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A-CNS Pharma > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

بسم الله الرحمن الرحيم
_______________________
Depression is classieef into

A

Unipolar common =major depressive disorder
Bipolar
Depression + Mania
هلوسات مش عارف ينام المود خربان بتيكلم كثير

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2
Q

Major depressie dioedere prevelance = ?
Woemn or men ?
Age?
Comrobidites?

A

17%
WOMEN
MID TWENTIES
anxiety + abuse

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3
Q

Symptoms of derpession ?

A

Emotinal physcial and cognitive
EMotional = Anhedonia saddness , sucidie , loss of interes gulit
Physcial : Sleep + appetite + psychomotor distrubances
Cognitice: concentration + memory disturbed
+
Severe= Deulisons + Hallucinations

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4
Q

Core symptoms of depression ?

A

Depressed mood
Anhedonia

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5
Q

Atypical depression =

A

Significant appetitie + hypersmonia
Resistant treatment
so Used MAOI!

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6
Q

Meahcnism of antidepressants

A

Increaisng Monamine dopamine serotonin and NE
dOWN Regulation of B and 5HT receptors delayed!
Neurotropich factors increased BDNF essentila for neuroplasticity

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7
Q

Mention mechanism of class of antidepressants

A

Prevention of reuptake of monoamines = TCA SSRI SNRI NDRI
______________________________
Prevention of Catabolism by MAO =MAO I

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8
Q

Describe response to antidepressants

A

First week = Imprve sleep and appetie but may be agitated and in anxiety
__________________________-
1-3 weeks Concentraion and memory improved but there is Hyperactivity and sex drive
____________________________
2-4 weeks:
Begins to Feel Pleasure ^_^
Relief of depressive mood

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9
Q

Mention TCAs

A

Imipramine
clomipramine
Antitriptline
Nortiptlyine
Desipramine
________________
I CAN DO !

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10
Q

Describe Mehanism of TCAs?

A

Prevent reuptake of NE and serotonin
but
Blocking autonimunc
Histaminc Muscarininc
and alpha adrenergic rcepetors

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11
Q

TCAs
block alpha adrengerfic receptors casugin ?
Blcok histaminc receptors causing ?
Blcok Muscarcinic receptors causing ?

A

Alpha= Hypoteension + arrythima
Histamine = sedation
Muscarinic = Atropin like action
constipation - urine retention and Dry mouth
_____________________
Caridotoxix
sexual dynsfunctiono
BPH
Narro TI
_____________________
Sucidie risk + Swithc to mania so cautiosuly in bipolar

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12
Q

TCA has caridotoxic effect causing ?

A

Arrythmia nad AV Block ! @

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13
Q

TCA shoud be taken cautiosuly in ?

A

Cardiacs and eplipticus

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14
Q

TCA is taken cautiously in Sucical or bipolar patients

A

Sucidie risk + Swithc to mania so cautiosuly in bipolar

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15
Q

Never give TCA with Alcohola and ansthetics
and hypotensive?

A

ALochol and anstheric increasing seation
Hypotensive!!@

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16
Q

Never give TCA with Sympatthomimietics and MAOI ?

A

MAOI increasing serotinin bay cause serotonin syndrome

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17
Q

Never give SSRI iwth TCAwhy?

A

Fluoxetine and Paroxetine inhibit TCA metabolism by inhibitng CYP2D6 Increasing TCA level that of Narrow therpautic index causing Toxicity

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18
Q

Patient with deprssion and Neuropathic pain is given ?

A

TCA + SNRI !

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19
Q

Mention indications of TCA

A

NMD = 1-Depression + ansxiety
2-Noctuernal enuresis
3-Migarane +CHRONIC PAIN neurophatic ( amitryptline )

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20
Q

Describe TCAs toxicity and Mangement

A

AC2
Atropine toxicity
Convulsions
Cardia: arryhmia hypotension and Block
___________________________
NaHCO3 for hypotension and arrythmia

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21
Q

Indications SSRI
Mention indication of fluoxetine

A

FAnE 1-First line DERPRESSION
2-ANXIETY ( GAD-OCD -PANIC ATTAKK)
3-Eating disorderes as bulemia nervosa and anxiety nervosa

22
Q

Advanatge os SSRI

A

TOCA
Less autonomic blocake
Less cardiotoxic
Less ObESITY
Wider TI

23
Q

Citalopram dose

A

never exceeds 40mg/day for risk of Increased QT interval

24
Q

Adverese effects of SSRI (FLUXOETINE PAROXETINT)

A

Nause -vomiting
Drowindwss =insmonia
Sexual dysfunction
Drug interaction
Risk of suicide in teenage
s2d2

25
Q

Paroxetin has ,,, effect on sleep
but fluoxetinte ?

A

Paroxetine sedating
Fluoxeitne activating

26
Q

Fluoxeitnie and paroxetine interactions

A

Inhibintg CYP 2D6 increasing TCA toxicity
also Antipsychotics antidepressants and B Blockers

27
Q

Never to give TCA AND CITOALOPRAM SSRI ?

