Antidepressants

Question 1

what are the causes of depression in regards to neurotransmitters

Answer 1

likely reduction in SEROTONIN RECEPTORS in hippocampus

Question 2

what do mono amine oxadase inhibitors do

Answer 2

inhibit MAO enzyme activity
MAO breaks down norepinephrine/ serotonin/ dopamine
therefore inhibiting MAO increases transmitter levels

Question 3

what are some MAOI

Answer 3

Phenelzine
selegiline
tranylcypromine

Question 4

what can selegiline be used for as well as depression

Answer 4

parkinsons

Question 5

what are some side effects of MAOI

Answer 5

weakness
dizziness
headache
fatigue
weight gain
impotence

Question 6

what are some interactions of MAOI

Answer 6

DRUGS
do not use with SSRI/ tricyclic/ analgesics - morphine/tramadol
this will increase serotonin to dangerous levels (confusion, tremor, coma, death)
14 day washout period

FOOD- if high in tyramine can cause high blood pressure crisis
cheese
venison
alcohol
green veg (broad beans)

Question 7

what is the washout period for MAOI

Answer 7

14 days

Question 8

what is moclobemide

Answer 8

it is a reversible MAOI
acts by reversible inhibition of MAO type A
not prescribed in primary care
has less effect from tyramine

Question 9

what is the washout period of moclobeminde

Answer 9

7 days
it is a short acting med

Question 10

how do tricyclic antidepressants work

Answer 10

they inhibit the re-uptake of norepinephrine and serotonin by blocking the transporters that are responsible for re-uptake of these neurotransmitters
therefore this increases the concentration on NT in synapses–> further neurotransmission

Question 11

what are tricyclics used for

Answer 11

depression
anxiety
chronic pain (fibromyalgia, reflex sympathetic dystrophy syndrome)
IBS
Neuralgia
OCD
Nocturnal enuresis
PTSD

Question 12

what side effects can tricyclic antidepressants cause

Answer 12

risk of arrythmias (if CV disease)
reduce intestinal mobility (have antimuscarinic activity- blocks muscarinic acetylcholine receptor activity)
induce brady, then tachycardia
reduce bronchial secretions
urinary retention
dry mouth
confusion

Question 13

name some tricyclic antidepressants

Answer 13

amitriptyline
clomipramine
imipramine
lofepramine
nortriptyline

Question 14

what are tricyclic antidepressants mainly used for now

Answer 14

chronic pain

Question 15

name a drug related to tricyclics

Answer 15

trazodone
it is more sedating

Question 16

why should you be concerned when prescribing trazadone

Answer 16

very dangerous in overdose and so be careful how much you prescribe
use with caution in patients at high risk of suicide in case overdose

Question 17

how do SSRI work

Answer 17

limit re-absorption of serotonin
only have a weak affinity for norepinephrine and dopamine transmitters

Question 18

what are the serotonin receptors known as

Answer 18

5-hydroxytryptamine
5-HT

Question 19

what are SSRIs prescribed for

Answer 19

depression
anxiety
OCD
panic disorder
PTSD
eating disorders
menopausal symptoms

Question 20

what do the SSRI receptors do and where are they found

Answer 20

found in the pns and cns (excitatory and inhibitory neurotransmission)
they modulate the release of many neurotransmitters
GABA, dopamine, epinephrine, norepinephrine, ach

they influence aggression, anxiety, cognition, learning memory, mood and sleep

Question 21

what are the side effects of SSRIs

Answer 21

reduced libido, dysfunction
bleeding- affects anticoagulants, increase GI bleeds
cardiac issues (eg. citalopram and QT interval prolongation)
suicide (particularly under 18, therefore only prescribed my a psychiatrist)
overdose (but safer than most)
epilepsy- reduced fit threshold
nausea
rash
muscle aches
insomnia
sweating

Question 22

name SSRIs from most toxic to least

Answer 22

citalopram
escitalopram
paroxetine
sertraline
fluoxetine

Question 23

Name a serotonin norepinephrine up-take inhibitor and its uses

Answer 23

Duloxetine
depression
neuropathic pain
stress urinary incontinence

Question 24

what are some side effects of duloxetine

Answer 24

nausea
insomnia
dizziness

Question 25

what is mirtazapine, its uses and side effects

Answer 25

presynaptic alpha2-adrenoreceptor antagonist
and a noradrenergic and specific serotonergic antidepressant

depression, anxiety, PTSD
low- drowsiness
high- more stimulant effect

Question 26

what is venlafaxine and its uses

Answer 26

serotonin-norepinephrine re-uptake inhibitor

major depressive disorder
anxiety
panic
social phobia
resistant depression

it is metabolised in the body by desvenlafaxine (by cytoP206 isoenzyme in the liver)

Question 27

what is lithium used for and its side effects

Answer 27

bipolar/ mania mood stabalisation
adverse kidney and thyroid affects

Question 28

what antidepressants are commonly used for pain

Answer 28

amitriptyline
nortriptyline
duloxetine- also for diabetic neuropathy

Question 29

how to antidepressants work with pain

Answer 29

they have a direct effect on the mechanisms of pain
tricyclics block the re-uptake of noradrenaline and serotonin (5-HT) into the nerve endings and increase their levels in the pain control pathways
useful for nerve damage/ abnormal nerve function/ muscle pain
good effect on pain sleep effects

Question 30

when is there a risk of torsades de pointes with antidpressants

Answer 30

citalopram (prolong QT)
use of nore than one drug that prolongs QT increases this and ventricular arrhythmias

Question 31

who have more risk factors for qtc prolongation and therefore vulnerable to drug-induced LQTS

Answer 31

major psychiatric disorders
CV disease
women
elderly

Question 32

what are some drugs that prolong qt

Answer 32

erythromycin
clarithromycin
fluconazole
sotalol
amiodarone
methadone
risperidone
doxepin
domperidone