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Antidepressants Flashcards

1
Q

What are the 2 types of depression? Differentiate between them

A
  1. Unipolar - mood swings always in the same direction (ie. repeated episodes of feeling emotionally low)
  2. Bipolar - alternating depression and MANIA
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2
Q

Describe the monoamine theory

A

Deficits in monoamine neurotransmitters (noradrenaline and 5-HT) causes depression.

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3
Q

List the classes of antidepressants

A
  1. Monoanime oxidase inhibitors (MAOIs)
  2. Tricyclic antidepressants
  3. **Selective serotonin reuptake inhibitors (SSRIs)
  4. Selective noradrenaline uptake inhibitors
  5. 5-HT and noradrenaline uptake inhibitors
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4
Q

What is the MOA of MAOIs?

A

Monoanime oxidase breaks down monoanimes.

Inhibit it = more monoanime neurotransmitters

MAO-A are serotonin selective

MAO-B is dopamine/noradrenaline selective

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5
Q

Name the MAO-B selective inhibitor used in Parkinson’s

A

Selegiline

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6
Q

When is selegiline used?

A

MAO-B selective inhibitor used in Parkinson’s

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7
Q

Name a non-selective MAOI and its unique property

A

Phenelzine

It is an irreversible inhibitor.

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8
Q

What are the adverse effects of MAOIs?

A
  1. Postural hypotension - sympathetic block due to accumulation of dopamine
  2. Restlessness and insomnia
  3. Cannot be combined with other drugs that agonise serotonin receptors - can cause hyperexcitability
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9
Q

What is the MOA of tricyclic antidepressants?

A

Monoamine (serotonin and noradrenaline) reuptake inhibitor

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10
Q

Name at least 2 non-selective tricyclic antidepressants

A

Imipramine
Amitriptyline
Nortriptyline

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11
Q

Name a tricyclic antidepressant selective for noradrenaline/dopamine

A

Desipramine

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12
Q

Of the non-selective tricyclic antidepressants, which drug has milder side effects and more desirable?

A

Nortriptyline

Second gen TCA

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13
Q

List the adverse effects of TCAs

A
  1. Sedation due to histamine receptor antagonism** but can develop tolerance in 1-2 weeks
  2. Postural hypotension (different from MAOIs which is due to non-selective sympathetic block, TCA is due to alpha adrenoreceptor sympathetic block)
  3. Cholinergic symptoms (dry mouth, blurred vision and constipation due to muscarinic receptor antagonism)
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14
Q

What is the most commonly used class of drugs for anti depressants?

A

Selective serotonin reuptake inhibitors (SSRIs)

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15
Q

What is the most widely prescribed antidepressants?

A

Fluoxetine

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16
Q

*** List at least 2 advantages of using SSRIs

A
  1. Low affinity for alpha adrenoreceptors (TCA) -> reduce risk of cardiovascular overstimulation -> SAFER IN OVERDOSE
  2. Lack of effect at histamine receptors (TCA)
    -> reduce sedation
  3. Low affinity for muscarinic receptors (TCA) -> minimal cholinergic side effects
  4. Overall, the less side effects compared to TCA/MAOIs leads to BETTER COMPLIANCE
17
Q

Compare between SSRIs and TCA

A

SSRIs has less side effects which leads to better compliance. Can prescribe higher dose as there is a lower risk of overdose.

Because of the adverse effects of TCA and fear of overdose, TCA is often prescribed at subtherapeutic dose.

18
Q

What are the adverse effects of SSRIs?

A

Nausea
Insomnia
Sexual dysfunction
**SEROTONIN SYNDROME

19
Q

Name 2 SSRIs

A

Citalopram
Fluoxetine

20
Q

What is the most severe adverse effect associated with serotonin?

A

SEROTONIN SYNDROME

Happens when there is DDI between drugs with serotoninergic activity (eg. MAOIs, TCA)

Tremor
Hyperthermia
Cardiovascular collapse

21
Q

What is the brand name of fluoxetine?

A

Prozac

22
Q

What is drug makes up the brand Prozac?

A

Fluoxetine

23
Q

What is the first line class of antidepressant?

A

SSRIs (ie. fluoxetine, citalopram)

24
Q

If patient is not responsive to SSRI treatment, what is the second line class of drug to give?

A

Noradrenaline reuptake inhibitors like reboxetine

25
Q

What is the SSRI with the highest selectivity for serotonin?

A

Citalopram

26
Q

Name a noradrenaline reuptake inhibitor

A

Reboxetine

27
Q

What is reboxetine?

A

A noradrenaline reuptake inhibitor

28
Q

List the adverse effects of reboxetine

A

More noradrenaline = more stimulation of CNS/SNS = less PNS

  1. Anticholinergic effects - dry mouth, constipation
  2. Stimulation of CNS = insomnia
  3. Stimulation of SNS = tachycardia
29
Q

Name a serotonin and noradrenaline reuptake inhibitors (SNRIs)

A

Venlafaxine
Duloxetine

30
Q

Will taking SNRIs with SSRIs increase the risk of serotonin syndrome?

A

Yes, since they both increase activity at serotonin receptors

31
Q

List some adverse effects of SNRIs

A

A mix of SSRI and NARI symptoms

SSRI: nausea, insomnia, sexual dysfunction, serotonin syndrome

NARI: dry mouth, constipation, tachycardia, insomnia

32
Q

List some adverse effects associated with increased activity at serotonin receptors

A

Nausea
Insomnia
Sexual dysfunction

33
Q

List some adverse effects associated with increased activity at NA receptors

A

Stimulation of CNS = insomnia and SNS = tachycardia

Less stimulation of PNS = dry mouth, constipation

34
Q

If a patient is not responsive to SSRI treatment, what are the other class of drugs that can be prescribed?

A

NARIs
SRNIs

35
Q

What is mirtazapine?

A

A noradrenaline and specific serotonin antidepressant

36
Q

What is bupropion?

A

A norepinephrine and DOPAMINE reuptake inhibitor

37
Q

What is agomelatine?

A

Agonist of melatonin MT1 and MT2 receptors

38
Q

What is ketamine?

A

A glutamate NMDA receptor antagonist

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