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Pharmacology > Anti-Depressants :) > Flashcards

Anti-Depressants :) Flashcards

1
Q 
SHARK = concept groupings, similaries etc
~ = bold in notes and high yield
* = other stuff i think is high yeild maybe
A

hurrah.

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2
Q

concept: Pathophys of depression ie NT involved

A 
DA
5Ht
NE
= happy making neuotransmitters
linked to a deficiency in ~signal transduction~
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3
Q

concept: Therefore, goal of antidepressants

A

increased SA, 5HT and NE to normal levels

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4
Q

concept: TCAs MOA

A

block monoamine reuptake - increases to normal levels

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5
Q

concept: MAO inhibitor MOA

A

prevent degradation of monoamines - increases to normal levels

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6
Q

concept: How long do a) pharmacological effects and b) clinical effects and c) beneficial effects of antidepressants take to kick in?

A

a) pharmaco - immediate
b) clinical - 2- 4 weeks
c) substantial benegit - 6-8 weeks
help patient through the transition

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7
Q

MAOi cause increase in which NT?

A

NE and 5HT

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8
Q

Name the MAOIs (SPIT + a/se dry mouth ;))

A 
S: seregliptine
P: phenylzine
I: isocarboxazid
T: tryanylcypromine
seregliptine, phenylzine, isocarboxazid, tryanylcypromine
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9
Q

~*~Two reasons MAOis suck and arent really used anymore

A

SEROTONIN SYNDROME

the CHEESE REACTION

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10
Q

~*~Describe Serotonin syndrome

A 
MAOi with anything that increases 5HT ie SSRI, SNRI, TCA, meperidine
* hyperthermia
* muscle rigidity
* myoclonus
apparently 5HT does those things
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11
Q

~*~Describe the Cheese reaction

A

Tyramine from food cant be broken down –> stimulates NE

  • tachycardia
  • hypertension
  • arrhytmias
  • seizure
  • maybe stroke
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12
Q

List the TCAs please (NACID/naked)

A 
N: nortryptiline
A: amytriptiline
C: clomipramine
I: imipramine
D: desipramine
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13
Q

List which ones are more 5HT-ergic and which ones are NE-ergic

triptylines and pramines

A

N: nortryptiline - more potent inhibitor of NET
A: amytriptiline - none
C: clomipramine - mroe potent inhibitor of SERT
I: imipramine - none
D: desipramine - more potentint inhibitor of NET

N-x-5-x-N @ NACID

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14
Q

What other receptors do TCAs affect and why do I care?

A

alpha adrenergic: orthostatic hypotension and reflex tachycardia

antimuscarinic: blurred vision, xerostomina, urinary retention, constipation and exacerbation of acute angle glaucoma
antihistamine: sedation and weight gain

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15
Q

~~~Whats your biggest concern fro someone on TCAs?

A

ARRHTYMIAS - largest cause of people passing away bc acts like class I antiarrhtymics by blocking FAST SODIUM CHANNELS

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16
Q

SHARK: how do you treat antiarrhtymias caused by TCA overdose

A

sodium bicarbonate

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17
Q

List the SSRI (SPEC-FF)

A 
S - sertraline
P - paroxetine
E - es-citaloprone
C - citalopram
F - fluoxetine
F - fluvoxamine
18
Q

~*~Why are SSRIs DOC for depression

A

no affects at histamine, muscarinic or alpha adrenoreceptors = way less side effects than TCAs

19
Q

What else can MAOis be used for

A

PMDD, bulimia, depression, OCD, GAD, PD, PTSD, SAD

20
Q

Which SSRIs inhibit what CYPs and who cares?

A

high potential for drug interactions
S - sertraline = low potential
P - paroxetine = HIGH potential via - of CYP2D6
E - es-citalopram = low potential
C - citalopram = low potential
F - fluoxetien = HIGH potential via - of CYP2D6
F - fluvosamine = HIGH potential via - of CYP1A2, CYP2C19, CYP3A4

21
Q

Other a/se of SSRI espeically when taking with MAOis

A

Serotonin Syndrome - hyperthermia, muscle rigidity, and myclonus

22
Q

List the SNRIs please

A

Venlafexine

Duloxetine

23
Q

Whats the difference between teh two SNRIs

A

Venlafexine - inhibits 5Ht and then Ne at higher doses + weak DA
Duloxetine - inhibits 5HT and NE at all doses

24
Q

**Why would you use a SNRI instead of an SSRI?

A

SNRIs inhibit P450 enzymes less

(SPEC FF: HIGH - paroxetine, fluoxetine, fluvoxamine and LOW - citalopram, es-citalopraim and sertraline

25
Q

Name a drug that lacks the sexual dysfunction of SSRI and SNRI that treats depression

A

Buproprion - NE and DA uptake inhibitor, and icnreases NE and DA release

26
Q

List the SARIs

A

NefaZODONE

traZODONE

27
Q

~A/se of Nefazodone

A

hepatotoxicity - so not relaly used

28
Q

MOA fo SARIs

A

strong inhibit 5HT2 receptors - no agitation and anxiery from stimulation in forebrain and no sexual dysfucntion from spc

weak inhibit SERT and NET

29
Q

What is the main use of trazodone?

A

inhibits SERT, NET, alpha1 and H1 receptors and inhibits 5HT2 receptors –> extremely sedating and excellent hypnotic = MAIN USE IS AS HYPNOTIC

30
Q

A/se of trazodone

A

priapism

31
Q

when i say SARI you think?

A

hepatoxocity with nefazodone

hypnotic priapsim with trazodone

32
Q

NASSA MOA

A

inhibit central alpha2
stimulate release of Ne and 5Ht
inhibit 5Ht2 and 5Ht3 – no sexual dysfunction, no anxiety, no agitation
inhibit H1 – sedation and weight loss

33
Q

Name of the NASSA please

A

Mirtazadine

34
Q

Atypical Antidepressants ?

A

quetiapine
aripiprazole
olanzapine - o-lanse-aux-epine

35
Q

Mainstay treatment for bipolar

A

Lithium

36
Q

MOA of Lithium

A

inhibits inositol poly/monophosphatase –> no inositol since cant cross BBB –> no IP3/DAG signalling –> prevention of manic episodes

also inhibits adrenergic, muscarinic and serotonergics

37
Q

~~What neurons will be affected by Lithium and why :)

A

only active neurons will be affected by Lithium bc it acts in an ‘‘uncompetitive’’ manner……

38
Q

Effects of Lithium on pregos?

A

cardiac problems in fetus

CATEGORY D!

39
Q

Alternative treatment for bipolar?

A

valproate and carbamazepine - anti epileptics
atypical antipsychotics: o-lanse-aux-pines, aripiprazole, quitiapine, risperidone, ziprasidone
antiepileptic - lamotrigine

40
Q

SHARK: list antidepressnats that dont cause sexual dysfunction

A

a) SARIs - nefazodone and trazodone - bc antag 5Ht liek NASSA
b) NDRI - buproprion; only affects Ne and DA
c) NASSA - mirtazadine bc antag 5HT2

Pharmacology (70 decks)

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