A

QT interval prolongation

28
Q

Mangemetn of sexual dysfunction

A

Rduce the dose
Vigra
repace with Mirtazapine and buporion

29
Q

Nevere give SSRI with MAOI to avoid,,,,,describe

A

Serotnin syndrome
=Mental abnormalities
=Autonimic abnormalitis :
tachycardia - diaphoreiss-mudriasis - shivering
=Neuromuclar abnormalitis :
Clonus hyperreflexia -tremoes and seizures

30
Q

SNRI AS ,,,,WORKING BY?

A

Vend and hend
Venlafaxine + Duloxetine
_____________________
Preventing reuptake of NE and Serotonin

31
Q

Mention pros and cons of Venlafaxeine

A

Pros no autoniminc blockade on H1 M a rceptors
_________________
Cons :-
Hypertension in Tachycardia in high dose>150 mg
Nause vomiting
Sexual dysfunvtion

32
Q

Used in stress Urinary incontinice?

A

Duloxetine
______________
Incrasing NE and serotonin in the scaral semgents increasing tone of shpincters !

33
Q

No sexual dysfunction in ?

A

atypical antidepressants

34
Q

Aypicla antidepressaants mention

A

Bupriopin increaisng NE and DA
Mirtazapine blocking Alpha 2 and 5HT2

35
Q

Imp notes on Bupropion

A

1-No sexual dysfunction
2-Smoking cessation Increasing DA in nucleus accumbens
3-Contraindicated in Epileptic patients + Alcohol withdrawal

36
Q

Mirtazapine is CC by?

A

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

37
Q

MAOI :
NON SELEVTIC MAO A ,B I AND ,,,,,,AND,,,,,,,,
SLECTIVE MAOAI: ……….
_____________________
MAO is safety valve targeted for ?
cuasing …..inactivation of MAO ?

A

Tranylcyprmoine & phenelzine
Moclobemide
_____________________:-
Preventing damage causing Reuptake of NE 5HT and dopamine increasing their propotions in synaptic clefts
____________________
Irreversible

38
Q

MAOI is condisered last line treamtnet in depression whyyy?

A

Due to cheses reaction HTN CRISIS If food containg tyraimine

39
Q

Tyramine is indirect,,,,,,,,,,
When taking ,,,,,,,,,, drugs
there is increased abosoprton of tyramine causign ?

A

Sympathomimetic
MAOI
Cheese Reaction of HTN crisis

40
Q

MAOI And Cold remedies

A

Cold remedis
may be sympathomumetic increasing NE with its increase by MAOI causing HTN Crisis

41
Q

MAOI and TCAS

A

TCAS increasing NE and MAOI increasit it also causing Hypertension hyperthermina and convulsions

42
Q

MAOI AND
SSRI
Pethidine
Tramadol

A

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

43
Q

pRECUATIONS OF MAOIs
Avoid drug interactions
Avoid in elderly why ?
Avoid RCAs or SSRI except after 2 weeks from stopping MAOI called “,,,,,,”:

A

Elderly :-
alpha 1blockade causing postural hypotension
Muscarinic blckade: causing atropine like actions
____________________
Washout period

44
Q

Selevtive revresible inhibiotor of MAO-A

A

Moclobemide

45
Q

Has the advantage over risk of cheese reaction ? why?

A

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

46
Q

Agomeltaine works on ?

A

Melatinionin recpros M1&M2 Agonist
5HT2C antagonist incresing NE And Dopamine
not hypnotic as ramelton due to increasd NE
________________________

47
Q

Indications of Agomelatinin ?

A

Major depressive disorder:
Ciradiacn Rythm correction

48
Q

Mention theraputic indications of antidepressants

A

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

49
Q

5Rs of tratment are?

A

Respione 50 %
Remission normal 3 months
Recovery nor relapse > 6 months
Relaspe after respone or remission
Reurrence: Epidoe after recovery

50
Q

Algorithim :-
Age comrobitis symptoms
-SSRI Fisrt line
-SNRI If chronic pain
-Isnomina weight loss = mirtazapine
-smoking cessation = bupirpion
-OCD Clomiparmine
____________________________
Maximize dose or
Class change! or Member change!
Combination enhancement!
Augmentation therapy! Li
Lamotigine
thyroid hormone
2nd generation antipsychotics :
quitapine + Olanzopine
____________________________________
ECT:جلسات ظبط ايقاغ المخ
_____________________________
remission ?

A

Remisson with maintaind 6 moth tratement if
recovery !
MAINTAINCE OR NO ?!
A question of Risk factors
__________________________
Sudden discontuniaion !!!!!!!
Discontuinaton syndome
Depressed mood
Disqeulibrium
Muscle aches
GIT symptoms
Trmors
Isomina nad Night mares
parasthesia
___________________________
gradual discontiunation

51
Q

رب إني لما أنزلت إلي من خير فقير ^_^

A

A-CNS Pharma (11 decks)

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