Antidepressants Flashcards
بسم الله الرحمن الرحيم
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Depression is classieef into
Unipolar common =major depressive disorder
Bipolar
Depression + Mania
هلوسات مش عارف ينام المود خربان بتيكلم كثير
Major depressie dioedere prevelance = ?
Woemn or men ?
Age?
Comrobidites?
17%
WOMEN
MID TWENTIES
anxiety + abuse
Symptoms of derpession ?
Emotinal physcial and cognitive
EMotional = Anhedonia saddness , sucidie , loss of interes gulit
Physcial : Sleep + appetite + psychomotor distrubances
Cognitice: concentration + memory disturbed
+
Severe= Deulisons + Hallucinations
Core symptoms of depression ?
Depressed mood
Anhedonia
Atypical depression =
Significant appetitie + hypersmonia
Resistant treatment
so Used MAOI!
Meahcnism of antidepressants
Increaisng Monamine dopamine serotonin and NE
dOWN Regulation of B and 5HT receptors delayed!
Neurotropich factors increased BDNF essentila for neuroplasticity
Mention mechanism of class of antidepressants
Prevention of reuptake of monoamines = TCA SSRI SNRI NDRI
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Prevention of Catabolism by MAO =MAO I
Describe response to antidepressants
First week = Imprve sleep and appetie but may be agitated and in anxiety
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1-3 weeks Concentraion and memory improved but there is Hyperactivity and sex drive
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2-4 weeks:
Begins to Feel Pleasure ^_^
Relief of depressive mood
Mention TCAs
Imipramine
clomipramine
Antitriptline
Nortiptlyine
Desipramine
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I CAN DO !
Describe Mehanism of TCAs?
Prevent reuptake of NE and serotonin
but
Blocking autonimunc
Histaminc Muscarininc
and alpha adrenergic rcepetors
TCAs
block alpha adrengerfic receptors casugin ?
Blcok histaminc receptors causing ?
Blcok Muscarcinic receptors causing ?
Alpha= Hypoteension + arrythima
Histamine = sedation
Muscarinic = Atropin like action
constipation - urine retention and Dry mouth
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Caridotoxix
sexual dynsfunctiono
BPH
Narro TI
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Sucidie risk + Swithc to mania so cautiosuly in bipolar
TCA has caridotoxic effect causing ?
Arrythmia nad AV Block ! @
TCA shoud be taken cautiosuly in ?
Cardiacs and eplipticus
TCA is taken cautiously in Sucical or bipolar patients
Sucidie risk + Swithc to mania so cautiosuly in bipolar
Never give TCA with Alcohola and ansthetics
and hypotensive?
ALochol and anstheric increasing seation
Hypotensive!!@
Never give TCA with Sympatthomimietics and MAOI ?
MAOI increasing serotinin bay cause serotonin syndrome
Never give SSRI iwth TCAwhy?
Fluoxetine and Paroxetine inhibit TCA metabolism by inhibitng CYP2D6 Increasing TCA level that of Narrow therpautic index causing Toxicity
Patient with deprssion and Neuropathic pain is given ?
TCA + SNRI !
Mention indications of TCA
NMD = 1-Depression + ansxiety
2-Noctuernal enuresis
3-Migarane +CHRONIC PAIN neurophatic ( amitryptline )
Describe TCAs toxicity and Mangement
AC2
Atropine toxicity
Convulsions
Cardia: arryhmia hypotension and Block
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NaHCO3 for hypotension and arrythmia
Indications SSRI
Mention indication of fluoxetine
FAnE 1-First line DERPRESSION
2-ANXIETY ( GAD-OCD -PANIC ATTAKK)
3-Eating disorderes as bulemia nervosa and anxiety nervosa
Advanatge os SSRI
TOCA
Less autonomic blocake
Less cardiotoxic
Less ObESITY
Wider TI
Citalopram dose
never exceeds 40mg/day for risk of Increased QT interval
Adverese effects of SSRI (FLUXOETINE PAROXETINT)
Nause -vomiting
Drowindwss =insmonia
Sexual dysfunction
Drug interaction
Risk of suicide in teenage
s2d2
Paroxetin has ,,, effect on sleep
but fluoxetinte ?
Paroxetine sedating
Fluoxeitne activating
Fluoxeitnie and paroxetine interactions
Inhibintg CYP 2D6 increasing TCA toxicity
also Antipsychotics antidepressants and B Blockers
Never to give TCA AND CITOALOPRAM SSRI ?
QT interval prolongation
Mangemetn of sexual dysfunction
Rduce the dose
Vigra
repace with Mirtazapine and buporion
Nevere give SSRI with MAOI to avoid,,,,,describe
Serotnin syndrome
=Mental abnormalities
=Autonimic abnormalitis :
tachycardia - diaphoreiss-mudriasis - shivering
=Neuromuclar abnormalitis :
Clonus hyperreflexia -tremoes and seizures
SNRI AS ,,,,WORKING BY?
