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BMB Test 4 Leesy > B7.069 - Drugs for Mood Disorders > Flashcards

B7.069 - Drugs for Mood Disorders Flashcards

1
Q

primary use of antidepressants

A

treatment of depressive symptoms resulting in euthymia, should not elevate mood in non depressed people

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2
Q

four major classes of antidepressants

A

MAOIs
TCAs
SSRIs
miscellaneous

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3
Q

mechanism of most antidepressants

A

increased synaptic availability of NE and 5HT

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4
Q

therapeutic effects of antidepressants takes how long to develop

A

several weeks

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5
Q

ultimate effects of antidepressants may be due to

A
  1. secondary changes in receptors
  2. increased brain derived neurotrophic factors in hippocampus
  3. cognitive changes, supported by the proven efficacy of cognitive therapy
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6
Q

what are the MAOIs

A

Phenelzine

Tranylcypromine

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7
Q

mechanism of MAOIs

A

increase synaptic availability of NE and 5HT by blocking their catabolism
IRREVERSIBLY inhibits MAOa (NE and 5HT) and MAOb (DA)

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8
Q

receptors to MAOIs

A

Cholinergic
Histaminergic
alpha adrenergic

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9
Q

use of MAOIs

A

Primarily in individuals not adequately treated by other antidepressants

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10
Q

SE of MAOIs

A

Postural hypotension
weight gain
sexual dysfunction

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11
Q

MAOIs overdose symptoms

A

unusual but can cause seizures, shock, delirium, hyperthermia, not typically fatal

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12
Q

drug interactions of MAOIs

A

numerous!! Esp any drug that increases 5-HT or acts on its receptors
Can cause potentially fatal serotonin syndrome

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13
Q

what is serotonin syndrome

A 
Tremor
muscle rigidity
hyperthermia
hypertension
tachycardia
myoclonus
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14
Q

food interactions with MAOIs

A

tyramine containing foods leading to hypertensive crisis, precautions must be observed for 2 weeks after cessation because of irreversible action

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15
Q

what are the TCAs

A

Amitriptyline
Nortriptyline
Clomipramine

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16
Q

TCA mechanism

A

inhibit the reuptake of NE and/or 5HT and also potent antagonists at various receptors including cholinergic, histaminergic, apha adrenergic

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17
Q

AEs of TCAs

A 
sleepiness
Sympathomimetic effects
Anticholinergic effects*
Orthostatic hypotension* 
Weight gain*
sexual dysfunction*
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18
Q

TCA overdoses

A 
Life threatening suicide risk
Coma
Arrhythmias
seizures
cardiac effects
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19
Q

Interactions of TCAs

A

when combined with MAOIs

20
Q

what are the SSRIs

A 
Fluoxetine
sertraline
paroxetine
citalopram
escitalopram
21
Q

SSRI mechanism

A

inhibit 5HT reuptake, can inhibit NE reuptake at higher doses

22
Q

SSRI SEs

A

anxiety
GI*
Decreased libido*
sexual dysfunction*

23
Q

discontinuation syndrome

A

can be seen with SSRIs, most associated with drugs with short half lives and anti muscarinin activity

24
Q

adverse drug interactions of SSRIs

A

MAOIs, can lead to serotonin syndrome

25
Q

Other dispositional interactions of SSRIs

A

CYP2D6 inhibitors - fluoxetine and paroxetine

CYP3A4 - fluvoxamine

26
Q

active metabolites of SSRIs

A

Fluoxetine metabolites inhibit CYP2D6, CYP3A4 –> long t1/2

27
Q

5-HT and NE uptake inhibitors

A

Duloxetine
Venlafaxine
Milnacipran

28
Q

NE uptake inhibitors

A

Maprotiline

29
Q

5-HT uptake inhibitors

A

Vilazodone

Vortioxetine

30
Q

Vilazodone uptake

A

5HT1A partial agonist

5HT uptake inhibitor

31
Q

Vortioxetine

A

5-HT3 antagonists and 5HT1A agonist

32
Q

Mirtazepine

A

Increases 5-HT and NE release by blocking alpha 2 receptors on nerve terminals
sedating

33
Q

Buproprion

A

Inhibits dopamine reuptake as well as having effects on NE and a lesser extent 5-HT
Lower incidence of sexual dysfunction
SE include CNS stimulation including anxiety, agitation or insomnia

34
Q

Trazadone MOA

A

sedating at sub-antidepressant doses
5-HT2A antagonist
Weak inhibitor of NET and SERT
V short t1/2

35
Q

first degree use of Trazadone and main SE

A

Hypnotic and pre anesthetic

can cause priapism

36
Q

amoxapine MOA

A

inhibits reuptake of 5-HT and NE (NET>SERT)

Dopamine antagonist - antipsychotic activity

37
Q

Amoxapine SE

A

EPS and tardive dyskinesia, also similar to TCAs

38
Q

ROA of antidepressants

A

Oral, some TCAs can be IM

39
Q

exceptions to rule that antidepressants have relatively long t1/2

A

Trazadone, venlafaxine, buproprion

40
Q

metabolism and excretion of antidepressants

A

mostly hepatic
most eliminated in 7-10 days
More rapid than children, slower in aged –> adjust dose

41
Q

black box warning of antidepressants

A

can increase risk of suicidal thinking and behavior

42
Q

Other uses of antidepressants

A

Panic disorder, OCD, enuresis, chronic pain, eating disorders, smoking cessation, sedative, migraine prophylaxis, ADHD

43
Q

drugs of bipolar

A

mood stabilizers
antidepressants
drugs for bipolar depression
antipsychotics

44
Q

Mood stabilizers for bipolar

A

Lithium carbonate
Valproic acid
Carbamazepine
Lamotrigine

45
Q

lithium mech

A

may affect ion transport, serotinin system, PI cascade or arachadonic acid signaling

46
Q

lithium pharmacokinetics

A

absorbed rapidly but accumulates slowly in brain
Therapeutic levels reached in 6 to 10 days
95% excreted in urine

47
Q

Lithium side effects

A 
low therapeutic index
Tremor
Acne
polydipsia and polyuria
teratogenic

BMB Test 4 Leesy (4 decks)

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