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Pharmacology Y2 > Depression > Flashcards

Depression Flashcards

1
Q

What is the function of monoamine oxidase?

A

Metabolises dopamine, noradrenaline, serotonin in the synaptic cleft to remove it

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1
Q

What is the function of monoamine oxidase?

A

Metabolises dopamine, noradrenaline, serotonin in the synaptic cleft to remove it

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2
Q

What are the 2 main ways that antidepressants work?

A

1 - blocks metabolism of the neurotransmitter so it is not removed from the synapse
2 - blocks reuptake of noradrenaline and serotonin into the presynaptic membrane

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3
Q

What are the 4 categories of reuptake inhibitors?

A

1- Tricyclic antidepressants
2- Selective serotonin reuptake inhibitors
3- Noradrenaline reuptake inhibitors
4- Serotonin and noradrenaline reuptake inhibitors

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4
Q

What is the mechanism of action of 3rd generation antidepressants?

A

They are antagonists of the negative feedback mechanism for pre synaptic neurotransmitter release - means pre synaptic receptors will keep releasing neurotransmitter

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5
Q

Name some psychological symptoms of depression

A

Pessimism
Poor concentration
Low self esteem
Indecisiveness
Suicidal thoughts
Hypochondria

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6
Q

Name some biological symptoms of depression

A

Retardation of thoughts and action
Fatigue
Loss of appetite
Loss of libido
Aches and pains

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7
Q

Name some behavioural symptoms of dperession

A

Psychomotor agitation/retardation
Self neglect

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8
Q

What are thymoleptics?

A

Drugs that re elevate the mood

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9
Q

What is an example of a thymoleptic drug?

A

Tricyclic antidepressants

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10
Q

What are thymeretics?

A

Drugs that activate the psychomotor drive

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11
Q

What is an example of a thymeretic drug?

A

Monoamine Inhibitors

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12
Q

Why should a thymoleptic and thymeretic drug always be given together?

A

If there is a thymeretic drug without the mood elevation from the thymoleptic drug, it will increase suicide risk

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13
Q

Define bipolar depression

A

Depression that alternates with mania over periods of weeks

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14
Q

What is the monoamine hypothesis?

A

This states that lack of monoamine transmitter in the synapse (noradrenaline, dopamine, serotonin) can cause depression

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15
Q

Reserpine is an old antihypertensive drug. It removes pre synaptic catecholamines from the vesicles. Based on monoamine hypothesis what would this effective be?

A

Less monoamine neurotransmitter in the synapse = depressive symptoms

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16
Q

The action of which drug gives evidence for the monoamine hypothesis?

A

Iproniazid

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17
Q

What happened when patients took Iproniazid that gives evidence for the monoamine hypothesis?

A

Iproniazid prevents monoamine metabolism. Patients taking this drug felt euphoric.

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18
Q

What is the mechanism of alpha 2 receptors on the presynaptic membrane?

A

If the receptor is bound to its substrate, it will decrease release of neurotransmitter as it detects that enough is in the synaptic cleft

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19
Q

What would an alpha 2 antagonist result in?

A

Increased neurotransmitter release as the receptor does not know that there is enough neurotransmitter in the synapse due to the antagonism

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20
Q

Name an irreversible monoamine oxidase inhibitor

A

Clorgyline

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21
Q

List 5 reversible monoamine oxidase inhibitors

A

Moclobemide
Brofaromine
Pirlindole
Toloxatone
Befloxatone

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22
Q

List 4 non selective monamine oxidase inhibitors

A

Iproniazid
Isocarboxazid
Phenelzine
Tranylcypromine

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23
Q

How do monoamine oxidase inhibitors affect the body systemically?

