Exam 5 - Lec 67-68 Antidepressants Watt Flashcards by Rehman Hameed

1st antidepressant drug

a. isoniazid
b. reserpine
c. imipramine
d. selegiline

c. imipramine

(also first TCA)

How well did you know this?

Not at all

Perfectly

3 types of depression; what percent are they among depression cases?

reactive (60%)
major depressive disorder (25%)
bipolar affective (15%)

How well did you know this?

Not at all

Perfectly

decreased sleep, appetite changes, fatigue, psychomotor dysfunctions, menstrual irregularities, palpitations, constipation, headaches, non-specific body aches

a. physiological features of depression
b. psychological features of depression
c. cognitive features of depression

a. physiological features of depression

How well did you know this?

Not at all

Perfectly

dysphoric mood, worthlessness, excessive guilt, loss of interest/pleasure in all or most activities

a. physiological features of depression
b. psychological features of depression
c. cognitive features of depression

b. psychological features of depression

How well did you know this?

Not at all

Perfectly

decreased concentration, suicidal ideation

a. physiological features of depression
b. psychological features of depression
c. cognitive features of depression

c. cognitive features of depression

How well did you know this?

Not at all

Perfectly

look at slide 6 for drug-induced depression examples

fo sho

How well did you know this?

Not at all

Perfectly

what are the 3 hypotheses of depression?

biogenic amine
neuroendocrine
neurotrophic

How well did you know this?

Not at all

Perfectly

which is NOT part of the “biogenic amine” hypothesis of depression?

a. Reserpine causes depression by depleting NE and 5HT from vesicles
b. Agents that increase 5HT and NE are effective for treating depression
c. Depressed patients have reduced BDNF levels
d. Genetic polymorphisms in SERT promoter
(s = short vs l = long allele)
e. alterations in 5HT1A/2C and alpha 2 receptors

c. Depressed patients have reduced BDNF levels (this is part of neutrophic hypothesis)

How well did you know this?

Not at all

Perfectly

what is the neuroendocrine hypothesis of depression? (from internet)

depression is tied to neuroendocrine dysregulation; changes in HPA axis leads to increased levels of stress hormones

How well did you know this?

Not at all

Perfectly

arousal, anxiety-like behavior, disruption of sexual behaviors, and disruption of sleep is involved with

a. CRF1
b. CRF2

a. CRF1

How well did you know this?

Not at all

Perfectly

slow adaptive recovery and appetite suppression are involved with

a. CRF1
b. CRF2

b. CRF2

How well did you know this?

Not at all

Perfectly

activation of the HPA axis is done by

a. CRF1
b. CRF2

a. CRF1

How well did you know this?

Not at all

Perfectly

the HPA axis and CRF is involved in which hypothesis of depression?

a. biogenic amine hypothesis
b. neuroendocrine hypothesis
c. neurotrophic hypothesis

b. neuroendocrine hypothesis

How well did you know this?

Not at all

Perfectly

which hypothesis of depression involves BDNF?

a. biogenic amine hypothesis
b. neuroendocrine hypothesis
c. neurotrophic hypothesis

c. neurotrophic hypothesis

How well did you know this?

Not at all

Perfectly

explain how BDNF affects dendritic sprouts

more BDNF leads to more sprouting; loss of sprouts leads to depressed state

How well did you know this?

Not at all

Perfectly

hippocampal glucocorticoid receptors are activated by cortisol during stress, which _______ BDNF

a. inc
b. dec

b. dec

How well did you know this?

Not at all

Perfectly

how long does it take antidepressants to start working? (range)

2-3 weeks

How well did you know this?

Not at all

Perfectly

how do MAO inhibitors work?

NE and serotonin are normally degraded by monoamine oxidase (MAO), so by inhibiting MAO, there is an inc amount of NE and serotonin packaged into vesicles and released into the synapse

How well did you know this?

Not at all

Perfectly

two non-selective MAO inhibitors

a. phenelzine
b. selegiline
c. moclobemide
d. tranylcypromine

a, d

How well did you know this?

Not at all

Perfectly

MAO-B selective

a. phenelzine
b. selegiline
c. moclobemide
d. tranylcypromine

b. selegiline

How well did you know this?

