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PHRM 845 Therapeutics > Exam 5 - Lec 67-68 Antidepressants Watt > Flashcards

Exam 5 - Lec 67-68 Antidepressants Watt Flashcards

1
Q

1st antidepressant drug

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

A

c. imipramine

(also first TCA)

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2
Q

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

A

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

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3
Q

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

a. physiological features of depression

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4
Q

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

A

b. psychological features of depression

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5
Q

decreased concentration, suicidal ideation

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

A

c. cognitive features of depression

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6
Q

look at slide 6 for drug-induced depression examples

A

fo sho

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7
Q

what are the 3 hypotheses of depression?

A

biogenic amine
neuroendocrine
neurotrophic

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8
Q

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

A

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

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9
Q

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

A

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

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10
Q

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

a. CRF1
b. CRF2

A

a. CRF1

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11
Q

slow adaptive recovery and appetite suppression are involved with

a. CRF1
b. CRF2

A

b. CRF2

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12
Q

activation of the HPA axis is done by

a. CRF1
b. CRF2

A

a. CRF1

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13
Q

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

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

A

b. neuroendocrine hypothesis

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14
Q

which hypothesis of depression involves BDNF?

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

A

c. neurotrophic hypothesis

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15
Q

explain how BDNF affects dendritic sprouts

A

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

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16
Q

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

a. inc
b. dec

A

b. dec

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17
Q

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

A

2-3 weeks

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18
Q

how do MAO inhibitors work?

A

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

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19
Q

two non-selective MAO inhibitors

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

A

a, d

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20
Q

MAO-B selective

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

A

b. selegiline

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21
Q

MAO-A selective

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

A

c. moclobemide

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22
Q

what herbal product for depression has MAOI activity?

A

St. John’s Wort

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23
Q

pts on MAO inhibitors should avoid foods with

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

A

c. tyramine

(MAO breaks down tyramine)

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24
Q

indications for TCAs (4)

A

depression
panic disorder
chronic pain
enuresis (bedwetting)

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25
Q

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

A

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

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26
Q

tertiary amines do not act on which transporter/receptor?

a. NET
b. SERT
c. H1
d. antimuscarinic receptors
e. alpha 1
f. beta 1

A

f. beta 1

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27
Q

what are the side effects of tertiary amines?

A

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

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28
Q

which tertiary amine is metabolized to desipramine?

a. imipramine
b. amitriptyline
c. clomipramine
d. doxepin

A

a. imipramine

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29
Q

which tertiary amine is metabolized to nortiptyline?

a. imipramine
b. amitriptyline
c. clomipramine
d. doxepin

A

b. amitriptyline

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30
Q

which tertiary amine is used for OCD?

a. imipramine
b. amitriptyline
c. clomipramine
d. doxepin

A

c. clomipramine

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31
Q

which drug can cause orgasm when yawning?

a. imipramine
b. amitriptyline
c. clomipramine
d. doxepin

A

c. clomipramine

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32
Q

which has less SE, tertiary or secondary amines?

A

secondary amines

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33
Q

3 secondary amines to know

A

desipramine
nortiptyline
maprotiline (also a tetracyclic)

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34
Q

mechanism of SSRIs

A

they block serotonin transporter pumps, inc serotonin in synapse

35
Q

why are there so many uses for SSRIs?

A

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

36
Q

6 SSRIs to know

A

fluoxetine
fluvoxamine
paroxetine
sertraline
citalopram
escitalopram

37
Q

which SSRI has little autonomic SE, no sedation?

a. sertraline
b. escitalopram
c. paroxetine
d. fluoxetine

A

d. fluoxetine

38
Q

SE of SSRIs (6 of them; slide 36)

A

N/V
headache
sexual dysfunction
anxiety
insomnia
tremor

39
Q

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

A

SSRI discontinuation syndrome

40
Q

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

A

serotonin syndrome

41
Q

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

A

e. aspirin

42
Q

2 SSRI + 5HT1A partial agonists to know

A

vilazodone (Viibryd)
vortioxetine (Brintellix)

43
Q

which drug is both tetracyclic and a secondary amine?

A

maprotiline

44
Q

which is FALSE about mirtazapine?

a. NET inhibitor
b. tetracyclic structure
c. alpha 2 antag
d. 5HT2 and 5HT3 antag
e. H1 antag

A

a. NET inhibitor

(it is a receptor antagonist, doesn’t hit transporters)

45
Q

2 tetracyclic drugs to know

A

maprotiline
mirtazapine

46
Q

which drug is unicyclic?

a. maprotiline
b. mirtazapine
c. bupropion

A

c. bupropion

47
Q

which is FALSE about bupropion?

a. DAT, NET, SERT inhibitor
b. H1 antagonism
c. treats GAD
d. unicyclic
e. Zyban for smoking cessation

A

b. H1 antagonism

48
Q

which drug is described below?

