Drugs of Dependance and Anti-Depressants 2 Flashcards
LSD is an agonist to […..] receptors, causes the downstream release of NT, […], in the cortex.
5-HT2 receptors
glutamate.
LSD also inhibits firing of 5-HT containing neurons in the [….], act as an agonist of the inhibitory autoreceptors of these cells.
raphe nucleus
affective disorders include:
- [….] or Major Depression
- […]
Unipolar - can be reactive (due to tragedy/loss) or endogenous (no known cause)
Bipolar.
why is it that drugs elevating mood (noradrenaline, serotonin, dopamine) do not necessarily make good anti-depressants?
many of them have dopaminergic activities causing dependance and/or also affect peripheral sympathetic nerves causing CV effects.
1st generation unipolar depression drugs are […]
tricyclic antidepressants and MAO inhibitors
2nd gen unipolar depression drugs are [….]
SSRI’s or SSNRI’s (selective serotonin/noradrenaline reuptake inhibitors)
3rd gen unipolar depression drugs (atypical antidepressants) are
novel monoaminergic drugs and non-monoaminergic drugs
bipolar depression drugs are [….]
lithium
anti-epileptics such as carbamazepine
trycyclic antidepressant mechanism of action is to:
1) INHIBIT neuronal uptake of [….] and [….]
2) antagonise [..4 types..] receptors,
adverse effect:
3) qunidine like membrane stabilizing effect at high concentrations
serotonin and noradrenaline
alpha-adrenoreceptors, muscarininic receptors, serotonin receptors, and histamine receptors
why must you carefully monitor and titrate the doses of trycyclic antidepressants in patients over time?
in depressive patients, body may have downregulated or upregulated receptors during periods of inactivity
—>produce either hypersensitive states or delayed sensitivity
what are the common trycyclic antidepressants?
imipramine
nortriptyline (safest)
amityrptiline (severe anticholinergic effects)
doxepin (severe sedation)
what are the common MAO inhibitors?
how do they work?
iproniazid
tranylcypromine
they work by increasing levels of 5-HT, NA, and DA.
What is a well known dietary conraindication of MAO inhibitors?
how does it work?
what are the adverse effects when taken together?
the cheese reaction.
MAO in gut wall is responsible for breaking down dietary amines (tyramine) present in foodstuffs (cheese, wine, chocolate bananas)
- ->tyramine releases NA from peripheral nerve terminals (exerts sympathomimetic affect, like amphetamine)
- –>MAO inhibitions allows tyramine to be absorbed
acute hypertension, throbbing headache, intracranial hemorrhage.
the improvement on MAO inhibitors is […..] inhibitors, meant to taper down the cheese rxn effects.
MAO A inhibitors (only selects A subtype of receptors, allowing for competition)
what are the SSRI’s?
how do they work?
caution notes or contraindications?
fluoxetine
paroxetine
sertraline
not to be combined with TCA or MAOI or it will cause serotonin syndrome. (cardiovascular collapse, hyperthermia, muscle rigidity).
can bring on anxiety and suicidal thoughts in teenagers.
