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Pharm extra > anti-depressants > Flashcards

anti-depressants Flashcards

1
Q

what can psychoses be classified into

A

Schizophrenia

OR

Affective disorders

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2
Q

further divide affective disorders into different classes

A

Mania

Depression

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3
Q

what can the symptoms of depression be split into

A

Emotional
(Psycho-
logical)

Biological
(Somatic)

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4
Q

what are the emotional symptoms of depression

A

Misery, apathy, pessimism

Low self-esteem

Loss of motivation

Anhedonia

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5
Q

what are the biological symptoms of depression

A

Slowing of thought & action

Loss of libido

Loss of appetite, sleep disturbance

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6
Q

describe onset and key characteristic of unipolar depression

A

Mood swings in same direction

Relatively late onset

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7
Q

state some causes of unipolar depression

A

Reactive depression

endogenous depression

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8
Q

what can cause reactive depression

A

stressful life events

non-familial

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9
Q

what can cause endogenous depression

A

unrelated to external
stresses

familial pattern

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10
Q

Describe key feature and onset of bipolar depression

A

Oscillating depression/mania

Less common; Early adult onset

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11
Q

what increases likelihood of bipolar depression

A

Strong hereditary tendency

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12
Q

how is bipolar depression treated

A

lithium carbonate – decrease cAMP

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13
Q

what is the 1 theory of depression and mania

A

Monoamine theory of depression

Depression = functional deficit of central MA transmission (NA & 5-HT)

Mania = functional excess

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14
Q

what are strengths and weaknesses of this theory

A

Supportive Evidence:
Strong pharmacological
evidence

Inconsistency:

Delayed onset of clinical effect of drugs

Adaptive changes → down regulation of α2, β, 5HT receptors

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15
Q

what is the pharmacological evidence of this theory

look at table from lecture

A

drugs which increase NA and 5-HT levels increase mood

drugs which decrease NA/ 5-HT levels decrease mood

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16
Q

give an example of a TCA

A

Amitriptyline

17
Q

what is the MOA of TCAs

A

Neuronal monoamine re-uptake inhibitors

Bind to NA & 5HT
carriers to slow
down reuptake

18
Q

describe the pharmacokinetics of TCAs

A

Rapid oral

T1/2 (10-20hrs)

Highly PPB

Hepatic Met – active
metabolites

19
Q

describe the unwanted effects of TCAs

A

Atropine like

Postural hypotension

Sedation (blocks H1)

Acute toxicity :
CNS
(excitement, resp depression)

CVS (v fib) (sudden death)

20
Q

drug interactions of TCAs

A

PPB: increase TCA effects (aspirin, phenytoin)

Hepatic microsomal enzymes: increase TCA effects (neuroleptics; oral contraceptives)

Potentiation of CNS depressants (alcohol)

Antihypertensive drugs (monitor closely)

21
Q

what are 3 commonly used antidepressants

A

TCAs

selective serotonin reuptake inhibitors

Monamine oxidase inhibitors

22
Q

name a MAOIs

A

Phenelzine

23
Q

what is the MOA of MAOIs

A

inhibits:
MAO-A : NA & 5-HT
MAO-B : DA

non selective and irreversible

24
Q

Delayed effects : clinical response of MAOIs

A

down-regulation of β-adrenoceptors & 5-HT2 receptors

25
Q

Pharmacokinetics of MAOIs

A

Rapid oral

Short T1/2

Metabolised in liver, excrete
in urine

26
Q

unwanted effects of MAOIs

A

Atropine like, postural
hypotension, weight gain,
sedation, hepatotoxicity.

Avoid if liver problems.

27
Q

MAOIs drug reactions

A

MAOIs + Tyramine containing foods → hypertensive crisis

MAOIs + TCAs → hypertensive crisis could = intracranial haemorrhage

MAOIs + pethidine→ hyperpyrexia, restlessness, coma

28
Q

what is the clinical significan of moclobomide

A

reversible MAO-A inhibitor (RIMA).

↓ Drug interactions ↓ doa.

29
Q

give an example of a SSRI

A

Fluoxetine

30
Q

MOA of SSRIs

A

Selective 5-HT re-uptake inhibition

31
Q

pharmacokinetics of SSRIs

A

Oral

T1/2 = 18-24hrs

Delayed onset action
(2-4wks)

Avoid coadmin with TCAs (hepatic enzyme competition)

32
Q

grade the effects of SSRIs compared to other antidepressants

A

less effective in severe depression

33
Q

unwanted effects of SSRIs

A

Less than TCAs/MAOIs

Nausea, diarrhoea, insomnia
1/10). Loss libido (1/3

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