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Pharmacy Stage 3 > depression pharmacological treatment > Flashcards

depression pharmacological treatment Flashcards

1
Q

what 2 receptors do the most effective anti-depressants work on?

A

5-HT (serotonin) and NA (noradrenaline)

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2
Q

Where are 5HT cell bodies contained in the brain?

A

in the dorsal and median raphe nuclei

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3
Q

Where are NA cell bodies contained in the brain?

A

in the Locus coerulus

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4
Q

what determines the synthesis rate of NA and 5HT?

A
  1. TPH for 5HT (tryptophan hydroxylase)

2. TH for NA (tyrosine hydroxylase)

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5
Q

what determines the breakdown of 5HT and NA?

A

MAO (monoamine oxidase)

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6
Q

what determines the release rate of 5HT and NA?

A

the firing activity of the impulse

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7
Q

what determines the reuptake rate of 5HT and NA?

A

the transporter activity

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8
Q

what part of 5HT, NA and DOPA does MAO act on?

A

the NH2 at the end of the chain

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9
Q

where do MAO act?

A

they break down the monoamine in the cytosol and regulate the vesicle content

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10
Q

How do the monoamine reuptake transporters work?

A

they transport the monoamines from the synaptic cleft to the presynaptic terminal

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11
Q

how can we increase 5HT and NA neurotransmission?

A
  1. reduce their breakdown in the synaptic cleft hence increase their release per impulse
  2. block their reuptake hence increase their duration and concentration in the synaptic cleft.
  3. increase the post-synaptic receptor activation.
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12
Q

what are the two main classes of antidepressant drugs?

A
  1. inhibitors of monoamine metabolism (so they inhibit monoamine oxidase)
  2. inhibitors of monoamine reuptake e.g. (SSRIs, SNRIs and TCAs)
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13
Q

what group of MAO are blocked by monoamine oxidase inhibitors (MAOi)?

A
  1. Monoamine Oxidase A (MAOAa)
    or drugs that block
  2. Monoamine oxidase A and B (MAOA and MAOb)
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14
Q

what are drugs that target just MAOb used for?

A

used for treating Parkinson’s disease.

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15
Q

give an example of only an MAOb inhibitor?

A

Selegiline

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16
Q

Give an example of an MAOa and MAOb inhibitor?

A

Iproniazid

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17
Q

Give an example of a MAOa inhibitor?

A

Clorgyline

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18
Q

Give an example of a TCA?

A

amitriptyline

19
Q

Give an example of a SSRI?

A

citalopram

20
Q

give an example of SNRI

A

duloxetine and venlafaxine

21
Q

which of these are selective: SSRI, SNRI or TCA

A

SSRIs

22
Q

what are the side effects of reuptake inhibitors

A 
GI disturbance 
sexual dysfunction 
dry mouth 
sedation 
hypotension 
weight gain 
skin lashes 
anaphylaxiss
23
Q

how do MAOIs bind: reversibly or irreversibly

A

ireeversibily

24
Q

what effect do MAOIs have on blood pressure

A

they lower blood pressure by causing vasoconstriction, hence provoking hyperetensive crisis

25
Q

what is the downside of taking other antidepressants alongside the depressant your already on

A

causes serotonin syndrome

26
Q

what happens in serotonin syndrome

A
  • blocks reuptake transporter and inhbiting MAO would increase 5HT release and there’ll be a build up of serotonin in the synaptic cleft
27
Q

symptoms of serotonin syndrome

A 
high temp 
agitation 
in creased reflexes 
tremor 
sweating 
dilated pupils 
diarrhoea 
delirium 
comvulsions 
death
28
Q

what is the first lien antidepressant treatment

A

SSRIs

29
Q

last line antidepressant treatment

A

MAOI

30
Q

How long should you continue to treat after patient has recovered

A

6 month - 2 years after recovery

31
Q

what symptoms are experienced in antidepressant discontinuation syndrome

A

dizziness, headache, nausea and lethargy

32
Q

what is used to treat bipolar disorder

A

lithium
valproate
atypical antipschotics
fluoxetine

33
Q

what causes bipolar disorder

A

dpomaine hyperactivity

  • antagonists of the dpomaine receptor reduce mania
  • reducing dopamine synthesis reduces mania
34
Q

where are dopamine cell bodies contained

A

in the ventral tegmental area in the midbrain

35
Q

how is dopamine released

A

by tonic and phasic release

36
Q

how does lithium work

A

decreases DA release
decreases DA ( and 5HT) receptor signalling
inhbits seconf mess

37
Q

what is the main use of lithium in Bipolar Disorder

A

acute mainia and prophylaxsis

38
Q

what is the recommended plasma lithium levels

A

0.4-1mmol / L

39
Q

side effects of lithium

A 
dry mouth or metallic taste in mouth 
mild shaking or fine tremor of the hand (s) 
thirst 
passing mroe urine 
dizziness 
mild dizziness 
weight gain 
oedema
40
Q

what does it mean by lithium being teratogenic

A

interferes with fetal development and causes birth defects

41
Q

how does sodium valproate work

A

increases GABA transmission

42
Q

when do we use valproate

A

when lithium isn’t tolerated

43
Q

side effects of valproate

A 
nausea 
vomiting 
sedation 
tremor 
hair loss 
weight gain 
pancreatitis
44
Q

is valproate teratogenic

A

yes, causes fetal valproate syndrome, neural tube defects and intellectual impairment

Pharmacy Stage 3 (51 decks)

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