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Antidepressant Drugs Flashcards

1
Q

the timeline for diagnosis of major depressive disorder is after how long

A

2 weeks

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2
Q

what are the 2 types of depression

A

reactive/secondary
endogenous

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3
Q

what is the difference between reactive/secondary and endogenous depression in terms of treatment response

A

reactive/secondary- transient and responds to treatment
endogenous- responds to treatment but recurrence is high

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4
Q

5-HT mainly used what type of receptor

A

GPCR

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5
Q

what does the amine hypothesis of depression say

A

depression is due to the deficiency of amount and functions of 5-HT, NE, and DA neurons

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6
Q

the amine hypothesis of depression was based on what antihypertensive drug

A

reserpine

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7
Q

how does reserpine act which is used to further the amino hypothesis of depression

A

reserpine acts by blocking the transportation of monoamines into the pre-synaptic vesicles, leading to the inactivation of MAO enzymes= monoamine depletion in CNS

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8
Q

what does the neurotrophic hypothesis of depression say

A

neurotrophic factors (ex: brain derived neurotrophic factor) are needed for neural plasticity, resilience and neurogenesis

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9
Q

what is the relationship between brain derived neurotropic factor and depression

A

depressed patients have a decrease in BDNF

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10
Q

amygdala __ CRF release, hippocampus __ CRF release

A

stimulates
inhibits

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11
Q

what is the relationship between stress, CRF, ACTH, cortisol, and BDNF

A

stress= increased CRF, ACTH, and cortisol
high cortisol= decreased BDNF
decreased BDNF=depression

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12
Q

what are the 3 possible effects of action of antidepressant drugs

A

inhibit uptake of NE and 5-HT
inhibit MAO
block presynaptic alpha2 autoreceptors

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13
Q

what are 3 secondary adaptive changes as a result of antidepressant drug use

A

desensitization of presynaptic NE and 5-HT receptors
increase neurogenesis
increase BDNF transcription

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14
Q

monoamine oxidase is an intracellular enzyme present in __

A

neurons

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15
Q

what is the function of monoamine oxidase

A

prevents accumulation of neurotransmitters outside the vesicle

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16
Q

selegiline as a MAO inhibitor inhibits __

A

irreversibly inhibits MAO-B

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17
Q

MAO inhibitors mechanism of action

A

inactivation of MAO
=decreased monoamine clearance
=increased NE, 5-HT, and dopamine

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18
Q

what is the effect of inhibition of MAO in the liver and gut

A

decreases the metabolism of tyramine, increasing drug-food interactions

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19
Q

what drug class is preferred in atypical or refractory depression

A

MAO inhibitors

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20
Q

why are MAO inhibitors rarely used in clinical practice compared to SSRIs (3)

A

more side effects
potential for food-drug interactions
restriction of tyramine rich foods

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21
Q

what are the 3 main adverse effects of MAO inhibitors

A

postural (orthostatic) hypotension
weight gain
sexual dysfunctions

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22
Q

MAO inhibitors can cause drug-drug interactions in use with…

A

drugs that increase NE
drugs with alpha agonists
tyramine rich foods
SSRIs, TCAs

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23
Q

what is the cheese reaction that can occur when MAO inhibitors are used with tyramine rich foods