Not at all

Perfectly

MAO-A selective

a. phenelzine
b. selegiline
c. moclobemide
d. tranylcypromine

c. moclobemide

How well did you know this?

Not at all

Perfectly

what herbal product for depression has MAOI activity?

St. John’s Wort

How well did you know this?

Not at all

Perfectly

pts on MAO inhibitors should avoid foods with

a. tyrosine
b. tryptophan
c. tyramine
d. high salt

c. tyramine

(MAO breaks down tyramine)

How well did you know this?

Not at all

Perfectly

indications for TCAs (4)

depression
panic disorder
chronic pain
enuresis (bedwetting)

How well did you know this?

Not at all

Perfectly

why are patients more likely to commit self-harm or suicide 2 weeks into tx?

when ppl are depressed, they don't have the energy to take their lives, but when on an antidepressant they have more energy to commit self-harm before the actual therapeutic effects kick in

tertiary amines do not act on which transporter/receptor? a. NET b. SERT c. H1 d. antimuscarinic receptors e. alpha 1 f. beta 1

f. beta 1

what are the side effects of tertiary amines?

they cause the most sedation, weight gain, autonomic SE; also conduction disturbances of the heart

which tertiary amine is metabolized to desipramine? a. imipramine b. amitriptyline c. clomipramine d. doxepin

a. imipramine

which tertiary amine is metabolized to nortiptyline? a. imipramine b. amitriptyline c. clomipramine d. doxepin

b. amitriptyline

which tertiary amine is used for OCD? a. imipramine b. amitriptyline c. clomipramine d. doxepin

c. clomipramine

which drug can cause orgasm when yawning? a. imipramine b. amitriptyline c. clomipramine d. doxepin

c. clomipramine

which has less SE, tertiary or secondary amines?

secondary amines

3 secondary amines to know

desipramine nortiptyline maprotiline (also a tetracyclic)

mechanism of SSRIs

they block serotonin transporter pumps, inc serotonin in synapse

why are there so many uses for SSRIs?

bc there are 14 serotonin receptors involved in a lot of different things (13 GPCR, 1 ionotropic)

6 SSRIs to know

fluoxetine fluvoxamine paroxetine sertraline citalopram escitalopram

which SSRI has little autonomic SE, no sedation? a. sertraline b. escitalopram c. paroxetine d. fluoxetine

d. fluoxetine

SE of SSRIs (6 of them; slide 36)

N/V headache sexual dysfunction anxiety insomnia tremor

what syndrome makes pts feel brain zaps, confusion, and some other SE?

SSRI discontinuation syndrome

what syndrome can occur when giving SSRis with MAOIs, or TCAs?

serotonin syndrome

when given with SSRIs, which drug does NOT increase risk for serotonin syndrome? a. MAOIs b. St. John's Wort c. TCAs d. tramadol e. aspirin f. triptans g. metoclopramide

e. aspirin

2 SSRI + 5HT1A partial agonists to know

vilazodone (Viibryd) vortioxetine (Brintellix)

which drug is both tetracyclic and a secondary amine?

maprotiline

which is FALSE about mirtazapine? a. NET inhibitor b. tetracyclic structure c. alpha 2 antag d. 5HT2 and 5HT3 antag e. H1 antag

a. NET inhibitor (it is a receptor antagonist, doesn't hit transporters)

2 tetracyclic drugs to know

maprotiline mirtazapine

which drug is unicyclic? a. maprotiline b. mirtazapine c. bupropion

c. bupropion

which is FALSE about bupropion? a. DAT, NET, SERT inhibitor b. H1 antagonism c. treats GAD d. unicyclic e. Zyban for smoking cessation

b. H1 antagonism

which drug is described below? -5HT2A antag -weak SERT inhibitor -off label use as hypnotic -pts generall wake up refreshed, usually no morning hangover

trazodone

which drug is a 5HT2A antagonist/SERT inhibitor? a. trazodone b. bupropion c. mirtazapine d. amitriptyline

