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Depression/Anxiety Flashcards

1
Q

precursor to NE

A

tyrosine

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2
Q

NE synthesis steps (4)

A

tyrosine, L-DOPA, DA, NE

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3
Q

NE location in brain

A

locus ceruleus

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4
Q

5HT role

A

arousal, sleep-wake cycle, mood, motivaton

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5
Q

5HT location in brain

A

raphe nuclei

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6
Q

5HT precursor

A

tryptophan

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7
Q

which 5HT receptor is on the presynaptic terminal

A

1D

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8
Q

4 MAO-I

A

Phenelzine
tranylcypromine
isocarboxazid
selegiline

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9
Q

MOA of MAO-I

A

decrease MAO activity in neruons and liver
in neurons: inc. NE concentration
in liver: inc. tyramine from foods in circulation
increase NE and 5HT transmission in CNS

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10
Q

Antidepressants (6)

A 
MAO-I
TCA
SSRI
SNRI
Serotonin Modulators
Atypical antipsychotics
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11
Q

ADE for MAO-I (4)

A

Orthostatic hypotension
CNS stimulation
Weight gain
sexual dysfunction

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12
Q

TCA MOA

A

block uptake of amines by nerve terminals

inhibit NE and 5HT transporters

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13
Q

TCA drugs (5)

A 
Amitriptyline
Imipramine
clomipramine
protriptyline
doxepin
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14
Q

TCA ADE

A 
anti-ach
sedation
weight gain
orthostatic hypotension
lowered seizure threshold
qt prolongation
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15
Q

Combine TCA and MAO-I

A

NO, risk of hypertensive crisis

cause tons of NE in synapse

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16
Q

SSRI drugs (5)

A 
fluoxetine
sertraline
paroxetine
citalopram
escitalopram
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17
Q

SSRI MOA

A

selective inhibition of serotonin transporters

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18
Q

SSRI ADE

A

insomnia
dizziness
sexual dysfunction
GI: n/v/d

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19
Q

Serotonin Syndrome treatment

A

supportive
sedation: BDZ
cyproheptidine

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20
Q

Serotonin Syndrome symptoms

A 
ataxia
myoclonus
confusion
hypomania
agitation
restlessness
fever
chills
sweating
diarrhea
HTN
tachycardia
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21
Q

Withdrawal from SSRI symptoms

A 
flu-like
light-headedness
restlessness
sleep and sensory disturbances
headache
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22
Q

SNRI drugs (5)

A 
Duloxetine
venlafaxine
desvenlafaxine
levomilnacipran
milnacipran
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23
Q

serotonin modulators drugs (3)

