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Pharmacology > Antidepressant > Flashcards

Antidepressant Flashcards

1
Q

What’s the 2nd or 3rd line for major depressive disorder

A

Tricyclic antidepressants

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2
Q

List tricyclic antidepressants

A 
Imipramine
Desipramine
Clomipramine
Amitriptyline
Nortriptyline
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3
Q

Tricyclic antidepressants mechanism of action

A

Inhibit presynaptic erupts me of serotonin and norepinephrine by binding to NET and SERT-> increasing mono amines in the synapse

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4
Q

When is Tricyclic antidepressants usually used

A

Treatment of depression not responsive to other antidepressants
(Resistant depression)

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5
Q

Tricyclic antidepressants therapeutic uses

A 
Neruopathic pain or chronic pain 
Migraine prophylaxis 
OCD 
Bed wetting 
Phobic disorders
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6
Q

Which tricyclic antidepressants is used for migraine prophylaxis

A

Amitriptyline

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7
Q

Which tricyclic antidepressants is used for OCD

A

Clomipramine

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8
Q

Which tricyclic antidepressants is used for bed wetting

A

imipramine

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9
Q

What’s the first line drug in treatment of OCD

A

SSRIs

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10
Q

Tricyclic antidepressants side effects

A

Sexual dysfunction
AntiMuscarinic side effects
Antihistamine side effects
A1 antagonism

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11
Q

Which tricyclic antidepressant mostly shows AntiMuscarinic side effects

A

Amytriptyline - mostly seen as urinary retention

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12
Q

Antihistamine side effects seem in tricyclic antidepressants

A

Sedation weight gain and increased appetite

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13
Q

a1 antagonist side effects seem in tricyclic antidepressants

A

Orthostatic hypotension

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14
Q

What’s tricyclic antidepressants most common cause of death

A

Cardiotoxicity by blocking of Na+ fast channels

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15
Q

What happens if TCAs and MAOIs are given together

A

Serotonin syndrome

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16
Q

List SSRIs

A

Fluoxetine
Paroxetine
Sertraline
Citalopram

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17
Q

SSRI mechanism of action

A

SSRIs inhibit the presynaptic resp take of serotonin by blocking SERT

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18
Q

What are SSSRIs first line treatment for

A 
Depression 
Panick attacks 
OCD 
Eating disorders 
Chronic pain - diabetic neuropathy 
Menstural sundrome
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19
Q

Which SSRI is used in OCD treatment

A

Fluvoxamine

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20
Q

Which SSRI is used to treat menstural syndrome

A

Fluoxetine

21
Q

SSRIs side effects

A

Serotonin syndrome, sexual dysfunction, anxiety and GI disturbances

22
Q

SSRI exception in having an active metabolite

A

Only fluoxetine has an active metabolite which is norfluoxetine which is more potent and selective half life = 30 days so even after treatment is stopped the drug lingers in the blood
- P450 inhibitors

23
Q

SSRI + MAOI

A

Serotonin syndrome

SSRI Should be taken 2 weeks after MAOI and MAOI 5 weeks after SSRI

24
Q

Atypical depression vs depression

A

In atypical we have hypersomina, increased apetite and brief periods of pleasure, indulge in pleasure seeking behaviour

25
Q

What is usually given for atypical depression

A

Bupropion or venlafaxine

26
Q

Why aren’t MAOIs used often

A

More adverse effects than other antidepressants and limited use due to complicated dietary restrictions

27
Q

what does MAO A breakdown

A

5-HT (serotonin), NE and Tyramine

28
Q

What does MAO B breakdown

A

Dopamine and tyramine

29
Q

MAOI mechanism of action

A

Works by inactivation of monoamine oxidase increasing concentration of neurotransmitters causing them to leak in to the synaptic cleft

30
Q

List non selective irreversible MAOIs

A

Phenelzine
Isocarboxazid
Tranylcypromine

31
Q

Irreversible MAO B inhibitor

A

Selegiline

32
Q

Reversible MAO A inhibitor

A

Moclobemid

33
Q

MAOIs therapeutic uses

A

3rd line for ATYPICAL DEPRESSION
Depression with sting anxiety
Resistant depression
Facial pain

34
Q

What’s a cheese reaction

A

Tyramine not inactivated by MAOs -> increase catecholamine release-> tachycardia headache nausea hypertension and cardiac arrhythmias
Happens within 30mins - 1 hr after eating

35
Q

MAOIs contraindications

A

Pheochromocytoma, CHF and liver failure

36
Q

List SNRIs

A

Duloxetine and venlafaxine

37
Q

Duloxetine indication

A

Depression and neuropathic pain

38
Q

Mlinacipran indication

A

In fibromyalgia

39
Q

Atomexetine indication

40
Q

Atypical antidepressants:

A

Bupropion
Mirtazapine
Nefazodone
Trazodone

41
Q

Bupropion mechanism of action

A

Selective D and 5HT reuptake inhibitor

42
Q

Bupropion indication

A

First line for atypical depression

Could be helpful in smoking cessation

43
Q

Mirtazapine mechanism of action

A

Inhibits post synaptic 5HT2a and 5HT2c and presynaptic a2 receptors
(Increase NE neurotransmission)

44
Q

Mirtazapine special feature

A

Doesn’t cause sexual dysfunction

45
Q

Mirtazapine side effects

A

Sedation and appetite stimulation

46
Q

Trazadone and nafazadone mechanism of action

A

Selective 5-HT 2a/2c agonists

47
Q

Trazadone and nafazadone indications

A

Used in Schizophrenia

Used in depression and insomnia

48
Q

Trazadone and nafazadone side effects

A

Somnorific agent (sedation)

Pharmacology (33 decks)

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