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M&M Pharma > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Depression is =

A

Unipolar mood disorder

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2
Q

Less severe depression disorder is called ?

A

Dysthymia

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3
Q

Episodes of depression and mania =

A

Bipolar mood disorder

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4
Q

Less severe episodes of bipolar mood disorder =

A

Cyclothymia

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5
Q

Definition of depression :

A

Extended state of sadness and helplessness

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6
Q

A major depressive episode criteria :

A

Must last at least 2 weeks

Have at least four symptoms

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7
Q

Symptoms of depression :

A
  • 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
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8
Q

Definition of mania :

A

Abnormal and persistent elevated, expansive or irritable mood.

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9
Q

Criteria for mania :

A

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
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10
Q

Depression theory:

A

1-monoamine theory.

2-neurotrophic hypothesis.

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11
Q

Monoamine theory :

A

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

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12
Q

Neurotrophic hypothesis :

A

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.

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13
Q

Fast (2-4 weeks) treatments for depression :

A

Antidepressants:

  • TCAs
  • SSRIs
  • NaRIs
  • SNRIs
  • MAOIs
  • Atypical antipsychotics
  • Ketamine
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14
Q

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

A

Psychotherapy :

  • Talking therapy
  • Cognitive behavioral therapy
  • Counseling
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15
Q

Immediate treatment of depression :

A

Physical intervention:

  • Electroconvulsive treatment
  • Electromagntic treatment
  • Deep brain stimulation
  • Vagel stimulation
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16
Q

Classification of antidepressants :

A 
A-Monoamine uptake inhibitors
-TCAs
-SSRIs
-SNRIs
-NaRIs
B-Mnonamine oxidase inhibitors (MOIs)
C-Monoamine receptor antagonists
D-Melatonin receptor agonists
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17
Q

Mechanism of action of TCAs ?

A

Inhibits reuptake of 5-HT and/of NA

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

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18
Q

Examples of TCAs :

A

Amitryptiline / Imipramine

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19
Q

Important side-effects of TCAs :

A

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

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20
Q

Acute overdose of TCAs cause :

A

Confusion
Mania
Cardiacs dysrhythymias

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21
Q

TCAs interaction with other drugs :

A

Alcohol
Anaesthetics
Hypotensive drugs
NSAIDs

22
Q

Which class of drugs TCAs should not be used with :

A

Monoamine oxidase inhibitors (MAOIs)

23
Q

Examples of selective serotonin reuptake inhibitors:

A

Fluoxetine (long-acting)

Citalopram

24
Q

What are the advantages of SSRIs :

A 
Less Acute toxicity
Less sedation
Less antimuscarinic side effects
Less overdose risk
No food reactions
25
Q

What are the side effects of SSRIs :

A

Nausea
Insomnia
Sexual dysfunction
Sedation

26
Q

Which class of drugs SSRIs should not be used with ?

A

MAOIs

27
Q

What’s meant by serotonin reaction ?

A

Hyperthermia
Muscle rigidity
Cardiovascular collapse

28
Q

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

A

Duloxetine (more potent, no receptor blocking)

29
Q

Uses of Duloxetine :

A

Depression
Neuropathic pain
Fibromyalgia
Urinary incontinence

30
Q

Advantages of Duloxetine :

A

Similar efficacy as SSRIs

Lower adverse effects that other SNRIs

31
Q

Side effects of SNRIs :

A

sedation
Dizziness
Nausea
Sexual dysfunction

Hypertension

32
Q

Example for selective noradrenalin reuptake inhibitors (NaRIs) :

A

Bupropion (inhibitors of noradrenalin and dopamine uptake)

Atomoxetine

33
Q

Uses of bupropion :

A

Used in :
Depression associated with anxiety.

Treat nicotine dependence

34
Q

Side-effects of bupropion :

A 
Headache
Dry mouth
Agitation
Insomnia
Seizures at high dose

Less sexual dysfunction

35
Q

Uses of atomoxetine :

A

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

36
Q

Example of monoamine oxidase inhibitors (MAOIs) :

A

Moclobemide

37
Q

Mechanism of action of Moclobemide :

A

Reversible, short acting, MAO-A selective

Inhibits the substance that break the monoamines

38
Q

Side effects of MAOIs :

A

Postural hypotension
Atropine-like effects
Weight gain
CNS stimulation

Hepatotoxicity & neurotoxicity (Rare)

Cheese reaction (up to 2 weeks after treatment is stoped)

39
Q

What’s meant by cheese reactions ?

In which class ?

A

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

MAOIs

40
Q

Interactions of MAOIs :

A

SSRIs
SNRIs
TCAs
Sympathomimetic amines

41
Q

Example of monoamine receptor antagonists

A

Mirtazapine

42
Q

Mechanism of action of Mirtazapine :

A

Block the following receptors :

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

43
Q

Example of melatonin receptor agonists :

A

Agomelatine

44
Q

An effective depression treatment should last for …….

A

At least 2 years

45
Q

The major difference between different classes of antidepressants is :

A

Side effects

46
Q

SSRIs are usually preferred because :

A

Better tolerated

Less dangerous in overdose

47
Q

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

A

Electroconvulsive therapy

48
Q

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

A

SSRIs

49
Q

Example for mood stabilizers :

A

Lithium

50
Q

Uses of lithium :

A

Treatment of bipolar disorders

51
Q

What is the mechanism of action of lithium ?

A

Unknown mechanism

52
Q

Which class of drugs increase the Toxicity of lithium ?

A

Diuretics

M&M Pharma (4 decks)

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