A

trazodone
Vilazodone
Vortioxetine

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24
Q

Trazodone MOA

A

weak 5HT uptake inhibitor
5HT2A and 5HT2C antagonist
H1 antagonist: sedation

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25
viibryd, Brintellex MOA
combined selective serotonin reuptake inhibitor and partial 5-HT1A receptor agonist
26
atypical antidepressants drugs (2)
Mirtazapine | Bupropion
27
Bupropion MOA
inhibits DA and Ne uptake | > for DA
28
bupropion Contraindication
history of head trauma | seizures
29
Mirtazapine
Antagonize alpha2 adrenergic autoreceptor -inc. firing rate or noradrenergic neurons -inc. NT release antagonize 5HT2A,3 serotonin
30
2 theories of delayed effect of anti-depressants
1. alternation in pre-synaptic auto-receptors or transports and NT synthesis 2. activation of neuronal repair
31
stress effect on neurons
elevate glucocorticoids increase glutamate levels cause neuronal damage and dysfunction reduction in BDNF (growth factor)
32
Antidepressants effect on CREB and BDNF
increase level of CREB (cAMP) | CREB increases BDNF
33
BDNF role
enhances dendritic sprouting, opposite effects of stress
34
Treatment of Anxiety Disorder (4)
Antidepressants Buspirone BZD non-pharm
35
BZD MOA
selectively enhance the response to GABA to open the GABA-A receptor
36
what type of channel is GABA-A
chloride
37
GABA binding requires what 2 subunits
alpha | beta
38
2 subunits for BZD binding
alpha | gamma
39
BZD for anxiety (7)
``` Alprazolam Lorazepam Clonazepam Diazepam Oxazepam Chlordiazepoxide Clorazepate ```
40
BZD effect on sleep
``` releive symptoms of insomnia promotes onset dec. SL dec. stage 3,4, REM increase stage 2 ```
41
BZD for insomnia (5)
``` Triazolam Estazolam Temazepam Flurazepam Quazepam ```
42
Z-hypnotics moa
bind to the bzd at alpha 1 site on the GABA-A receptor
43
Z-hypnotics (3)
Zaleplon Zolpidem Eszopiclone
44
alpha 1 subunit of GABA function
sedative effects of BZD
45
alpha 2 subunits of GABA function
anxiolytic effects of BZD
46
BZD antagonist
FLumazenil
47
Barbiturates MOA
bind to GABA-A receptor -enhance GABA at low concentrations -directly activate GABA at high concentration prolong duration of channel opening
48
Suvorexant MOA
orexin receptor antagonist both OX1 and 2
49
Melatonin synthesis
in pineal gland from tryptophan
50
Melatonin receptor agonists (2)
Tasimelteon | Ramelteon
51
Tasimelteon approved for
non-24 hour sleep wake rhythm disorder
52
Ramelteon approved for
insomnia
53
Antihistmaine sleep effects
feel sleepy but does not improve sleep suppress REM
54
Histamine location
tuberomammillary nucleus of the posterior hypothalamus
55
Antidepressants for insomnia
amitriptyline doxepin trazodone
56
MAO-A deaminates?
serotonin | NE
57
MAO-B deaminates?
DA phenylethylamine benzylamine
58
Selegiline at low concentrations inhibits?
MAO-B irreversibly
59
Selegiline at high concentrations inhibit?
MAO-A and B
60
MAO-B functions for what disease
parkinson's
61
drugs that bind covalently to FAD in function of MAO
Phenelzine Selegiline Isocarboxazid
62
Drug that binds to MAO itself
Tranylcypromine
63
TCA which prefer to inhibit 5HT reuptake
Clomipramine Imipramine Trimipramine Doxepin
64
TCA which prefer to inhibit NE reuptake
Protriptyline Desipramine Nortriptyline Amoxapine
65
7 major diagnostic categories for depression
``` Depressed patients sound anxious, so claim psychiatrics depression psychotic disorders substance abuse anxiety disorders somatic disorder cognitive disorder personality disorder ```
66
DSM-V Depression
depressed mood most of the day or markedly diminished interest or pleasure in almost all activities and 4 other signs
67
untreated depression episode lasts?
>6 months
68
treated depression episode lasts?
4-5 months
69
Major depressive episode symptoms
``` SIGECAPS 4 of 8 w/ depressed mood for 2 weeks sleep disorder interest deficit guilt energy deficit concentration deficit appetite disorder psychomotor retardation or agitation suicidality ```
70
Persistent depressive disorder symptoms
``` ACHEWS 2/6 w/ depressed mood for 2 years appetite disorder concentration deficit hopelessness energy deficit worthlessness sleep disorder ```
71
Manic episode symptoms
``` DIGFAST elevated mood w/ 3 of 7 or irritable mood w/ 4 of 7 for one week distractibility indescretion grandiosity flight of ideas activity increase sleep deficit talkativeness ```
72
