CNS- Depression & Anxiety

Question 1

what is bipolar affective disorder?

Answer 1

mood swings not correlated to external environment.

Question 2

what is the monoamine theory (NE, dopamine, 5-HT)

Answer 2

ˇ monoamine activity -> depression

ˆmonoamine activity-> ˆMood

Question 3

what is the single drug treatment for bipolarism?

Answer 3

lithium alone

antipsychotics

Question 4

what is the multiple medication treatment for bipolarism?

Answer 4

antipsychotic with antidepressant
lithium with antipsychotic
lithium with antidepressant

Question 5

what is the lithium mechanism?

Answer 5

ˇ in precursors for IP3 and DAG synthesis therefore ˇIP3 and DAG when receptors linked to there secondary mesengers are activated

*it may ˆ serotonin neurotransmission and ˇ NE and dopamine neurotransmission

Question 6

what is the adverse effect of lithium?

Answer 6

it has a narrow therapeutic index thus blood levels need to be monitored.

Question 7

describe tricyclic antidepressants

Answer 7

primarily affect NE and serotonin,
not first chosen to use
side effects: block cardiac sodium channels
antagonist at: muscarinic, histaminic and alpha1 receptors.

Question 8

describe bupropion

Answer 8

its unicyclic,

modest inhibitor of reuptake and stimulates release of DA and NE

Question 9

describe the selective serotonin reuptake inhibitor (SSRI) fluoxetine (PROZAC)

Answer 9

side effects: insomnia, sexual dysfunction, ^ suicide rates
inhibits CYP2D6
overdose generally not dangerous unless combined with other antidepressants

Question 10

what is serotonin syndrome?

Answer 10

when CYP2D6 metabolizes tricyclic antidepressants it combines with MAO inhibitors and causes serotonin syndrome.

Question 11

what are monoamine oxidace inhibitors? (MAO) and in what case would you use them?

Answer 11

not selective for MAO-A, or MAO-B, therefore NE, serotonin, and dopamine pathways are all affected via their metabolites.
There are only used if tricyclic antidepressants are not effective.

Question 12

what is the danger/toxicity with MAO inhibitors?

Answer 12

hypertensive crises can occur if thyramine-containing foods are ingested or if taking CNS stimulant like cocaine.
mix with SSRIS or SNRIS, or trycyclic antidepressants can cause serotonin-syndrome.

Question 13

what is the clinical steps to prescribing antidepressants?

Answer 13

1. SSRIs first (low dose for 8-12 weeks)

the dosage = balance between clinical effectiveness and adverse effects. `

Question 14

what are some long term effects of antidepressants?

Answer 14

long-term treatments reported to alter sensitivity or levels of a verity of CNS receptor and neuronal growth factors

Question 15

List some anxiety disorders

Answer 15

panic disorder
phobias
OCD
general

Question 16

what is anxiety?

Answer 16

feelings of apprehension, tension, uncertainty and fear, its usually a secondary to other disorders. usually best treated with acting on primary illness

Question 17

what two kinds of sedative hypnotics are used to treat anxiety?

Answer 17

1. benzodiazepines

2. barbiturates

Question 18

what is the pharmacokinetics of the benzodiazepine Diazepam.

Answer 18

phase 1: (oxidation by cytochrome p450; all metabolites active)
phase 2: (oxazepam conjugation with glucuronide)
oxidation—> active metabolite

Question 19

what is the method of action of the benzodiazepines?

Answer 19

it binds to subset of GABAa receptors distint from GABA, causes an opening of Cl- channels, and therefore ^ inhibition of many neurons. This enhances GABA neurotransmission, but it requires GABA for effect.

Question 20

what are the pharmacokinetics of the barbiturates phenobarbital?

Answer 20

Phase 1 (oxidation by cytochrome p450) 
phase 2 (conjugation with glucuronide)

Question 21

what is the method of action of barbiturates?

Answer 21

enhance GABA neurotransmission, by binding to all GABAa receptors at site distict from GABA and benzodiazepines.
high doses can directly activate GABAa receptors + inhibit glutamate receptors and high-frequency sodium channels

Question 22

what is the toxicity of dose-dependent sedative hypnotics?

Answer 22

CNS depression ( impaired judgement/ motor skills) -> amnesia -> coma -> death)

prolonged: symptoms of withdrawal.
* *barbituates= alter metabolism of self & other drugs