Depression

Question 1

What is the PHQ-9?

Answer 1

a nine item questionnaire designed to screen for depression in primary care

Question 2

What questionnaire can we use in a primary care setting to diagnose depression?

Answer 2

Patient Health Questionnaire 9 (PHQ-9)

Question 3

How can do we score the PHQ-9? What do the numbers mean?

Answer 3

Question 4

What are the 3 most common prescribed SSRIs?

Answer 4

Sertraline
Citalopram
Fluoxetine

Question 5

What are SSRIs?

Answer 5

selective serotonin reuptake inhibitors

Question 6

What is the mechanism of action of SSRIs?
(target, location, effect)

Answer 6

Target: 5HTT
Location: pre-synaptic neurone
Effect: increased serotonin availability

Question 7

What is the role of 5HTT?

Answer 7

transports the neurotransmitter serotonin from synapses to presynaptic neurons (reuptake of serotonin)

Question 8

What change in an ECG might you see after someone starting taking citalopram?

Answer 8

prolonged QT interval

Question 9

What factors may predispose someone to QT interval prolongation? (4)

Answer 9

increasing age
female sex
cardiac disease
hypokalaemia

Question 10

What antibiotic may cause QR interval prolongation?

Answer 10

erythromycin

Question 11

What can QT interval prolongation lead to?

Answer 11

Torsades de pointes

Question 12

How does Torsades de pointes come about?

Answer 12

If you have a Long QT interval and your ventricles get an extra contraction during the time when they’re supposed to be getting ready for the next one, you may get Torsades de Pointes.

Question 13

What 2 transporters does Venlafaxine target?

Answer 13

serotonin transporter
noradrenaline transporter

Question 14

What 4 receptors does Mirtazapine target?

Answer 14

Histamine H1 receptor
Alpha-2 receptor
5HT2 receptor
HT3 receptor

Question 15

What 4 receptors does Mirtazapine target?

Answer 15

Histamine H1 receptor
Alpha-2 receptor
5HT2 receptor
HT3 receptor

Question 16

Why should you not prescribe Venlafaxine when a patient has hypertension?

Answer 16

Venlafaxine targets and inhibits the noradrenaline receptor and therefore has an adrenergic effect.
This can cause hypertension

Question 17

Why may Mirtazapine help those who have trouble sleeping?

Answer 17

has a beneficial impact on sleep continuity and duration due to its anti-histaminergic effects.

Question 18

Explain the selectivity, affinity and efficacy of Mirtazapine.

Answer 18

not high selectivity!

mirtazapine has very high affinity to histamine receptor

high efficacy for a-2-receptor and 5HT2 receptor for anti-depression effect

Question 19

Potency vs efficacy of drugs?

Answer 19

Potency is the amount of drug necessary to produce a biological response of a certain magnitude.

Efficacy is the ability of the drug to produce a response by the activation of the receptor.

Question 20

Affinity vs efficacy of drugs?

Answer 20

Affinity describes strength of drug binding with receptor (“fit the lock”).

Efficacy describes ability of drug-bound receptor to produce a response

Question 21

Selectivity vs specificity of drugs?

Answer 21

Selectivity is the degree to which a drug acts on a given site relative to other sites.

Specificity is the measure of a receptors ability to respond to a single ligand

Question 22

Explain selectivity and give an example of how a non-selective drug by act.

Answer 22

Selectivity is the degree to which a drug acts on a given site relative to other sites.

Relatively nonselective drugs affect many different tissues or organs. For example, atropine, a drug given to relax muscles in the digestive tract, may also relax muscles in the eyes and in the respiratory tract.

Question 23

Explain specificity and give an example of how a non-specific drug by act.

Answer 23

Specificity is the measure of a receptors ability to respond to a single ligand.

Low specificity generally results in physiological responses not targeted or intended. (side effects of different effect of what the drug is meant to do)