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Pharmacology Exam 7 > Depression, Bipolar > Flashcards

Depression, Bipolar Flashcards

1
Q

What are the three types of depression?

A

Reactive
Unipolar (major)
Bipolar

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2
Q

Unipolar depression types

A

Typical
Atypical
Other

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3
Q

Typical depression

A

insomnia, weight loss, decreased appetite, social disinterest

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4
Q

Atypical

A

Hypersomnia, increased appetite, weight gain, sensitivity

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5
Q

Which theory of depression is the most likely?

A

Neurotransmitter theory

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6
Q

What is the belief of the NT theory of depression?

A

Upregulation of auto-receptors is the main reason why a person experiences depression due to a lack of NT, once the NT levels are re-established the body must down regulate the receptors (latency period)

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7
Q

Strategies to treat depression

A

Block NT reuptake
Block NT degradation
Increase NT release

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8
Q

Selective Serotonin Reuptake Inhibitors

A

Fluoxetime

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9
Q

MOA of Fluoxetime (SSRI)

A

Selective inhibition of 5HT reuptake

SERT 300x&raquo_space;> NET

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10
Q

Use of Fluoxetime

A

Major depression

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11
Q

When will a patient begin to experience effects of Fluoxetime?

A

3-8 weeks

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12
Q

When does tolerance begin to develop in Fluoxetime?

A

3-8 weeks

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13
Q

When does the effect start to wear off in SSRIs?

A

> 18 months

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14
Q

What are the main side effects of SSRIs?

A

5HT1A and 5HT2A: Serotonin Syndrome
5HT2: sexual dysfunction
5HT3: GI distress

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15
Q

What are the contraindications of SSRIs / Fluoxetime?

A

MAOIs

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16
Q

What is an Serotonin Norepinephrine Reuptake Inhibitor?

A

Duloxetine

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17
Q

MOA of Duloxetine

A

Inhibition of SERT and NET equally

No action at A-1, H1 or M3

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18
Q

TCAs

A

Amitriptylline

19
Q

MOA of Amitryptilline

A

NON-selective (block NE, 5HT, H1, A-1, M3) everything

Inhibit NET > SERT

20
Q

What are the most common associated symptoms with amitryptilline?

A 
Anticholinergic
H1: Drowsy/sedation
A-1: Vasodilation, postural hypotension
5HT2: Sexual dysfunction
Overdose toxicity
21
Q

What is the concern with overdose toxicity in amitryptilline?

A

Neurological and cardio, severe tachycardia, hypotension and arrhythmia (inhibiting Na+ channels)

22
Q

What are two atypical anti-depressants?

A

Bupropion

Mirtazepine

23
Q

What is the likely mechanism of Bupropion

A

1) Block reuptake of NE and DA at NET and DAT

2) Increase release of NE and DA

24
Q

What is a benefit of using Atypical anti-depressants

A

Not associated with sexual dysfunction

25
Q

Which atypical is used for smoking cessation?

A

Bupropion (Zyban)

26
Q

What is the black box warning for Bupropion?

A

Smoking cessation - neuropsychiatric effects (using antidepressant for patient that does not have depression)

27
Q

What is the contraindication of Bupropion?

A

Epilepsy (lowers seizure threshold)

28
Q

What is the MOA of Mirtazepine

A

A-2 autoreceptor antagonist - increase release of 5HT and NE

29
Q

What is the benefit for using Mirtazepine

A

Good for patients that have insomnia and weight loss and want to gain weight

30
Q

What are the MAOIs?

A

Phenelzine

Selegiline

31
Q

What is the MOA of Phenelzine?

A

Non-selective irreversible inhibitor of MAO-A and MAO-B

MAO-A is the main target

32
Q

When are MAOIs used to treat depression?

A

Treatment resistant depression

Atypical depression

33
Q

What is the most concerning side effect of Phenelzine?

A

HTN crisis (wine and cheese effect)

34
Q

What is the MOA of Selegiline (unique property)?

A

Low dose: selective for MAO-B (Parkinson tx)

High dose: non-selective, MAO-A selective (depression tx)

35
Q

What is the high dose tx w/ Selegiline?

A

Depression

36
Q

What is the way that Selegiline is administered in treating depression?

A

Transdermal patch

37
Q

What is the benefit of using a transdermal patch?

A 
Less toxicity
Bypass GI (no wine and cheese HTN crisis)
38
Q

What drug is used to treat bipolar disorder?

A

Lithium

39
Q

What is Lithium

A

Monovalent Cation

40
Q

What is the most concerning side effect of lithium use?

A

Arrythmias (cation similar to Na+)

41
Q

What are other side effects of Lithium use?

A

Tremor, polyuria, polydipsia, diabetes insipidus, thyorid dysfunciton

42
Q

What is the range of Lithium

A

Very narrow range (0.8-1.2 mEq/L)

43
Q

Which drug is associated with diabetes like side effects?

A

Lithium

Pharmacology Exam 7 (8 decks)

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