in neurotransmission and gene transcription
- GABA pathway
- increase level of GABA
- directly activate GABA receptor - Second messenger systems
- cAMP: increase AC, cAMP and CREB (cAMP response element binding protein)
- PI signalling
- suppress GSK-3 (glycogen synthase kinase -3)
-> transcriptional regulation
-> gene expression
-> mood stabilizer
23
Q
Lithium interactions
A
- diuretics: cause plasma Li+ level to rise
- NSAID, tetracycline, ACEI: lithium retention
- neurotoxicity with haloperidol, carbamazepine, chlorpromazine
24
Q
Lithium overdose
A
- muscle twitching
- coma
- drowsiness