a. trazodone

5 SNRIs to know

venlafaxine desvenlafaxine duloxetine milnacipran levomilnacipran

which SNRI is used for GAD, panic disorder, diabetic neuropathy, and migraine prophylaxis? a. venlafaxine b. desvenlafaxine c. duloxetine d. milnacipran e. levomilnacipran

a. venlafaxine

which SNRI can be used for treatment of vasomotor symptoms associated with menopause? a. venlafaxine b. desvenlafaxine c. duloxetine d. milnacipran e. levomilnacipran

b. desvenlafaxine

which SNRI treats GAD and peripheral neuropathy? a. venlafaxine b. desvenlafaxine c. duloxetine d. milnacipran e. levomilnacipran

c. duloxetine

which SNRI is approved for fibromyalgia? a. venlafaxine b. desvenlafaxine c. duloxetine d. milnacipran e. levomilnacipran

d. milnacipran

which SNRI is the active enantiomer of milnacipran and was approved in 2013? a. venlafaxine b. desvenlafaxine c. duloxetine d. milnacipran e. levomilnacipran

e. levomilnacipran

2 NSRI drugs to know (NE selective reuptake inhibitors)

reboxetine atomoxetine

which NSRI is not used in the USA? a. reboxetine b. atomoxetine

a. reboxetine

which NSRI was originally intended to be an antidepressant drug and was not approved, so it is used for ADHD? a. reboxetine b. atomoxetine

b. atomoxetine

clomipramine selectivity for 5-HT:NE a. 1:136 b. 1:7 c. 8:1 d. 523:1

a. 1:136 (SERT selective)

amitriptyline selectivity for 5-HT:NE a. 1:136 b. 1:7 c. 8:1 d. 523:1

b. 1:7

nortriptyline selectivity for 5-HT:NE a. 1:136 b. 1:7 c. 8:1 d. 523:1

d. 8:1 (NE selective)

maprotiline selectivity for 5-HT:NE a. 1:136 b. 1:7 c. 8:1 d. 523:1

d. 523:1 (NET selective)

what drugs block serotonin, NE, and dopamine reuptake?

SNDRIs aka "triple blockers"

what drug class are the rapidly acting antidepressants?

NMDA antagonists

2 clinically used NMDA antagonists

ketamine and esketamine

which should be given at subanesthetic doses? a. ketamine b. esketamine

a. ketamine

which is intranasally and available only through REMS? a. ketamine b. esketamine

b. esketamine

T or F: esketamine is used in conjunction with an oral antidepressant

FDA-approved drug for postpartum depression

brexanolone

two SSRIs for postpartum depression

fluoxetine and paroxetine

SNRI for postpartum depression

venlafaxine

T or F: antidepressants can be used for pain

drug for hypoactive sexual desire disorder

filbanserin (Addyi) ("female Viagra")

approx ___-___% of Americans have bipolar disorder; onset is < ____ years old

1.5-3% < 30

5 types of bipolar disorder

bipolar I bipolar II cyclothymia disorder unspecified bipolar and related disorder substance-induced mood disorder

what two CCBs can be used for the treatment of bipolar?

verapamil, nimodipine

mechanism of lithium (2 things; look at slide 61)

-depletion of PIP2 and signaling (IP3 and PKC) -modulate GSK3 (phosphorylation and binding partners)

valproate MOA (4 things on slide)

-inc GABA activity, inhibit GABA transaminase -block Na+ channels -block T-type Ca2+ channels -inhibits histone deacetylase (HDAC5)

T or F: lithium has a small therapeutic index

T (so it has lots of SE)

3 mood stabilizers (one is a drug, two are drug classes)

lithium anticonvulsants atypical antipsychotics

how does carbamazepine/oxcarbazepine work for bipolar disorder? (from internet)

they inhibit sodium channels, which reduces the excitability of neurons and can help stabilize mood and bipolar sx

which anticonvulsant acts on sodium and calcium channels? a. carbamazepine b. lamotrigine c. topiramate

b. lamotrigine

which anticonvulsant acts on sodium channels and also may enhance GABA at receptor and blocks excitatory AA receptors? a. carbamazepine b. lamotrigine c. topiramate

c. topiramate

look at slide 64 for atypical antipsychotics for bipolar disorder

sure thing