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MJ- P2 E2 > Antidepressants 1 > Flashcards

Antidepressants 1 Flashcards

1
Q

What is the hypothesis of mood?

A

Major depressive disorders result from a functional deficiency of NE, 5-HT, and dopamine at synapses in the CNS

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2
Q

What 3 neurotransmitter defiiencies is thought to cause major depressive disorders?

A

NE

5-HT

Dopamine

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3
Q

T/F: All classes of antidepressants appear to enhance the synaptic availability of 5-HT, norepinephrine, or dopamine

A

TRUE

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4
Q

T/F: Attempts to develop antidepressants that work on other neurotransmitter systems have been effective to date.

A

FALSE

Attempts to develop antidepressants that work on other neurotransmitter systems have NOT been effective to date.

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5
Q

Changes in what 2 components appear to play a major role in the development of major depression?

A

BDNF

hormones

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6
Q

What is considered successful tx of depression?

A

a change in BDNF and hormones

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7
Q

NTs carry ______ between cells.

A

messages

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8
Q

These bind to a specific receptor, and this coupling initiates a cascade of events.

A

NTs

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9
Q

These are reabsorbed back ininto nerve cells by reuptake pumps (transporter molecules) at which point they may be recycled for later use or broken down by enzymes

A

NTs

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10
Q

MOA for which drugs?

inhibit the transporter molecules and allow more NT to remain in the synapse

A

antidepressants

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11
Q

Which dz?

associated with changes in serotonin or norepinephrine signaling in the brain (or both) with significant downstream effects (lesser-dopamine)

A

Depression

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12
Q

Most antidepressants cause changes in _____ signaling.

A

Most antidepressants cause changes in amine signaling.

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13
Q

What neuroendocrine factors are associated with more severe forms of depression?

A

Abnormal HPA axis

Elevated cortisol levels

Thyroid dysregulation

Estrogen/testosterone deficiency

Trytophan deficient diet

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14
Q

How do elevated cortisol levels contribute to major depression?

A

lead to dysregulation of the stress hormone axis

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15
Q

Why would a tryptophan deficient diet cause major depression?

A

tryptophan is a precursor of serotonin synthesis

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16
Q

What are the 3 phases of tx in MDD?

A

acute phase

continuation phase

maintenance phase

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17
Q

lasts 6 to 12 wks in which the goal is remission (absence of symptoms)

Which phase of MDD tx?

A

acute

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18
Q

lasts 4 to 9 mos after remission is achieved, in which the goal is to eliminate residual symptoms or prevent relapse (ie, return of symptoms within 6 months of remission)

Which phase of MDD is this?

A

Continuation Phase

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19
Q

lasts at least 12 to 36 mos in which the goal is to prevent recurrence (a separate episode of depression)

Which phase of MDD is this?

A

Maintenance Phase

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20
Q

Which acne tx is associated with drug-induced depressive sx?

A

isotretinoin

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21
Q

Which anticonvulsants are associated with drug-incuced depressive sx?

A

Levetiracetam

Topiramate

Vigabatrin

“Leave it To Viagara”

22
Q

Which antimigraine tx is associated with drug-induced depressive sx?

A

triptans

23
Q

Which CV tx are associated with drug-induced depressive sx?

A

Beta blocker

Clonidine

Methyldopa

reserpine

“The beta fish cloni takes meth with the serpent”

24
Q

Which hormonal therapies are associated with drug-induced depressive sx?

A

Gonadotropin-releasing hormone

Oral contraceptives

Steroids (prednisone)

Tamoxifen

25
Q

Which immunologic agents are associated with drug-induced depressive sx?

A

Interferons

26
Q

Which smoking cessation drug is associated with drug-induced depressive sx?

A

Varenicline

27
Q

What are the 6 antidepressant pharmacotherapy options?

A

Tricyclic antidepressants

MAO inhibitors

SSRIs

SNRIs (5-HT-NE)

5-HT₂

Heterocyclic antidepressants

28
Q

The hypothesis that major depressive disorders result from a functional deficiency of norepinephrine or serotonin at synapses in the CNS

Which hypothesis?

A

Amine hypothesis of mood

29
Q

Structurally related drugs that block reuptake transporters of both norepinephrine (NE) and serotonin (5-HT)

Which drug?

A

tricyclic

30
Q

Drugs that selectively inhibit serotonin (5-HT) transporters with only modest effects on other neurotransmitters

Which drug?

A

SSRIs

31
Q

Heterocyclic drugs that block NE and 5-HT transporters, but lack the alpha blocking, anticholinergic and antihistaminic actions of TCAs

Which drug?

A

SNRIs

32
Q

Structurally related drugs that block this subgroup of serotonin receptors with only minor effects on amine transporters

A

5-HT2 receptor antagonists

33
Q

Term used for antidepressants of varying chemical structures, the characteristics of which do not strictly conform to any specific designations

A

Heterocyclics

34
Q

What are the 4 PK of antidepressants?

A

Fairly rapid oral absorption

Achieve peak plasma levels within 2-3 hours

Tightly bound to plasma proteins

Undergoes hepatic metabolism

Renally cleared

35
Q

What are the 5 main antidepressant indications?

A

Major depressive disorder (MDD)

Panic disorder

Generalized anxiety disorder (GAD)

Post traumatic stress disorder (PTSD)

Obsessive-compulsive disorder (OCD)

36
Q

Other A-depressant indications

A

Neuropathic pain

Pain associated with fibromyalgia

Premenstrual dysphoric disorder (PMDD)

Mitigates vasomotor symptoms of menopause

Stress incontinence

37
Q

What 6 conditions would you use TCAs for?

A

MDD (backup)

chronic pain

OCD

Pain conditions

Enuresis (urinary inconintence)

insomnia

38
Q

What are the names of the 4 tricyclic antidepressants?

A

imipramine

desipramine

doxepin

nortriptyline

39
Q

What TCA would you use for OCD?

A

clomipramine

40
Q

Toxicities of which drug?

α block

Muscarinic block

sedation, weight gain

Overdose: arrhythmias, seizures

A

TCAs

41
Q

Drug interaction if you take TCAs with ethanol or sedative hypnotics?

A

increased CNS depression

42
Q

Drugs inhibiting monoamine oxidases that metabolize norepinephrine and serotonin (MAO type A) and dopamine (MAO type B)

Which drug?

A

MAOI

43
Q

What are the 4 indications for MAOI?

A

MDD unresponsive to other agents

Anxiety

panic disorder

Selegiline-Parkinson’s disease: Amphetamine-like metabolites

44
Q

What are the 3 MAOIs we should know?

A

Phenelzine

Tranylcypromine

Selegiline

45
Q

Which MAOI is more active against MAO-B?

A

selegiline

46
Q

What is the clinical application for MAOIs?

A

Major depression unresponsive to other drugs

47
Q

PK & drug interactions of which drug?

HTN with tyramine and sympathomimetics

Serotonin syndrome with SSRIs

Very long half-lives

A

MAOI

48
Q

What are the toxicities of MAOIs?

A

Hypotension

insomnia

49
Q

What foods should pts taking MAOIs avoid?

A

anything with tyramine content:

dairy products

alcohol

canned meats

yeast products

chocolate

coffee

50
Q
A

MJ- P2 E2 (19 decks)

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