A

excessive release of NE
–>hypertensive crisis, tachycardia, cardiac arrythmias

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24
Q

what must be done to avoid serotonin syndrome when using MAOIs and SSRIs

A

both require a washout period of 2 weeks prior to other drug use

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25
what antidepressant class is used if patients don't respond to SSRIs
tricyclic antidepressant (TCA)
26
tricyclic antidepressant (TCA) mechanism of action
increases NE and 5-HT by blocking transporters at presynaptic terminals leads to increased concentration of NE and 5-HT in the synaptic cleft
27
what drug class can be used in those with depression and Parkinson's disease
TCA
28
what are 4 adverse effects of TCA
antimuscarinic effects cardiac arrythmia alpha-1 blocker histamine blocker
29
how can TCA use lead to cardiac arrythmia
inhibition of fast Na+ channels
30
what are 3 symptoms of TCA toxicity
coma, convulsions, cardiotoxicity
31
what can be done to minimize withdrawal syndromes and cholinergic rebound effects with TCAs
tapering of dose
32
TCAs are contradicted in (3)
angina arrhythmias benign prostatic hyperplasia
33
TCAs reduce efficacy of what class of drugs
antihypertensives (alpha2 agonists)
34
what is used to treat cardiac toxicity in TCA use
sodium bicarbonate
35
how does sodium bicarbonate work to reduce the toxic effects of TCAs
displaces TCAs from cardiac sodium channels, preventing their blockage
36
what is the mechanism of action of amoxapine
it's a TCA which blocks 5-HT2 and dopamine D2 receptors
37
what is an adverse effect of amoxapine
parkinsonian syndrome
38
what drug is used to treat depression with agitation/anxiety
Maprotiline TCA
39
what drug is used to treat depression and insomnia
Maprotiline
40
what drug class is preferred for OCD
SSRI
41
what can the TCA amitriptyline be used for
neuropathic pain
42
doxepin is a TCA that can be used for __ and __ in addition to depression
hypnotics pruritus
43
what is the mechanism of action of SSRIs
selectively inhibit prejunctional serotonin transporter to block the reuptake of serotonin
44
SSRIs require __ weeks to improve mood but don't reach maximum benefit until __ weeks
2 12
45
what is the effect of antidepressants on BDNF
increases
46
why are SSRIs more preferred than TCAs for depression
SSRIs lack anticholinergic, alpha blocking, and antihistamine properties
47
how does the SSRI fluoxetine work
inhibits activation of Tamoxifen (antiestrogen) into an active metabolite
48
what drugs are preferred over fluoxetine due to having less interactions
citalopram escitalopram
49
with fluoxetine, how long must be waited after discontinuation before starting MAO inhibitors
4 weeks
50
what are 3 adverse effects of SSRIs
sexual dysfunction rebound/discontinuation syndrome SIADH-->hyponatremia
51
why is less rebound/discontinuation syndrome seen less with fluoxetine
its a long acting metabolite
52
how do SSRIs differ from SNRIs
SSRIs block alpha1 adrenergic, muscarinic, and histamine receptors SNRIs do not
53
what drug class is preferred in depression with chronic pain conditions and also neuropathic pain
SNRIs
54
what is an adverse effect of the SNRI Venlafaxine
hypertension
55
the SNRI Duloxetine is not preferred in patients with what 2 conditions
hepatic insufficiency end stage renal disease
56
what is the mechanism of action of trazodone
5-HT2 presynaptic receptor antagonist -->increased 5HT release
57
trazadone has __ blocking activity and __ blocking activity
alpha1 H1
58
what are 3 effects of alpha1 blocking activity by trazodone
priapism cardiac arrythmia postural hypotension
59
what is the effect of H1 blocking activity by trazodone
produces mode sedation, useful in insomnia
60
what drug is preferred in depression with agitation and insomnia
trazodone
61
what drug is preferred for sleep over benzodiazepines due to the lack of tolerance of dependence
trazodone
62
nefazodone adverse effect
hepatotoxicity
63
what is the mechanism of action of buproprion
blocks reuptake of NE and DA
64
unlike other antidepressants, buproprion has little risk of causing ___
sexual dysfunction
65
bupropion can cause __ or __ with toxicity
seizures insomnia
66
what is the mechanism of action of mirtazapine
inhibition of presynaptic alpha2 receptors increases NA and 5-HT release
67
what drug is used in depression with anorexia
mirtazapine
68
what drug class is used for bulimia
SSRI
69
what drugs can be used for treatment resistance major depression
atypical antipsychotics+SSRIs or SNRIs
70
what antidepressant has rapid effect within 24 hours
ketamine-like drugs (esketamine)
71
what is the mechanism of action of ketamine like esketamine
blocks presynaptic NMDA receptors
72
what antidepressant can be used in postpartum depression
brexanolone

Pharmacology (16 decks)

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