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Psychopharm Q6 > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

What are the core elements of depression (MDD)

A

emotional, behavioral, cognitive

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2
Q

emotional elements of MDD

A

sadness, anhedonia, lack of motivation,

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3
Q

behavioral elements of MDD

A

anergia, psychomotor slowing

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4
Q

cognitive elements of MDD

A

helplessness, distortions (maladaptive thoughts)

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5
Q

monoamine theory for MDD

A

result of below-normal levels of DA, NE, and 5-HT

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6
Q

Key to treating depression

A

restore monoamine levels

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7
Q

what causes monoamine depletion

A

reserpine

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8
Q

antidepressants pharmacodynamic effect

A

boosting monoamine levels

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9
Q

MDD is a

A

neurohormonal disorder

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10
Q

MDD frequently appears in the aftermath of events (loss and failure), which are experienced as

A

uncontrollably stressful

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11
Q

uncontrollably stressful events are associated with

A

excessive output of the hormone cortisol

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12
Q

The tendency to interpret loss/failure events as uncontrollably stressful probably lies in

A

pre-existing ways of processing information

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13
Q

Dexamethasone suppression test in non-depressed people

A

DXM suppresses release of cortisol for about 24 hours, and then cortisol slowly comes back to its relatively low levels

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14
Q

Dexamethasone suppression test in depressed people

A

DXM suppresses release of cortisol for just a few hours, and then cortisol bounces back to its relatively high levels

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15
Q

HPAC system during stress (CNS stress system)

A

hypothalamus activates pituitary gland with CRH, pituitary gland activates adrenal cortex with ACTH, adrenal cortex activates cortisol release, cortisol activates hippocampus, hippocampus stops hypothalamus

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16
Q

what does the hypothalamus also do in the HPAC system during stress

A

stops CNS positive motivation system (BAS)

17
Q

what is CRH

A

corticotropin releasing hormone

18
Q

what is ACTH

A

adrenocorticotropic hormone

19
Q

what does the hippocampus do in the HPAC system during stress specifically

A

sends signal to hypothalamus to stop cortisol release

20
Q

when the HPAC system is activated, what happens to the brains positive motivation system (BAS)?

A

decreases in activity

21
Q

where are the adrenal glands located

A

kidneys

22
Q

behavioral activation system (reward based system)

A

BAS

23
Q

what do high levels of cortisol do to the hippocampus

A

kill it

24
Q

what happens in HPAC dysregulation

A

excess levels of cortisol are released causing the hippocampus to deteriorate, leading to the hippocampus no longer being able to tell the hypothalamus to stop producing cortisol

25
Q

first true antidepressant medications

A

MAOIs: Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), MAO-B only: Emsam transdermal patch (selegiline, deprenyl)

26
Q

T1/2 elimination of MAOIs

A

a couple of hours

27
Q

nonselective inhibitors of both MAO-A and MAO-B

A

reduce breakdown of DA, NE, and 5-HT, do NOT have adverse effects on ACh activity

28
Q

issues of MAOI antidepressants

A

-Excess DA levels can precipitate psychotic symptoms and agitation
-MAOIs bind to MAO and block its activity permanently = drug effect lasts even after
discontinuation, until new MAO is synthesized (1-2 weeks)
-Cheese syndrome

29
Q

cheese syndrome

A

tyramine, found in food and beverages gone under fermentation can be fatal in people taking MAOI antidepressants

30
Q

why can taking an MAO-A inhibiter lead to cheese syndrome

A

MAO-A in the gut breaks down tyramine, when taking an MAO-A inhibitor, tyramine has sympathetic effects (mimics sympathetic nervous system, fight/flight), which increases heart rate and blood pressure, and can trigger hypertensive crisis which can be fatal

31
Q

what would be preferable instead of an MAO-A inhibitor to reduce risk of cheese syndrome

A

A RIMA (reversible inhibitor of MAO-A), doesn’t bind permanently

32
Q

what RIMA is available worldwide except in USA because it would have to go through FDA approval process, and no one will make money off of it

A

Aurorix (moclobemide), a better RIMA

33
Q

the second type of ADM

A

tricyclic antidepressants (TCAs)

34
Q

Good absorption after PO admin, blood levels peak after ~60 minutes

A

Tricyclic antidepressants (TCAs)

35
Q

TCA T1/2

A

around 24 hours, daily usage

36
Q

main mechanism of TCA

A

reuptake blockade of NE and 5-HT

37
Q

TCAs have what kind of side effects

A

anti-cholinergic, blocks Ach activity

Psychopharm Q6 (1 decks)

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