Vend and hend
Venlafaxine + Duloxetine
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Preventing reuptake of NE and Serotonin
Mention pros and cons of Venlafaxeine
Pros no autoniminc blockade on H1 M a rceptors
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Cons :-
Hypertension in Tachycardia in high dose>150 mg
Nause vomiting
Sexual dysfunvtion
Used in stress Urinary incontinice?
Duloxetine
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Incrasing NE and serotonin in the scaral semgents increasing tone of shpincters !
No sexual dysfunction in ?
atypical antidepressants
Aypicla antidepressaants mention
Bupriopin increaisng NE and DA
Mirtazapine blocking Alpha 2 and 5HT2
Imp notes on Bupropion
1-No sexual dysfunction
2-Smoking cessation Increasing DA in nucleus accumbens
3-Contraindicated in Epileptic patients + Alcohol withdrawal
Mirtazapine is CC by?
Blocking a2 inhibiotry effect
increasing 5HT3 and NE
_______________CC BY?
Anti emetics effect blocking 5TH3 receptor in CTZ and GIT
-No sexual dysfunction instead of SSRI
-SEDATION AND WEIGHT GAIN WORKING IN H1 BLOCKING
MAOI :
NON SELEVTIC MAO A ,B I AND ,,,,,,AND,,,,,,,,
SLECTIVE MAOAI: ……….
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MAO is safety valve targeted for ?
cuasing …..inactivation of MAO ?
Tranylcyprmoine & phenelzine
Moclobemide
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Preventing damage causing Reuptake of NE 5HT and dopamine increasing their propotions in synaptic clefts
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Irreversible
MAOI is condisered last line treamtnet in depression whyyy?
Due to cheses reaction HTN CRISIS If food containg tyraimine
Tyramine is indirect,,,,,,,,,,
When taking ,,,,,,,,,, drugs
there is increased abosoprton of tyramine causign ?
Sympathomimetic
MAOI
Cheese Reaction of HTN crisis
MAOI And Cold remedies
Cold remedis
may be sympathomumetic increasing NE with its increase by MAOI causing HTN Crisis
MAOI and TCAS
TCAS increasing NE and MAOI increasit it also causing Hypertension hyperthermina and convulsions
MAOI AND
SSRI
Pethidine
Tramadol
SSRI increase Serotonin as MAOI
ALSO
Pehtidine to norpethdine increasing Seortinin as MAOI
Also
Tramadol Decreasing reuptake of Serotonin increasing it aas MAOI
Causing
Serotinin syndrome with conusloion and hyperthermia
pRECUATIONS OF MAOIs
Avoid drug interactions
Avoid in elderly why ?
Avoid RCAs or SSRI except after 2 weeks from stopping MAOI called “,,,,,,”:
Elderly :-
alpha 1blockade causing postural hypotension
Muscarinic blckade: causing atropine like actions
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Washout period
Selevtive revresible inhibiotor of MAO-A
Moclobemide
Has the advantage over risk of cheese reaction ? why?
Moclobemide
due to its selectivity to mao a so there is MAO B working on tyramine
and also its is short acting reversible easily displaced and replaced by tyramine allowing tyramine to be metabolized by MAO-A
Agomeltaine works on ?
Melatinionin recpros M1&M2 Agonist
5HT2C antagonist incresing NE And Dopamine
not hypnotic as ramelton due to increasd NE
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Indications of Agomelatinin ?
Major depressive disorder:
Ciradiacn Rythm correction
Mention theraputic indications of antidepressants
UNSe DAP
1-Depressive disorderes
2-Anxiety - OCD ( SSRI + Clompreamine)
3-Post-traumatic-stress -disorder and Impulse control disorder
4-Eating disorders bulemia and anxiety nervosa
5-smoking cessation Bupropion
6-Neurophatic pain : TSD TCAS
SNRI and DULOXETINE
7-Urinary incotinece dulxetine
Nocutrnal enrurisis Impiramine
5Rs of tratment are?
Respione 50 %
Remission normal 3 months
Recovery nor relapse > 6 months
Relaspe after respone or remission
Reurrence: Epidoe after recovery
Algorithim :-
Age comrobitis symptoms
-SSRI Fisrt line
-SNRI If chronic pain
-Isnomina weight loss = mirtazapine
-smoking cessation = bupirpion
-OCD Clomiparmine
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Maximize dose or
Class change! or Member change!
Combination enhancement!
Augmentation therapy! Li
Lamotigine
thyroid hormone
2nd generation antipsychotics :
quitapine + Olanzopine
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ECT:جلسات ظبط ايقاغ المخ
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remission ?
Remisson with maintaind 6 moth tratement if
recovery !
MAINTAINCE OR NO ?!
A question of Risk factors
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Sudden discontuniaion !!!!!!!
Discontuinaton syndome
Depressed mood
Disqeulibrium
Muscle aches
GIT symptoms
Trmors
Isomina nad Night mares
parasthesia
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gradual discontiunation
رب إني لما أنزلت إلي من خير فقير ^_^
