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MD4001 Pharmacology > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

What was depression originally thought to be caused by?

A
  • Low levels of serotonin

- Now not as clear but likely a reduction in serotonin receptors in hippocampus

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2
Q

WHat were the first class of antidepressants developed?

A

Mono Amine Oxidase Inhibitors (MAOI)

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3
Q

What does Mono Amine Oxidase break down?

A
  • Norepinephrine
  • Serotonin
  • Dopamine
    MAOIs therefore increase the levels of these 3 transmitters
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4
Q

What are some common MAOIs?

A
  • Phenelzine
  • Selegiline - also used in parkinsons
  • Tranylcypromine
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5
Q

What are the side effects of Mono Amine Oxidase inhibitors MAOIs?

A
  • Weakness
  • Headache
  • Weight gain
  • Dizziness
  • Fatigue
  • Impotence
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6
Q

What should MAOIs not be used in combination with?

A
  • SSRI/Tricyclic

- Analgesics such as morphine/tramadol as they will increase serotonin to potentially dangerous levels

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7
Q

How many days should be given after stopping MAOI before starting other antidepressants?

A

14

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8
Q

What foods should you avoid whilst taking MAOIs?

A

Foods high in tyramine may also cause a hypertensive crisis

  • Cheese
  • Certain meats such as venison
  • Alcohol
  • Some green vegetables i.e broad beans
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9
Q

How do Reversible MAOIs differ to MAOIs?

A
  • Reversible inhibition of MAO type A ]
  • Tyramine has less of an effect
  • Only 1 week washout period
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10
Q

How do tricyclic antidepressants work?

A
  • Inhibit re-uptake of norepinephrin and serotonin by blocking the transporters responsible for their re-uptake
  • Increase concentration of neurotransmitters in the synapses and triggering further neurotransmission
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11
Q

What are tricyclic antidepressants used for?

A
  • Depression
  • Anxiety
  • Chronic pain (i.e fibromyalgia, reflex sympathetic dystrophy syndrome)
  • IBS
  • Neuralgia
  • OCD
  • Nocturnal enuresis
  • PTSD
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12
Q

What are the side-effects of tricyclic antidepressants?

A
  • Arrythmias
  • Antimuscarinic activity that blocks activity of the muscarinic Ach receptor and so reduce intestinal mobility
  • Bradycardia followed by tachycardia, reduced bronchial secretions, urinary retention, dry mouth and confusion (not used in elderly)
  • Use with caution in patients with high risk of suicide (very dangerous in overdose)
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13
Q

What are the common tricyclic antidepressants?

A
  • Amitriptyline
  • Clomipramine
  • Imipramine
  • Lofepramine
  • Nortriptyline
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14
Q

What is a drug relating to tricyclics?

A
  • Trazodone - more sedating
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15
Q

How are SSRIs believed to work?

A
  • Limit re-absorption of serotonin thus increasing its leves
  • Have only a weak affinity for norepinephrine and dopamine
  • Most prescribed, Cleaner, less side-effects, better tolerated
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16
Q

What are serotonin receptors known as?

A

5-hydroxytryptamine (5-HT)

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17
Q

What are the uses of SSRIs?

A
  • Depression (first line)
  • Anxiety
  • OCD
  • Panic disorder
  • PTSD
  • Eating disorder
18
Q

Where are 5-HT receptors found?

A

Peripheral and central nervous systems mediating both excitatory and inhibitory neurotransmission

19
Q

What neurotransmitters do SSRIs modulate the release of?

A
  • GABA
  • Dopamine
  • Epinephrine
  • Norepinephrine
  • Ach
20
Q

What do 5-HT receptors have an influence on?

A
  • Aggression
  • Anxiety
  • Cognition
  • Learning memory
  • Mood
  • Sleep
21
Q

What are the side-effects of SSRIs?

A
  • Sexual: dysfunction, reduced libido
  • Cardiac: QT interval prolongation therfore dose dependant with citalopram
  • Bleeding: affects antocoagulants (i.e. warfarin and aspirin) and also increased risk of GI bleeds
  • Suicide
  • Overdose (safer than most)
  • Epilepsy
  • Nausea, rash, muscle aches, insomnia, sweating
22
Q

Who is able to prescribe SSRIs to under 18s?

A

Only psychiatrists due to increased risk of suicide in adolescents and children

23
Q

Name a serotonin norepinephrine up-take inhibitor)

A

Duloxetine

24
Q

What are the uses of duloxetine (SNRI)?

A
  • Depression
  • Neuropathic pain (diabetes, fibromyalgia)
  • Stress urinary incontinance
25
Q

What are the side-effects of duloxetine (SNRI)?

A
  • Nausea
  • Insomnia
  • Dizziness
26
Q

WHat is mirtazapine?

A

A presynaptic alpha2-adrenoreceptor antagonist. Also a noradrenergic and specific serotonergic antidepressant NaSSA

27
Q

What are the uses of Mirtazapine?

A
  • Depression
  • Anxiety
  • PTSD
28
Q

What are the side-effects of Mirtazapine?

A
  • Low dose drowsiness so best taken at night

- Higher dose more stimulant effect

29
Q

What is Venlafaxine?

A

Serotonin-norepinephrine re-uptake inhibitor (SNRI)

30
Q

What are the uses of Venlafaxine (SNRI)?

A
  • Major Depressive disorder
  • Anxiety
  • Panic
  • Social phobia
  • Metabolised in the body into desvenlafaxine (by cytochrome P206 isoenzyme in the liver)
  • Often used in treatment of resistant depression
31
Q

Name an antipsychotic which can be used for depression?

A

Risperidone

32
Q

What antidepressant can be used in bipolar disorder?

A

Lithium

33
Q

What are some possible adverse effects of lithium?

A

Adverse effects on thyroid and kidney function

34
Q

How can antidepressants treat pain?

A
  • Tricyclics by blocking re-uptake of NA and serotonin (5-HT) into the nerve endings and increasing their levels in the pain control pathways
  • Can benefit fighting pain through direct effect and also though beneficial effects on sleep
35
Q

What antidepressants can be used in fighting pain?

A
  • Amnitriptyline, nortriptyline, duloxetine

- Duloxetine also liscensed for diabetic neuropathy

36
Q

What is the life-threatening arrhythmia associated with QT-prolongation?

A

Torsades de pointes

37
Q

What drug has a highlighted risk of QT-prolongation?

A

Citalopram

38
Q

What groups of people have a greater risk of QT-prolongation?

A
  • Major psychiatric disorders
  • CV disease
  • Elderly
  • Women
39
Q

How can anti-depressants increase the chances of suicide?

A
  • Side-effect of increased stimulation

- Gives individual ‘drive’ to do something to oneself

40
Q

Are SSRIs prolonged release drugs?

A

No - have a long half-life as is

41
Q

What are some examples of SSRIs from most toxic to least toxic?

A
  • Citalopram (QT interval)
  • Escitalopram
  • Paroxetine
  • Sertraline
  • Fluoxetine

MD4001 Pharmacology (8 decks)

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