Antidepressants

Question 1

Depression is =

Answer 1

Unipolar mood disorder

Question 2

Less severe depression disorder is called ?

Answer 2

Dysthymia

Question 3

Episodes of depression and mania =

Answer 3

Bipolar mood disorder

Question 4

Less severe episodes of bipolar mood disorder =

Answer 4

Cyclothymia

Question 5

Definition of depression :

Answer 5

Extended state of sadness and helplessness

Question 6

A major depressive episode criteria :

Answer 6

Must last at least 2 weeks

Have at least four symptoms

Question 7

Symptoms of depression :

Answer 7

• changes in appetite and weight
• changes in sleep and activity
• lack of energy
• feeling of guilt
• problems thinking and making decision
• recurring thoughts of death or suicide

Question 8

Definition of mania :

Answer 8

Abnormal and persistent elevated, expansive or irritable mood.

Question 9

Criteria for mania :

Answer 9

Must last for 1 week.

Associated with :
Inflated self esteem
decreased need for sleep
distractibility
great physical and mental activity
over involvement of pleasurable behavior

Question 10

Depression theory:

Answer 10

1-monoamine theory.

2-neurotrophic hypothesis.

Question 11

Monoamine theory :

Answer 11

It’s suggests that depression is due to deficiency of monoamine neurotransmitters
(noradrenalin and serotonin)

Question 12

Neurotrophic hypothesis :

Answer 12

Chronic stress leads to decreases in brain drive neurotrophic factor (BDNF) in the hippocampus.

Long term increases in glucocorticoids, ischemia, neurotoxins, hypoglycemia etc. May be associated with neurodegeneration and reduce neurogenesis in the hippocampus.

Question 13

Fast (2-4 weeks) treatments for depression :

Answer 13

Antidepressants:

• TCAs
• SSRIs
• NaRIs
• SNRIs
• MAOIs
• Atypical antipsychotics
• Ketamine

Question 14

Long (weeks,months,years) treatments of depression :

Answer 14

Psychotherapy :

• Talking therapy
• Cognitive behavioral therapy
• Counseling

Question 15

Immediate treatment of depression :

Answer 15

Physical intervention:

• Electroconvulsive treatment
• Electromagntic treatment
• Deep brain stimulation
• Vagel stimulation

Question 16

Classification of antidepressants :

Answer 16

A-Monoamine uptake inhibitors
-TCAs
-SSRIs
-SNRIs
-NaRIs
B-Mnonamine oxidase inhibitors (MOIs)
C-Monoamine receptor antagonists
D-Melatonin receptor agonists

Question 17

Mechanism of action of TCAs ?

Answer 17

Inhibits reuptake of 5-HT and/of NA

Also block some receptors (Adrenergic, Histaminic, Muscarinic.)

Question 18

Examples of TCAs :

Answer 18

Amitryptiline / Imipramine

Question 19

Important side-effects of TCAs :

Answer 19

Sedation (H1)
Postural hypotension (Alpha adrenoceptor)
Dry mouth, blurred vision, constipation (Muscarinic)
Impotence
Occasionally Mania, convulsions

Question 20

Acute overdose of TCAs cause :

Answer 20

Confusion
Mania
Cardiacs dysrhythymias

Question 21

TCAs interaction with other drugs :

Answer 21

Alcohol
Anaesthetics
Hypotensive drugs
NSAIDs

Question 22

Which class of drugs TCAs should not be used with :

Answer 22

Monoamine oxidase inhibitors (MAOIs)

Question 23

Examples of selective serotonin reuptake inhibitors:

Answer 23

Fluoxetine (long-acting)

Citalopram

Question 24

What are the advantages of SSRIs :

Answer 24

Less Acute toxicity
Less sedation
Less antimuscarinic side effects
Less overdose risk
No food reactions

Question 25

What are the side effects of SSRIs :

Answer 25

Nausea Insomnia Sexual dysfunction Sedation

Question 26

Which class of drugs SSRIs should not be used with ?

Answer 26

MAOIs

Question 27

What's meant by serotonin reaction ?

Answer 27

Hyperthermia Muscle rigidity Cardiovascular collapse

Question 28

Example of selective serotonin and noradrenalin reuptake inhibitors (SNRIs) :

Answer 28

Duloxetine (more potent, no receptor blocking)

Question 29

Uses of Duloxetine :

Answer 29

Depression Neuropathic pain Fibromyalgia Urinary incontinence

Question 30

Advantages of Duloxetine :

Answer 30

Similar efficacy as SSRIs Lower adverse effects that other SNRIs

Question 31

Side effects of SNRIs :

Answer 31

sedation Dizziness Nausea Sexual dysfunction Hypertension

Question 32

Example for selective noradrenalin reuptake inhibitors (NaRIs) :

Answer 32

Bupropion (inhibitors of noradrenalin and dopamine uptake) Atomoxetine

Question 33

Uses of bupropion :

Answer 33

Used in : Depression associated with anxiety. Treat nicotine dependence

Question 34

Side-effects of bupropion :

Answer 34

``` Headache Dry mouth Agitation Insomnia Seizures at high dose ``` Less sexual dysfunction

Question 35

Uses of atomoxetine :

Answer 35

It's used in treatment of attention deficit hyperactivity disorder (ADHD)

Question 36

Example of monoamine oxidase inhibitors (MAOIs) :

Answer 36

Moclobemide

Question 37

Mechanism of action of Moclobemide :

Answer 37

Reversible, short acting, MAO-A selective Inhibits the substance that break the monoamines

Question 38

Side effects of MAOIs :

Answer 38

Postural hypotension Atropine-like effects Weight gain CNS stimulation Hepatotoxicity & neurotoxicity (Rare) Cheese reaction (up to 2 weeks after treatment is stoped)

Question 39

What's meant by cheese reactions ? In which class ?

Answer 39

Severe hypertensive response to tyramine-contenting food (Cheese, beer, yeast) It can happen after 2 weeks after treatment is stoped MAOIs

Question 40

Interactions of MAOIs :

Answer 40

SSRIs SNRIs TCAs Sympathomimetic amines

Question 41

Example of monoamine receptor antagonists

Answer 41

Mirtazapine

Question 42

Mechanism of action of Mirtazapine :

Answer 42

Block the following receptors : Presynaptic Alpha 2 (increases noradrenalin) 5-HT2 and 5-HT3 (enhancing the effect on 5-HT1)

Question 43

Example of melatonin receptor agonists :

Answer 43

Agomelatine

Question 44

An effective depression treatment should last for .......

Answer 44

At least 2 years

Question 45

The major difference between different classes of antidepressants is :

Answer 45

Side effects

Question 46

SSRIs are usually preferred because :

Answer 46

Better tolerated | Less dangerous in overdose

Question 47

In urgent cases ................. should be considered.

Answer 47

Electroconvulsive therapy

Question 48

Which class of antidepressants is used for treatment of premature ejaculation :

Answer 48

SSRIs

Question 49

Example for mood stabilizers :

Answer 49

Lithium

Question 50

Uses of lithium :

Answer 50

Treatment of bipolar disorders

Question 51

What is the mechanism of action of lithium ?

Answer 51

Unknown mechanism

Question 52

Which class of drugs increase the Toxicity of lithium ?

Answer 52

Diuretics