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Pharmacology 2 > Depression > Flashcards

Depression Flashcards

1
Q

Pathophysiology
Depression

A

A depletion of the neurotransmitters serotonin, norepinephrine or dopamine in the central nervous system

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2
Q

Rationale for drug use
Depression

A

Relieve psychological and physical symptoms.

Improve functional capacity.

Reduce the likelihood of self-harm or suicide.

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3
Q

Diagnostic criteria
Depression

A

Pervasive depressed mood (or irritable mood in children) and/or marked loss of interest or pleasure unexplained by personal circumstances, eg grief, plus 4 or more of the following:

  • marked change in weight or appetite
  • insomnia/hypersomnia nearly every day
  • psychomotor agitation/retardation nearly every day
  • fatigue/loss of energy nearly every day
  • feelings of worthlessness, excessive/inappropriate guilt
  • indecisiveness or diminished concentration
  • feelings of hopelessness
  • thoughts of death, suicidal ideation/attempt.
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4
Q

What to consider when choosing an antidepressant

A
  • Previous response
  • adverse effects
  • Drug interactions
  • Serotonin toxicity
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5
Q

Drug treatment
Depression

A
  1. SSRIs
  2. Nonselective MAOIs (phenelzine, tranylcypromine) when other treatments are not tolerated

Other:
TCA
SNRI
Melatonin Agonist
TeCA
NaRI

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6
Q

Drug class
Monoamine oxidase inhibitors

A

Antidepressants

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7
Q

Generic drug names
Monoamine oxidase inhibitors

A

Phenelzine
Tranylcypromine

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8
Q

MAOI a.k.a.

A

Monoamine oxidase inhibitors

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9
Q

Monoamine oxidase inhibitors a.k.a.

A

MAOIs

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10
Q

Indication
MAOIs

A

Major depression (third line)
Some anxiety disorders

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11
Q

MOA
MAOIs

A

Nonselective MAOIs irreversibly inhibit monoamine oxidases A and B (MAO‑A and MAO‑B), increasing the synaptic concentrations of adrenaline, noradrenaline, dopamine and serotonin.=

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12
Q

Precautions
MAOIs

A

Overdose carries high risk of fatality; avoid MAOIs if there is a high risk for overdose/suicide.!!!

  • Treatment with rizatriptan or sumatriptan—contraindicated (risk of ischaemia is increased as their metabolism is inhibited).
  • Angina—MAOIs may reduce pain associated with myocardial ischaemia; use with caution.
  • Epilepsy, history of seizures or other risks for reduced seizure threshold, including treatment with drugs that may increase the risk of seizures (table)—MAOIs may increase the risk of seizures (risk less than with TCAs); use low doses and titrate slowly. Note that depression may also increase the risk of seizures.
  • Diabetes—MAOIs may reduce blood glucose concentration, possibly affecting control of diabetes; the dose(s) of antidiabetic drugs may need to be reduced.
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13
Q

Adverse effects
MAOIs

A

orthostatic hypotension, sleep disturbances (including insomnia and less commonly hypersomnia), headache, drowsiness, fatigue, loss of libido

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14
Q

Counselling
MAOIs

A
  • It is best to take your last dose of the day before 3 pm or you may have trouble sleeping at night.
  • Sometimes people who take large amounts of caffeine feel jittery or get headaches when they take this medicine. If this happens, reduce the amount of caffeine you take.
  • This medicine may cause drowsiness and increase the effects of alcohol; do not drive or operate machinery if you are affected.
  • significant interactions with other medicines (eg hay fever or cold treatments and weight-reducing products). Do not use non-prescription medicines (even nasal sprays) or herbal products, eg St John’s wort, without discussing these with a pharmacist.
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15
Q

Practice points
MAOIs

A

MAOIs are third-line antidepressants, and are usually reserved for use by psychiatrists; they may be useful in atypical depression and psychotic depression; some specialists use MAOIs for post-traumatic stress disorder

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16
Q

Drug class and indication

Phenelzine

A

Antidepressants - MAOIs
Major depression

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17
Q

Drug class and indication

Tranylcypromine

A

Antidepressants - MAOIs
Major depression

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18
Q

Drug interactions
MAOIs

A

MAOIs can cause hypotension; administration with other drugs* that can also reduce BP may result in an additional effect; monitor effect of combinations closely.
MAOIs can cause serotonin toxicity; administration with other drugs that may contribute to serotonin toxicity (table) may increase likelihood; avoid combinations or monitor carefully

Bad / many drug interactions with any drugs such as adrenaline that act on sympathetic nervous sytem

adrenaline + MAOIs
cocaine + MAOIs
dopamine + MAOIs
noradrenaline + MAOIs
pseudoephedrine + MAOIs
SSRIs + MAOIs

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19
Q

“pram”, “ine” suffix

A

SSRIs
Selective serotonin reuptake inhibitors

Antidepressants

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20
Q

Suffix
SSRIs / Selective serotonin reuptake inhibitors

A

“pram”, “ine”

21
Q

Drug class
SSRI

A

Antidepressants

22
Q

SSRI a.k.a.

