CNS affective disorders Flashcards
affective disorders
- includes _____ and _____ disorders
- depression is an _____ disorder characterized by changes in _____ (depression)
- distinct from _____ which is disturbance of thought
- patients feel sad, anxious, empty, hopeless, worried, helpless, worthless, guilty, irritable, hurt, or restless
- they may lose interest in activities that once were pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details, or making decisions
depression bipolar affective mood schizophrenia
common depressive syndromes
_____: chronic depressive illness for _____ or more years, fewer and less severe symptoms than major depression
antidepressants and psychotherapy: _____
dysthymia
SSRIs
antidepressants \_\_\_\_\_ (MAOI) \_\_\_\_\_ (TCA) \_\_\_\_\_ (SSRI) \_\_\_\_\_ (heterocyclics) \_\_\_\_\_ blockers
monoamine oxidase inhibitors tricyclic antidepressants selective serotonin reuptake inhibitors atypical alpha 2 adrenoceptor
tricyclic antidepressants (TCA)
- _____ (Elavil)
- _____ (Anafranil): first line for OCD
- _____ (Norpramin)
- _____ (Tipramine)
clinical uses:
- depression
- _____
- migraine
- _____ pain
- panic disorders
- obsessive compulsive disorders
- chronic pain
- eating disorders
- ADHD
- sleep disorders: _____, night terrors
amitriptyline clomipramine desipramine imipramine enuresis neurological somnambulism
tricyclic antidepressants (TCA)
- mechanism of action
- -_____ reuptake inhibitor
- –NE, 5HT, DA
- -short term effects:
- –block the _____ of _____ (_____, _____, _____)
- –increase the synaptic concentration of neurotransmitters
- —increase stimulation of pre and post synaptic receptors
- —2-3 weeks for clinical effects… why?
non selective reuptake neurotransmitters NE, 5HT, DA because receptors have to be down regulated back to normal for them to be able to function
tricyclic antidepressants (TCA)
MOA: long term effects
-increases the synaptic concentration of _____
–increase stimulation of _____ receptors
–down regulation of _____ autoreceptors
NT
post synaptic
presynaptic
tricyclic antidepressants (TCA) pharmacokinetics -absorption and distribution --\_\_\_\_\_ absorption --undergo significant \_\_\_\_\_ --high \_\_\_\_\_ binding, high \_\_\_\_\_ solubility, large \_\_\_\_\_ --\_\_\_\_\_ metabolized --active and inactive metabolites: ---amitriptyline to \_\_\_\_\_ (Aventyl) ---imipramine to \_\_\_\_\_ (Norpramin) --TCAs and their active metabolites have a relatively \_\_\_\_\_ half-life (18 to 70 hours)
incomplete first pass effect protein lipid volume of distribution extensively nortriptyline desipramine long
tricyclic antidepressants (TCA) adverse effects -drowsiness and sedation -\_\_\_\_\_ effects (tremor, insomnia) -\_\_\_\_\_ effects (blurred vision, constipation, dry mouth -\_\_\_\_\_ (\_\_\_\_\_ hypotension, reflex tachycardia, \_\_\_\_\_) -\_\_\_\_\_ (withdrawal syndrome) -\_\_\_\_\_ (lower seizure threshold) -\_\_\_\_\_ (weight gain, sexual disturbance)
sympathomimetic anticholinergic cardiovascular orthostatic arrhythmias psychiatric neurological metabolic-endocrine
tricyclic antidepressants (TCA) drug interactions -CNS \_\_\_\_\_, \_\_\_\_\_ effects --alcohol; antidepressants -sympathomimetics: \_\_\_\_\_ -\_\_\_\_\_ intervals --\_\_\_\_\_ and \_\_\_\_\_ cause fatal torsades de pointes -antihypertensices --\_\_\_\_\_ hypotensive effects
depressants additive arrhythmias prolonged QT azole antifungals macrolide antibiotics additive
selective serotonin reuptake inhibitors (SSRI) examples: -\_\_\_\_\_ (Prozac) -\_\_\_\_\_ (Lovox) -\_\_\_\_\_ (Paxil) -\_\_\_\_\_ (Zoloft) -\_\_\_\_\_ (Celexa) -\_\_\_\_\_ (Lexapro)
fluoxetine fluvoxamine paroxetine sertraline citalopram escitalopram
selective serotonin reuptake inhibitors (SSRI)
MOA:
-_____ block serotonin (5HT) reuptake
-well absorbed
-extensively metabolized by CYP450 enzymes
adverse effects:
- less anticholinergic and sedation than _____
- nervousness, dizziness, insomnia
- male sexual dysfunction
- _____ tendencies
- less problem with overdose
- -seldom cause cardiac arrhythmias
- -less likelihood of seizures
selectively
TCA
suicidal
selective serotonin reuptake inhibitors (SSRI)
drug interactions:
-CNS _____
-cytochrome P450 inhibition
–inhibit CYP2D6 isoenzyme
—increase serum concentrations of _____; _____
–inhibit CYP2C and CYP3A4 iso-enzymes
—increase serum concentrations of _____, _____, _____
depressants antipsychotics dextromethorphan benzodiazepines carbamazepine phenytoin
selective serotonin reuptake inhibitors (SSRI)
drug interactions:
-MAO inhibitors
–both drugs increase _____ levels, concurrent use may precipitate the _____ syndrome
–symptoms:
–agitation, severe hypotension, GI symptoms
-psychosis
-high grade fever
-myoclonus
-hyperreflexia
-need a _____ wash out period
serotonin
serotonin
2-5 week
serotonin syndrome
- _____ effects: headache, agitation, hypomania, mental confusion, hallucinations
- _____ effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea
- _____ effects: myoclonus
cognitive
autonomic
somatic
selective serotonin reuptake inhibitors (SSRI)
indications:
-depression
-eating disorders: bulimia nervosa, anorexia nervosa
-anxiety disorders: panic, phobic, obsessive-compulsive
-fibromyalgia
-obsessive compulsiive behaviors
-_____
-PMS
autism
