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PAS - PHARM > CNS disorders part 1 > Flashcards

CNS disorders part 1 Flashcards

1
Q

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
A 
depression
bipolar
affective
mood
schizophrenia
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2
Q

Major Depression
_______: depressed mood or loss of interest and four other depressive symptoms

treatment: ______& _______

A

antidepressants

psychotherapy

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3
Q

Major Depression
_______: overeating/weight gain, oversleeping, rejection sensitivity, mood reactivity

treatment: antidepressants: ____, ____, and _____

A

atypical
SSRIs
MAOI
TCAs

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4
Q

Major depression
_______: prominent anxiety in addition to major depressive symptoms

treatment: ____, ______

A

anxious

SSRI’s, MAOI

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5
Q

Major Depression
______: fall onset, spring offset, reccurent

treatment: _____

A

SSRI’s

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6
Q

common depressive syndromes
_____: chronic depressive illness for _____ or more years, fewer and less severe symptoms than major depression

treatment: _____

A

dysthymia

SSRIs

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7
Q 
antidepressants
\_\_\_\_\_ (MAOI)
\_\_\_\_\_ (TCA)
\_\_\_\_\_ (SSRI)
\_\_\_\_\_ (heterocyclics)
\_\_\_\_\_ blockers
A 
monoamine oxidase inhibitors
tricyclic antidepressants
selective serotonin reuptake inhibitors
atypical
alpha 2 adrenoceptor
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8
Q

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
A 
amitriptyline
clomipramine
desipramine
imipramine
enuresis
neurological
somnambulism
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9
Q

tricyclic antidepressants (TCA)

  • mechanism of action
  • -_____ reuptake inhibitor
  • –NE, 5HT, DA
  • -short term effects:
  • –block the _____ of neurotransmiitters (_____, _____, _____)
  • –increase the _______ concentration of neurotransmitters
  • —increase stimulation of pre and post synaptic receptors
  • —2-3 weeks for clinical effects… why?
A 
non selective
reuptake
NE, 5HT, DA
synaptic
because receptors have to be down regulated back to normal for them to be able to function
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10
Q

tricyclic antidepressants (TCA)
MOA: long term effects
-increases the synaptic concentration of _____
–increase stimulation of _____ receptors
–down regulation of _____ autoreceptors

A

NT
post synaptic
presynaptic

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11
Q 
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
A 
incomplete
first pass effect
protein
lipid
volume of distribution
extensively
nortriptyline
desipramine
long
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12
Q 
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)
A 
sympathomimetic
anticholinergic
cardiovascular
orthostatic
arrhythmias
psychiatric
neurological
metabolic-endocrine
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13
Q 
tricyclic antidepressants (TCA)
drug interactions
-CNS \_\_\_\_\_, \_\_\_\_\_ effects
--alcohol; antidepressants
-sympathomimetics: \_\_\_\_\_
-\_\_\_\_\_ intervals
--\_\_\_\_\_ and \_\_\_\_\_ cause fatal torsades de pointes
-antihypertensives
--\_\_\_\_\_ hypotensive effects
A 
depressants
additive
arrhythmias
prolonged QT
azole antifungals
macrolide antibiotics
additive
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14
Q 
selective serotonin reuptake inhibitors (SSRI)
examples:
-\_\_\_\_\_ (Prozac)
-\_\_\_\_\_ (Lovox)
-\_\_\_\_\_ (Paxil)
-\_\_\_\_\_ (Zoloft)
-\_\_\_\_\_ (Celexa)
-\_\_\_\_\_ (Lexapro)
A 
fluoxetine
fluvoxamine
paroxetine
sertraline
citalopram
escitalopram
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15
Q

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
  • _____ sexual dysfunction
  • _____ tendencies
  • less problem with overdose
  • -seldom cause cardiac ______
  • -less likelihood of ________
A 
selectively
TCA
male
suicidal
arrythmias
seizures
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16
Q

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 _____, _____, _____

A 
depressants
antipsychotics
dextromethorphan
benzodiazepines
carbamazepine
phenytoin
17
Q

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

A

serotonin
serotonin
2-5 week

18
Q

serotonin syndrome

  • _____ effects: headache, agitation, hypomania, mental confusion, hallucinations
  • _____ effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea
  • _____ effects: myoclonus
A

cognitive
autonomic
somatic

19
Q

selective serotonin reuptake inhibitors (SSRI)
indications:
-depression
-eating disorders: bulimia nervosa, anorexia nervosa
-anxiety disorders: panic, phobic, obsessive-compulsive
-fibromyalgia
-obsessive compulsiive behaviors
-_____
-PMS

20
Q 
atypical antidepressants
heterocyclics
-2nd generation
--\_\_\_\_\_ (Asendin)
--maprotiline (Ludimil)
---related to TCAs
--\_\_\_\_\_ (Desyrel)
--\_\_\_\_\_ (Wellbutrin)
  • 3rd generation
  • -_____ (Effexor)
  • -nefazodone (Serzone)
  • -mirtazapine (Remeron)
A

amoxapine
trazodone
bupropion
venalfaxine

21
Q

buproprion (Wellbutrin, Zyban)
MOA:
-unclear
-_____ uptake inhibitor of _____, _____, and _____
-few anticholinergic effects, little sedation
-rarely any cardiovascular or sexual dysfunction effects
-employed in _____ cessation

A 
weak
dopamine
NE
serotonin
smoking
22
Q

venlafaxine (Effexor) SNRI

  • structurally unique
  • blocks reuptake of both _____ and _____
  • adverse effects:
  • –similar to ____
  • –does not inhibit _____, _____ or _____ receptors
  • –minimal sedative or cardiovascular effects
A 
NE
serotonin
SSRIs
muscarinic
adrenergic
histamine
23
Q

nefazodone (serzone)

  • inhibit _____ receptors
  • little or no _____, _____ or _____ activity
  • may cause sedation dizziness, nausea and visual changes
  • not associated with ________
A 
5-HT2
anticholinergic
antiandrenergic
antihistamine
sexual disfunction
24
Q

trazodone

  • _____ inhibits _____ reuptake
  • considerable _____ and orthostatic hypotension
  • minimal ________ side effects
  • minimal effects on ______conduction
A 
selectively
serotonin
sedation
anticholinergic
cardiac
25
Q

mirtazapine (Remeron)

  • an _____ antagonist
  • -increase _____ release from _____ nerve ending
  • –blocks _____ alpha-2 receptors
A

alpha-2
amine
presynaptic
presynaptic

PAS - PHARM (26 decks)

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