-5HT2A antag
-weak SERT inhibitor
-off label use as hypnotic
-pts generall wake up refreshed, usually no morning hangover

A

trazodone

49
Q

which drug is a 5HT2A antagonist/SERT inhibitor?

a. trazodone
b. bupropion
c. mirtazapine
d. amitriptyline

A

a. trazodone

50
Q

5 SNRIs to know

A

venlafaxine
desvenlafaxine
duloxetine
milnacipran
levomilnacipran

51
Q

which SNRI is used for GAD, panic disorder, diabetic neuropathy, and migraine prophylaxis?

a. venlafaxine
b. desvenlafaxine
c. duloxetine
d. milnacipran
e. levomilnacipran

A

a. venlafaxine

52
Q

which SNRI can be used for treatment of vasomotor symptoms associated with menopause?

a. venlafaxine
b. desvenlafaxine
c. duloxetine
d. milnacipran
e. levomilnacipran

A

b. desvenlafaxine

53
Q

which SNRI treats GAD and peripheral neuropathy?

a. venlafaxine
b. desvenlafaxine
c. duloxetine
d. milnacipran
e. levomilnacipran

A

c. duloxetine

54
Q

which SNRI is approved for fibromyalgia?

a. venlafaxine
b. desvenlafaxine
c. duloxetine
d. milnacipran
e. levomilnacipran

A

d. milnacipran

55
Q

which SNRI is the active enantiomer of milnacipran and was approved in 2013?

a. venlafaxine
b. desvenlafaxine
c. duloxetine
d. milnacipran
e. levomilnacipran

A

e. levomilnacipran

56
Q

2 NSRI drugs to know (NE selective reuptake inhibitors)

A

reboxetine
atomoxetine

57
Q

which NSRI is not used in the USA?

a. reboxetine
b. atomoxetine

A

a. reboxetine

58
Q

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

a. reboxetine
b. atomoxetine

A

b. atomoxetine

59
Q

clomipramine selectivity for 5-HT:NE

a. 1:136
b. 1:7
c. 8:1
d. 523:1

A

a. 1:136 (SERT selective)

60
Q

amitriptyline selectivity for 5-HT:NE

a. 1:136
b. 1:7
c. 8:1
d. 523:1

A

b. 1:7

61
Q

nortriptyline selectivity for 5-HT:NE

a. 1:136
b. 1:7
c. 8:1
d. 523:1

A

d. 8:1 (NE selective)

62
Q

maprotiline selectivity for 5-HT:NE

a. 1:136
b. 1:7
c. 8:1
d. 523:1

A

d. 523:1 (NET selective)

63
Q

what drugs block serotonin, NE, and dopamine reuptake?

A

SNDRIs aka “triple blockers”

64
Q

what drug class are the rapidly acting antidepressants?

A

NMDA antagonists

65
Q

2 clinically used NMDA antagonists

A

ketamine and esketamine

66
Q

which should be given at subanesthetic doses?

a. ketamine
b. esketamine

A

a. ketamine

67
Q

which is intranasally and available only through REMS?

a. ketamine
b. esketamine

A

b. esketamine

68
Q

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

A

T

69
Q

FDA-approved drug for postpartum depression

A

brexanolone

70
Q

two SSRIs for postpartum depression

A

fluoxetine and paroxetine

71
Q

SNRI for postpartum depression

A

venlafaxine

72
Q

T or F: antidepressants can be used for pain

A

T

73
Q

drug for hypoactive sexual desire disorder

A

filbanserin (Addyi)

(“female Viagra”)

74
Q

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

A

1.5-3%
< 30

75
Q

5 types of bipolar disorder

A

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

76
Q

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

A

verapamil, nimodipine

77
Q

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

A

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

78
Q

valproate MOA (4 things on slide)

A

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

79
Q

T or F: lithium has a small therapeutic index

A

T (so it has lots of SE)

80
Q

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

A

lithium
anticonvulsants
atypical antipsychotics

81
Q

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

A

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

82
Q

which anticonvulsant acts on sodium and calcium channels?

a. carbamazepine
b. lamotrigine
c. topiramate

A

b. lamotrigine

83
Q

which anticonvulsant acts on sodium channels and also may enhance GABA at receptor and blocks excitatory AA receptors?

a. carbamazepine
b. lamotrigine
c. topiramate

A

c. topiramate

84
Q

look at slide 64 for atypical antipsychotics for bipolar disorder

A

sure thing

PHRM 845 Therapeutics (34 decks)

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