A

Stimulates alpha 1 -> hypertension
Stimulates beta 1 -> tachycardia

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24
What is the function of monoamine oxidase in the intestines and liver?
Metabolises dietary amines to prevent them passing into systemic circulation
25
Name the amine that increases in plasma concentration when there are monoamine oxidase inhibitors
Tyramine
26
What are fatal problems with monoamine oxidase inhibitors?
Fatal respiratory depression with overdose Postural hypotension Increased motor excitability
27
How do tricyclic antidepressants work?
They inhibit the reuptake of serotonin and noradrenaline
27
How do tricyclic antidepressants work?
They inhibit the reuptake of serotonin and noradrenaline
28
What are the problems with TCAs?
Alpha 1 antagonist -> postural hypotension H1 antagonist -> sedation Muscarinic antagonism -> Dry mouth, blurred vision, constipation
29
Name 3 TCAs that target serotonin reuptake
Imipramine Amitriptyline Clomipramine
30
Name a TCA that targets noradrenaline reuptake
Desipramine
31
What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?
Inhibits SERT, the serotonin transporter, thereby preventing the reuptake of serotonin from the synapse
32
List some examples of SSRIs
Zimelidine Fluoxetine Citalopram Paroxetine Vortioxetine Fluvoxamine Sertraline
33
What are the adverse effects of SSRIs?
Constipation, diarrhoea -> there are serotonergic neurones in the gut so these can be overactivated Rashes and tremors Loss of libido
34
What is the mechanism of action of NRIs?
Inhibits NET, noradrenaline reuptake transporter, so noradrenaline remains in the synapse
35
Give an example of an NRI?
Maprotiline
36
What is the mechanism of action of SNRIs?
Inhibits SERT and NET transporters, serotonin and noradrenaline remain in the synapse
37
Give an example of an SNRI?
Venlafaxine
38
Which 2 receptors are targeted as monoamine antagonist antidepressants?
Alpha 2 adrenoreceptors Presynaptic 5HT1a receptors
39
What is the effect of the monoamine antagonists?
Increased release of neurotransmitter from the presynaptic membrane
40
Name 3 monoamine antagonists
Mirtazapine Mianserin Trazodone
41
Which receptors does monoamine antagonist mirtazapine antagonise?
Alpha 2 receptors
42
Which receptors does monoamine antagonist mianserin antagonise?
Alpha 2 receptors Presynaptic 5HT receptors
42
Which receptors does monoamine antagonist mianserin antagonise?
Alpha 2 receptors Presynaptic 5HT receptors
43
Which receptors does monoamine antagonist trazadone antagonise?
Presynaptic 5HT receptors
43
Which receptors does monoamine antagonist trazadone antagonise?
Presynaptic 5HT receptors
44
Does mirtazapine antogonise alpha 1 receptors aswell?
No
45
Does trazadone antagonise alpha 1 receptors aswell?
Yes
46
What systemic side effect could occur when antagonising alpha 1 receptors?
Orthostatic hypotension
47
Do monoamine antagonists block H1 receptors aswell?
Yes !
48
What is the systemic effect of blocking H1 receptors?
Sedation
49
Name a drug that targets intracellular messengers that can be used as an antidepressant
Rolipram
50
What is the mechanism of action of rolipram?
It is a phosphodiesterase inhibitor, so prevents the breakdown of cAMP
51
Why is rolipram not widely used?
It has a lot of side effects - involved in anti inflammatory pathways
52
What therapy is used on severely depressed and manic patients that are non responsive to medication?
Electro convulsive therapy, increases patients sensitivity to noradrenaline and serotonin
53
What evidence is there to support the monoamine hypothesis of depression?
1- Inhibition of storage and synthesis of monoamines, results in a low mood. 2- Whereas preventing reuptake and metabolism of monoamines results in a good mood.
54
What evidence is there to counter the monoamine hypothesis of depression?
1- Some drugs such as cocaine, amphetamines, increase noradrenaline transmission but do not have antidepressant action. 2- There is delayed therpeutic action of all drugs. 3- Not all antidepressants increase monoaminergic transmission.
55
What is the difference between short term and long term use of SSRIs?
Short term - Increased serotonin activates 5HT1a + 5HT1b (a is inhibitory) so has an inhibitory effect Long term - 5HT1a receptors are desensitised, so increased serotonin activates 5HT1b only, which gives an excitatory effect
56
Describe what happens in bipolar 1
Manic episodes with psychotic element requiring hospitalisation, in a cycle with major depression
57
Describe what happens in bipolar 2
Chronic hypomaniac episodes
58
What is given to bipolar patients to prevent mood switching?
Lithium - reduces GPCR activity
59
Name 3 anticonvulsants given to patients with bipolar 1
Lamotrigine Carbemazepine Valproate
60
Name Name 3 antipsychotics given to patients with bipolar 2
Quetiapine Olanzapine Risperidone
61
Why would ketamine theoretically be an effective antidepressant?
It works acutely and rapidly in people with major depressive disorders
62
What is the mechanism of action of ketamine?
1- Blocks NMDA receptors 2- Increases AMPA receptors activation 3- DIsinhibits glutamate release (inhibits GABA) 4- Activates protein translation 5- Upregulates BDNF pathway

Pharmacology Y2 (9 decks)

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