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Pharmacy Year 3 > Depression > Flashcards

Depression Flashcards

1
Q

What is usually the physiological cause of depression?

A

Deficit of noradrenaline or serotonin

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2
Q

How is noradrenaline synthesised?

A

From dopamine by dopamine-beta hydroxylase

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3
Q

How is noradrenaline removed from the synapse and how is this relevant to depression treatment?

A

Normally reuptake by noradrenergic receptors in presynaptic membrane
Some antidepressants inhibit this action

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4
Q

What is controlled by the noradrenaline pathways?

A

Alertness
Arousal
Sensory perception
Motor tone

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5
Q

How is serotonin synthesised?

A

Tryptophan to 5-hydroxytryptophan by tryptophan hydroxylase

5-hydroxytryptophan to 5-hydroxytryptamine by aromatic amin acid decarboxylase

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6
Q

How is serotonin in the synapse controlled?

A

Reuptake by serotonin transporter in presynaptic membrane

Serotonin also activates 5-HT1a autoreceptor which regulates synthesis and release

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7
Q

What is controlled by the serotonin pathways?

A 
Sleep
Food intake
Thermoregulation
Sexual behaviour
Pain
Motor tone
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8
Q

When would depression be considered?

A

If low feelings last longer than 2 weeks and start to interfere with daily life

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9
Q

What is considered as unipolar depression?

A

Major depressive disorder
Dysthymia
Seasonal affective disorder
Postnatal depression

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10
Q

What is bipolar?

A

Alternating periods of mania and depression

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11
Q

How do SSRIs work and why do they take a few weeks to work?

A

Inhibit reuptake of serotonin from synapse

Autoreceptor reduces serotonin production as a result but eventually is down regulated and serotonin release is restored

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12
Q

What are the side effects of SSRIs?

A

GI side effect
Hyponatraemia
Bleeding risk
QT prolongation

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13
Q

What may be the advantage of using SSRIs?

A

Less concerns with overdose, sedation and cardiac problems

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14
Q

Give some examples of SSRIs

A 
Sertraline
Citalopram
Fluoxetine
Escitalopram
Paroxetine
Fluroxamine
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15
Q

How do SNRIs work and why are they not first line?

A

Inhibit reuptake of both serotonin and noradrenaline

Problems with tolerability

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16
Q

Which SNRI is contraindicated in uncontrolled hypertension?

A

Venlafaxine

17
Q

Give some examples of SNRIs

A

Venlafaxine

Duloxetine

18
Q

What are the side effects of mirtazapine?

A

Sedating
May cause weight gain
Could cause blood disorders

19
Q

How do tricyclic antidepressants work?

A

Inhibit reuptake of noradrenaline and serotonin and prevent action of acetylcholine

20
Q

What are the side effect of tricyclic antidepressants?

A

Antimuscarinic (constipation)
Confusion resulting from increased heart rate
Fall risk due to sedation
BP fluctuation

21
Q

What are the issues with tricyclic antidepressants?

A

Less well tolerated
Cardiotoxicity
Overdose risk

22
Q

Give some examples of tricyclic antidepressants

A 
Amitriptyline
Clomipramine
Nortriptyline
Lofepramine
Dosulepin
23
Q

How do MAOIs work?

A

Prevent breakdown of noradrenaline, serotonin and dopamine

24
Q

Why should cheese, alcohol and marmite be avoided when taking MAOIs?

A

MAOIs inhibit breakdown of tyramine, can cause hypertensive crisis

25
Q

Give some examples of MAOIs

A

Phenelzine
Tranylcypromine
Isocarboxazid
Moclobemide

26
Q

How does reboxetine work?

A

Prevents reuptake of noradrenaline

27
Q

How does agomelatine work and what are the monitoring requirements?

A

Melatonergic agonist

LFTs at baseline, 3 weeks, 6 weeks, 3 months, 6 months

28
Q

When would vortioxetine be used?

A

Depression in adults where 2 previous antidepressants haven’t worked

29
Q

Why would lithium or antipsychotics be used in depression?

A

Combination to augment action of antidepressant

30
Q

How should depression treatment be stopped?

A

Continue for 6 months after remission, up to 2 years

Slowly withdraw treatment with specialist input

31
Q

What is the pharmacist role in depression treatment?

A

Advise on class to use
Review patient history
Give patient advice on monitoring and side effects, also efficacy
Address patient concerns
Advice on moving forward or switching drugs

Pharmacy Year 3 (15 decks)

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