A

Selective serotonin reuptake inhibitors

23
Q

Generic drug names
SSRIs

A

Citalopram
Dapoxetine
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

24
Q

Indication
SSRIs

A

Major depression

25
Q

MOA
SSRIs

A

SSRIs selectively inhibit the presynaptic reuptake of serotonin

26
Q

Precautions
SSRIs

A

Bipolar disorder—all antidepressants may provoke a manic episode when used in people with bipolar disorder
Risk of bleeding

27
Q

Adverse effects
SSRIs

A

nausea, diarrhoea, agitation, insomnia, drowsiness, tremor

28
Q

Counselling
SSRIs

A

SSRIs are usually taken in the morning to minimise insomnia, but if somnolence occurs, they can be given in the evening.
Do not drive or operate machinery until you know how this medicine affects you.
Do not stop taking this medicine suddenly

29
Q

Practice points
SSRIs

A
  • SSRIs are less likely to alter ability to drive or operate machinery than TCAs
    in depression,
  • increasing the SSRI dose may not provide further improvement
  • increased suicidal thoughts and behaviour can occur soon after starting antidepressants, particularly with some SSRIs in young people; monitor patients frequently and carefully early in treatment
  • sexual dysfunction is an adverse effect that may affect compliance
30
Q

Drug class and indication

Citalopram

A

SSRI
Major depression

31
Q

Drug class and indication

Escitalopram

A

SSRI
Major depression
GAD
Social phobia
OCD

32
Q

Drug class and indication

Fluoxetine

A

SSRI
Major depression
OCD
Premenstrual dysphoric disorder

33
Q

Drug class and indication

Fluvoxamine

A

SSRI
Major depression
OCD

34
Q

Drug class and indication

Paroxetine

A

SSRI
Major depression
OCD
Panic disorder
GAD
PTSD
Social phobia

GAD = generalised anxiety disorder

35
Q

Drug class and indication

Sertraline

A

SSRI
Major depression
OCD
Panic disorder
Social phobia
Premenstrual dysphoric disorder

36
Q

Drug interactions
SSRIs

A
  • SSRIs can cause serotonin toxicity; administration with other drugs that may contribute to serotonin toxicity
  • SSRIs can affect platelet aggregation so that combinations with other drugs* that affect the clotting process may increase the risk of bleeding
  • MAOIs + SSRIs = Serotonin toxicity
  • SNRIs + SSRIs = Serotonin toxicity
  • tricyclic antidepressants + SSRIs = Serotonin toxicity
  • triptans + SSRIs = Serotonin toxicity
  • warfarin + SSRIs = risk of bleeding
37
Q

Serotonin and noradrenaline reuptake inhibitors a.k.a.

A

SNRIs

38
Q

SNRIs a.k.a.

A

Serotonin and noradrenaline reuptake inhibitors

39
Q

Generic drug names
SNRIs

A

Desvenlafaxine
Duloxetine
Venlafaxine

40
Q

Indication
SNRIs

A

Major depression

41
Q

MOA
SNRIs

A

Inhibit serotonin and noradrenaline reuptake.

42
Q

Precautions
SNRIs

A
  • Bipolar disorder—all antidepressants may provoke a manic episode when used in people with bipolar disorder
  • High risk of bleeding
  • SNRIs may cause palpitations, tachycardia, increased BP and orthostatic hypotension
  • Serotonin toxicity
43
Q

Adverse effects
SNRIs

A

nausea, dry mouth, constipation, yawning, sweating, dizziness, increased BP (infrequent with duloxetine), weakness, sexual dysfunction

44
Q

Practice points
SNRIs

A
  • check BP before starting treatment
  • increased suicidal thoughts and behaviour
  • Do not stop suddenly
45
Q

Drug class and indication

Desvenlafaxine

A

SNRIs
Major depression

46
Q

Drug class and indication

Duloxetine

A

SNRIs
Major depression
GAD
Painful diabetic peripheral neuropathy

47
Q

Drug class and indication

Venlafaxine

A

SNRIs
Major depression
GAD
Panic disorder
Social phobia

GAD = Generalised anxiety disorder

48
Q

Drug interactions
SNRIs

Serotonin and noradrenaline reuptake inhibitors

A

Antihypertensives
* effects BP control
* Further decrease BP = hypotension

Serotonin toxicity
* Antidepressants
* Opioids
* MDMA, LSD

Anticoagulants
* increased risk of bleeding

Pharmacology 2 (41 decks)

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