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Drug group - Antidepressant Flashcards

1
Q

Antidepressant drug types

A
  1. Tricyclic antidepressants
  2. Monoamine oxidase inhibitors
  3. Selective serotinin reuptake inhibitors
  4. Noradrenaline reuptake inhibitors
  5. Serotonin and noradrenaline reuptake inhibitors
  6. Serotonin antagonists an reuptake inhibitors (SARIs)
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2
Q

Tricyclic antidepressant - drug names

A
  1. Amitryptiline - more sedative
  2. Lofepramine - less anticholinergic
  3. Clomipramine - only effective OCD drug
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3
Q

Tricyclic antidepressant - mechanism of action

A
  1. Block serotonin transporters (SERT) and noradrenaline transporters (NET) to inhibit reuptake of 5-HT (serotonin) and NA (noradrenaline)
  2. increase extracellular levels and enhance neurotransmission
  3. Antagonise - M1-muscarinic receptor/H1-histaminergic/alpha 1 adrenergic receptors which causes side effects
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4
Q

Tricyclic antidepressant - indication

A
  1. Depression - 2nd line
    - particularly useful when sedation required
  2. Panic disorder - 2nd line
  3. OCD - 2nd line
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5
Q

Tricyclic antidepressant - contraindic

A
  1. MI/arrythmias
  2. severe Liver disease
  3. Acute porphyria
  4. manic phase of bipolar
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6
Q

Tricyclic antidepressant - side effects

A
  1. muscarinic M1 receptor antagonist - anticholinergic effects
    - dry mouth/blurred vision/constipation/impotence
  2. histaminergic H1 - antihistamine effects e.g. sedation + weight gain
  3. Alpha 1 - adrenergic - antisympathetic e.g. postural hypotension
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7
Q

MAOIs - mechanism of action

A
  1. inhibit monoamine oxidase to prevent the breakdown of amine neurotransmitters such as;
    - 5-HT, NA, melatonin
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8
Q

MAOIs - drug names

A
  1. Phenelzine - irreversible inhibitor

2. Moclobemide - reversible inhibitors/ fewer side effects

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9
Q

MAOIs - indications

A
  1. Depression - 2nd line
  2. Panic disorder - 3rd line
  3. Phobic disorder - 3rd line
  4. OCD - 3rd line
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10
Q

MAOIs - contraindic

A
  1. use of TCA or SSRI
  2. pheochromocytoma
  3. Manic phase of bipolar disorder
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11
Q

MAOIs- side effect

A
  1. postural hypotension/ dizziness
  2. Serotonin syndrome - interaction with TCA and SSRIs cause increase in serotonin + hypertensive crisis
  3. irreversible inhibitors prevent breakdown of dietary amines (tyramine) found in aged cheese
    - > hypertensive crisis
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12
Q

SSRI - drug names

A
  1. Fluroxetine
  2. Citalopram
  3. Setraline
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13
Q

SSRI - mechanism

A
  1. selectively inhibits presynaptic reuptake of 5-HT into neurones
  2. increases the amount of 5-HT neurotransmitter available for transmission
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14
Q

SSRI - indication

A
  1. Depression - 1st line
  2. GAD - 1st line
  3. Panic disorder - 1st line
  4. Phobic disorder - 1st line
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15
Q

SSRI contraindic

A
  1. Cardiovascular disease
  2. Diabetes mellitus
  3. Manic phase of bipolar
  4. Epilepsy
  5. Glucoma
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16
Q

SSRI - side effects

A
  1. GI upset
  2. Anorexia
  3. Increase in anxiety - only for a few early days
  4. Increased suicide risk in young patients
17
Q

NARI drug names

A
  1. Reboxetine (Lofepramine)
18
Q

NARI indication

A
  1. depression ( second line )

2. Panic disorder

19
Q

NARI contraindic/caution

A
  1. cardiovascular disease
  2. epilepsy
  3. BPH, urinary retention, risk of glaucoma
  4. Hepatic/renal impairment
  5. Bipolar disorder
20
Q

Side effects of NARI

A
  1. Nausea/ dry mouth/ Constipation/ urinary retention
  2. Drowsiness
  3. Adrenergic side effects :
    - tachycardia
    - Palpitations
    - Vasodilation
    - Hypertension
    - Postural hypotension
21
Q

SNRI drug names

A
  1. Venlafaxine

2. Duloxetine

22
Q

mechanism of action of SNRI

A
  1. inhibit the reuptake of 5-HT and NA into neurones and produce theraputic effects by increasing serotonin and noradrenaline
  2. inhibit dopamine reuptake
23
Q

indications of SNRI

A
  1. Depression - more effective SSRIs for severe depression so used in 2nd or 3rd line
  2. GAD - 1st
24
Q

contraindication of SNRI

A
  1. CVS disease
  2. Hypertenison
  3. Arrythmias
  4. Epilepsy
25
Q

SARI ( serotonin antagonists and reuptake inhibitors)

- DRUG NAMES

26
Q

SARI mechanism of action

A
  1. Predominantly acts as a Serotonin receptor antagonist but also has a weak inhibitory effect on serotonin reuptake
  2. Potent alpha-1 adrenergic blockade
  3. No muscarinic blockade
27
Q

SARI indications

A
  1. Depression - particularly useful where sedation is required
  2. GAD
28
Q

NASSAs

A

noradrenaline and specific serotonergic antidepressants

29
Q

NSSAs drug names

A

Mirtazapine

30
Q

NSSA indication

A

depression (2nd line)

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