depression Flashcards
Where is MAO found
nearly all tissues, including nerve terminals, intestine and liver
MAO is food intracellularly or extracellularly?
intracellularly
MAO A breaks down….
5HT, NA, dopamine
MAO B breaks down
NA and dopamine
Name a MAOI
phenelzine
phenelzine is a (selective/nonselective)
reversible/irreversible
nonselective and irreversible
adverse effects of MAOI
postural hypotension
restlessness and insomnia
MAOIs should not be combined with….
other drugs enhancing serotoninergic function
What is the cheese reaction
drug food interaction acute HTN (severe throbbing headache and inter cranial haemorrhage) less likely to occur with reversible mao-A selective vs irreversible non selective MAOIs
what are the categories of drugs for depression treatment
MAOIs tricyclic antidepressants SSRI NARI SNRI
what are some tricyclic antidepressants
non-selective:
imipramine, amitriptyline, nortriptyline
selective for NET:
desipramine
nortriptyline is a _______ gen TCA
second
what is the advantage of Nortriptyline
milder SE compared to amitriptyline and imipramine
improved compliance
add of TCAs (5)
sedation, postural hypotension, dry mouth, blurred vision, constipation
DDI of TCAs
plasma protein bound
rely on hepatic metabolism for elimination
advantages of SSRIs vs TCAs
greater 5-HT reuptake selectivity than TCAs
50-1000 fold selectivity for 5-HT than NA
fewer ADR
reduced sedation
lack of CV effects (safer in od)
what are some SSRIs (2)
fluoxetine
citalopram
ADR of SSRIs
nausea and insomnia
sexual dysfunction
which SSRI still has some sedation
citalopram
still has histamine receptor antagonism
what is a way to prevent SSRI-induced sexual dysfunction
cyproheptadine or other 5HT2 blockers
what is serotonin syndrome
DDI with the drugs increasing serotoninergic activity
effects: tremor, hyperthermia, CV collapse.
what is an example of NARI
reboxetine
advantage of NARIs
fewer ADR than TCAs and SSRIs
ADR of reboxetine
not well described dry mouth constipation insomnia tachycardia
examples of SNRIs (3)
venlafaxine, desvenlafaxine, duloxetine
advantages of venlafaxine
fewer ADR than TCAs
claimed to work faster and better in treatment resistant patients
ADR of SNRIs
nausea, insomnia, sexual dysfunction
what are some other antidepressants
mirtazapinei
bupropion
agomelatine
ketamine
what is mirtazapine
NE and specific serotonin antidepressant
antagonist of adrenergic alpha 2 auto receptors and 5-HT2c receptor
what is bupropion
norepinephrine-dopamine reuptake inhibitor
what is agomelatine
agonist of melatonin MT1 and MT2 receptors
less TCA/SSRI-associated SE
helps in sleep disorders
what is ketamine
glutamate NMDA receptor antagonist
