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therapeutics 2 > Antidepressants/Bipolar (Patho) > Flashcards

Antidepressants/Bipolar (Patho) Flashcards

1
Q

what are the physiological features of depression

A

decreased sleep, appetite changes, fatigue, psychomotor dysfunction

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2
Q

what are the psychological features of depression

A

dysphoria, worthlessness, excessive guild, loss of interest in all or most activities

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3
Q

what are the cognitive features of depression

A

decreased concentration and suicide ideation

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4
Q

what to rule out before diagnosing depression

A

drug induced depression
medical conditions
bereavement

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5
Q

what drugs can induce depression

A

antihypertensives
sedative hypnotics
anti-inflammatory/analgesics
steroids
PD drugs or neuroleptics

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6
Q

how is reserpine related to depression

A

depletes NE and 5HT from vesicles

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7
Q

how does neuroendocrine relate to depression

A

overactivity of HPA axis leads to desensitization of feedback
increased CRF and symptoms of depression

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8
Q

how does neurotrophic relate to depression

A

stress and pain decrease BDNF levels
BDNF has antidepressant activity via the sprouts that make neuro connections

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9
Q

how do the hypotheses of depression relate to one another

A

HPA and steroids regulate BDNF
glucocorticoid receptor activated by cortisol will decrease BDNF
chronic activation of monoamine receptors will increase BDNF signaling and downregulate HPA axis

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10
Q

how does selectivity relate to choosing drug therapy

A

some drug classes will have similar selectivity which means you may have to try different classes when treating depression

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11
Q

MOA of MAOIs

A

MAO-A break down NE and 5HT
MAO-B break down dopamine

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12
Q

what are the 3 types of MAOIs

A

non-selective
MAO-B selective
MAO-A selective

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13
Q

what are the non-selective MAOIs and when do you use them

A

phenelzine
tranylcypromine
reserved for treatment resistant depression

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14
Q

what are the MAO-B selective drugs

A

selegiline

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15
Q

what are the MAO-A selective drugs

A

moclobemide

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16
Q

what are the issues with MAOIs

A

severe side effects
HTN crisis (avoid tyramine)
Interactions w/ OTCs
Irreversible (long wash out period)

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17
Q

what is the major risk with tricyclics

A

dangerous to those with suicide ideation due to OD risk

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18
Q

MOA of tertiary amines

A

inhibit both NE and 5HT receptors via NET and SERT

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19
Q

what are tertiary amine antagonists for

A

antihistamines
antimuscarinics
antiadrenergics

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20
Q

what are the side effects of tertiary amines

A

sedation, autonomic SEs, weight gain

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21
Q

what are the tertiary amine drugs

A

imipramine
amitriptyline
trimipramine
clomipramine
doxepin

22
Q

MOA of secondary amines

A

more inhibition of NET than SERT

23
Q

what are secondary amines

A

desipramine
protriptyline
nortriptyline
maprotiline

24
Q

what are the side effects of secondary amines

A

same as tertiary amines but way less

25
Q

MOA of SSRIs

A

serotonin transporter pumps are blocked and there is an increase in serotonin in synapse as a result

26
Q

what are the SSRI drugs

A

fluoxetine
fluvoxamine
paroxetine
sertraline
citalopram
escitalopram

27
Q

what are the side effects of SSRIs

A

N/V
headache
sexual dysfunction
anxiety
insomnia
tremor

28
Q

what are the withdrawal symptoms of SSRIs

A

brain zaps
dizziness
sweating
nausea and vertigo

29
Q

when is serotonin syndrome risk highest

A

SSRI given with MAOI or TCAs

30
Q

serotonin syndrome symptoms

A

hyperthermia
muscle rigidity
restlessness
seizures
sweating

31
Q

serotonin syndrome treatment

A

d/c med
manage symptoms
serotonin antagonist (cyproheptadine)
benzos for seizures

32
Q

what are the SSRI + 5HT1a partial agonist

A

vilazodone
vortioxetine

33
Q

what are the tetracyclic and unicyclic drugs

A

maprotiline
amoxapine
mirtazapine
buproprion

34
Q

mirtazapine MOA

A

alpha 2 antagonist
5HT2 and 5HT3 antagonist
H1 antagonist
receptor antagonist not transporter

35
Q

bupropion MOA

A

NET and SERT inhibitor
DAT inhibitor

36
Q

what is the 5HT2 antagonist/SERT

A

trazodone

37
Q

trazodone side effect

A

extremely sedating

38
Q

what are the NMDA antagonists

A

ketamine
esketamine
both at low doses

39
Q

MOA of SNRIs

A

NET and SERT inhibitors

40
Q

SNRI drug examples

A

venlafaxine
desvenlafaxine
duloxetine
milnacipran
levomilnacipran

41
Q

how to treat postpartum depression

A

SSRIs
venlafaxine
CBT + counseling
Brexanolone

42
Q

MOA of brexanolone

A

GABA-A receptors resensitization
very expensive and REMS

43
Q

what are the 3 treatment options for bipolar

A

hospitalization
psychotherapy
pharmacotherapy

44
Q

what are the classes of drugs used in bipolar

A

mood stabilizers
atypical antipsychotics
calcium channel blockers
combo therapy

45
Q

what is the main mood stabilizer used in bipolar

A

lithium

46
Q

MOA of lithium

A

depletion of PIP2 and associated signaling of IP3 and PKC
modulates GSK3

47
Q

what are the steps of lithium MOA

A

-Gq activated
-PLC activated
-IP3 made and recycled into PIP2
-Lithium blocks the recycling
-membrane has no PIP2
-PLC has no substrate so no signaling or effects

48
Q

why does lithium have so many side effects

A

any substrate coupled to Gq will be shut down (lots of this)

49
Q

what are the main problems with using lithium

A

small therapeutic index
lag time for effectiveness
need a loading dose
many SE

50
Q

valproic and sodium valproate MOA

A

increase in GABAergic tone
block Na channels
Block T type Ca channels
inhibit HDAC5

51
Q

Carbamazepine/Oxcarbazepine MOA

A

block Na channel
drug binds in inactivated state

52
Q

Lamotrigine MOA

A

block Na and Ca channel

therapeutics 2 (24 decks)

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