Define response in depression
50% reduction in PHQ-9 score
73
define remission in depression
PHQ-9 score <4
74
define relapse in depression
return of symptoms meeting full criteria within 6-12 months following remission
75
define recurrence in depression
occurrence of new episode following 6 to 12 months of full and sustained remission
76
how long to recommend antidepressants after period of sustained remission
6-12 months
77
1st line antidepressants
``` SSRIs SNRIs vortioxetine buproprion mirtazapine ```
78
2nd line antidepressants
``` tca nefazodone trazodone levomilnacipran moclobemide quetiapine selegiline vilazodone ```
79
3rd line antidepressants
phenelzine tranylcypromine reboxetine
80
sertraline dose range
50mg qd-200/day
81
citalopram dose range
20mg qd-40mg/day max dose if <60 40mg max dose if >60 20mg
82
fluoxetine dose range
20mg qd-80mg/day
83
paroxetine dose range
20mg qd-50mg/day
84
venlafaxine dose range
75mg qd-375/day
85
duloxetine dose range
20-30bid-60/day
86
bupropion dose range
100mg bid-450/day
87
mirtazapine dose range
15mg-45mg
88
Manage sexual side effects (4) for depression
watchful waiting dosage reduction drug holiday switch antidepressants
89
antidepressants with least sexual sE
mirtazapine nefazodone bupropion vilazodone
90
Add on therapy for sexual dysfunction for depression
``` DA modulation -amantadine -bupropoin -ropinirole serotonin modulation -buspirone -cyprheptadine -mirtazapine -nefazodone NE modulation -yohimbine ```
91
Serotonin Syndrome Signs (12)
``` HTN tachycardia tachypnea hyperthermia mydriasis sialorrhea diaphoresis hyperactive bowel sounds incrased neuromuscular tone hyperrelexia agitation coma ```
92
Common drugs that can add to serotonin syndrome (6)
``` dextromethorophan fentanyl linezolid lithium tramadol sumatripans ```
93
D/c syndrome symptoms
``` FINISH flu-like insomnia nausea imbalance sensory disturbances hyperarousal ```
94
bupropion contraindicated
current seizures alcohol withdrawal benzo withdrawal bulemia
95
Secondary vs tertiary amines
tertiary NE>5HT reuptake inhibition | Secondary selective NE reuptake inhibiton
96
Depression no response at 4 weeks?
incresase in dose and reevaluate in another 2-4 weeks
97
Define panic attack
abrupt surge of intense fear or discomfort | have 4 symptoms
98
Define Panic disorder
recurrent unexpect panic attack 1 month of: persistent worry/concern or significant maladaptive changes in behavior
99
TCA not effective in?
SAD
100
Buspirone does not improve
mood/depression
101
BZD relief what anxiety symptoms
somatic and autonomic | not cognitive symptoms
102
which BZD ok for liver disease and elderly?
LOT lorazepam Oxazepam temazepam
103
1st line for anxiety
SSRI | SNRI
104
2nd line for anxiety
TCA | buspirone
105
3rd line for anxiety
MAO-I
106
when can BZD be used as monotherapy
Panic disorder w/ no underlying mood disorder
107
drugs not effective for SAD
ciralopram and fluoxetine 2nd line TCA busirone monotherapy daily beta blocker
108
drugs not effective for panic disorder
``` citalopram 2nd line buspirone antihistamines antipsychotics trazodone ```
109
PTSD augmentation
alpha-1 antagonist: prazosin -nightmares and insomnia atypical antipsychotics: risperidone, quetiapine -decrease hypervigilance and re-experiencing anticonvulsants/mood stabilizers -divalproex, carbamazepine, topiramate, lamotrigine -decrease re-experiencing and agression
110
drugs not effective for PTSD
Buspirone Bupropion Desimpramine
111
drugs not effective for OCD
SNRI Amitriptyline imipramine
112
``` time to response GAD panic SAD PTSD OCD ```
``` 2-4 initial, 4-6 full 6-12 4 weeks 8-12 weeks 10-12 weeks ```
113
pregnancy DOC for anxiety
citalopram, fluoxetine, sertraline
114
drugs to avoid in pregnancy for anxiety
paroxetine: cv malformation | BZD in 2st trimester: cleft lip
115
stage 1 sleep
sleep initiation | intact voluntary muscle tone
116
stage 2 sleep
50% sleep time | muscles relax
117
stages 3,4
delta or slow wave sleep
118
REM
20% sleep time dreaming paralysis active brain function
119
DSM-V Insomnia
poor sleep poor daytime functioning >3 nights/wk >3 months
120
alcohol effects on sleep
dec. SL inc. TST fragments sleep
121
OTC meds effect on sleep
inc. SM inc. TST no effect on SL
122
melatonin effect on sleep
dec. SL
123
RLSL DSM-V
urge to move the legs >3 times/wk >3 months poor daytime funcitoning

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