ISMH Mood Disorders 3rd of October Flashcards

Question

What symptoms does both 5HT and noradrenaline mediate?

Answer 1

Depressed Mood Anxiety Irritability Thought process Vague aches and pains

Answer 2

Tricyclic antidepressants (TCAs) Selective NA/5HT reuptake inhibitors (SS/NRIs) Monoamine Oxidase Inhibitors (MAOIs)

Answer 3

- Strategy is to increase extracellular levels of these neurotransmitters in the brain, - with varying degrees of selectivity for particular neurotransmitter systems - selectivity determines degree of side effects.

Answer 4

Clomipramine Amitriptyline Doxepin Imipramine Desipramine -pramine

Answer 5

Depression Migraine prophylaxis Neuropathic pain Obsessive compulsive disorder (Clomipramine) Enuresis Panic disorder Sleep disorders Attention deficit / hyperactivity disorder

Answer 6

Depression with Pain Fibromyalgia Migraine insomnia

Answer 7

Patients in whom anticholinergic effects would be problematic Overweight patients Suicidal patients Cardiac patients Patients with dementia

Answer 8

- Antagonist activity at mACh receptors, histamine H1 receptors and 𝛼1-adrenoceptors. - The antagonist activity at mACh receptors results in atropine-like side effects - The antagonist activity at histamine H1 receptors causes weight gain, drowsiness and sedation. - The antagonist activity at 𝛼1-adrenoceptors can produce postural hypotension, syncope in some patients and sedation. - The incidence of these side effects varies with different TCAs. Therefore, TCAs with excessive sedative properties, such as amitriptyline and doxepin, should be avoided in the elderly, who should be prescribed TCAs with less sedative properties such as imipramine or nortriptyline.

Answer 9

Confusion, convulsions, tachycardia, hypotension, ventricular arrhythmias. Ventricular arrhythmias - death

Answer 10

- removal of the remaining drug in the stomach - anticonvulsant agent (diazepam) - antiarrhythmic drugs and further cardiac support to prevent or treat ventricular arrhythmias.

Answer 11

- 4–6 weeks before a clinically significant antidepressant effect is observed - during this time, side effects may dissuade patient compliance - importance of patient counselling by pharmacists.

Answer 12

- generally better tolerated - possess less anticholinergic and cardiovascular side effects - low acute toxicity in overdose. - most widely prescribed antidepressants worldwide

Answer 13

Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Fluvoxamine (Luvox) Citalopram (Celexa) Escitalopram (Lexapro)

Answer 14

Depression Social phobia Panic disorder Obsessive compulsive disorder Bulimia Nervosa Post Traumatic Stress Disorder Pre Menstrual Dysphoric Disorder (Sarafem)

Answer 15

Patients with sexual dysfunction Patients with nocturnal myoclonus Patients with consistent agitation Patients with consistent insomnia

Answer 16

- Gastrointestinal - Nausea, vomiting, diarrhea - Sexual dysfunction - Some anticholinergic side effects, especially with paroxetine - Headache - insomnia - Long-term weight gain - Occasional aggressive and violent behaviours. - Fatigue - Akathisia (an inability to remain still) and dystonic reactions 5HT can reduce DA levels

Answer 17

Usually after prolonged treatment - dizziness, - nausea, - headache, - fatigue, - flu-like symptoms, - agitation, - impaired concentration, - paraesthesia - sensations of electric shocks, - vivid dreaming - anxiety.

Answer 18

- Occurs when several serotonergic drugs combined - Often involves MAOI’s as one of the drugs - Other serotonergic drugs implicated SSRI’s TCA’s Serotonin releasing agents (i.e. MDMA or “ecstasy”) Dextromethorphan, meperidine, others

Answer 19

- Altered mental status – confusion, agitation - Autonomic dysfunction – diaphoresis, tachycardia, BP changes, fever - Neuromusucular abnormalities – clonus

Answer 20

Allow 2 weeks between MAOI and other antidepressant administration - 5 weeks for fluoxetine

Answer 21

Yes. major risk factor for suicide in children, adolescents and young adults. WHY: Discontinuation or withdrawal symptom with an increased risk of suicidal ideation if dose missed.

Answer 22

SSRIs with short half-lives

Answer 23

- Avoid SSRIs with short half lives - SSRIs not to be prescribed in children and young adults (apart from fluoxetine which has a long half-life)

Answer 24

4-6 weeks before a clinical effect is observed.

Answer 25

Selectively inhibit NA transporters and block the reuptake of noradrenaline Indirectly increase 5-HT release by an action at presynaptic 𝛼1-adrenoceptors on 5-HT neurones.

Answer 26

Reboxetine

Answer 27

mild atropine-like effects, tachycardia, postural hypotension and sexual dysfunction.

Answer 28

Duloxetine Venlafaxine - can cause sustained increases in blood pressure in some patients. Inhibit the reuptake of both 5-HT and NA. The SNRIs are usually used as a second-line treatment for patients who do not respond well to SSRIs.

Answer 29

Inhibit the reuptake of both 5-HT and NA. Similar side-effect profile to SSRIs

Answer 30

Widely used in the past for first-line therapy but generally superseded by antipsychotics.

Answer 31

Slow onset of action (6-12 months) - more useful as prophylaxis therapy than treatment of acute phase.

Answer 32

- Prophylaxis and treatment of mania - Prophylaxis of bipolar disorder (manic-depression) - Concomitant anti-depressant treatment in patients with - incomplete response to treatment for depression in bipolar disorder. - Augmenting agent in treatment resistant depression.

Answer 33

- small monovalent cation - used therapeutically in its salt form. - Related to sodium functionally mechanism of action is unclear

Answer 34

Affects electrolytes and ion transport (Na+) Affects release of neurotransmitters (5HT, NA, DA) Affects second messengers and enzymes that mediate neurotransmitter function.

Answer 35

1. Antipsychotic drugs (olanzapine; quetiapine; risperidone) First line treatment (NICE guidelines) 2. Lithium carbonate 3. Carbamazepine 4. Valproate 5. Benzodiazepines (only for acute treatment)

Answer 36

- antagonist at 5-HT1A and 5-HT2 receptors and inhibits the reuptake of 5-HT. - Antagonist at 5-HT1A autoreceptors  increase the release of 5-HT - Inhibition of 5-HT reuptake will further enhance the postsynaptic effects of 5-HT.

Answer 37

Its main adverse effects include postural hypotension, sedation and weight gain.

Answer 38

main mechanism of action is to inhibit dopamine and noradrenaline transporters and, thereby, block the reuptake of DA and NA

Answer 39

The main adverse effects of bupropion include - nausea, - constipation, - epigastric distress, - dry mouth agitation - insomnia. More serious, but rare, side effects that can occur are the risk of seizures or the induction of psychosis.

Answer 40

Used in patients with atypical MDD/ anxiety

Answer 41

Phenelzine (Nardil) Tranylcypromine (Parnate)

Answer 42

Hypertensive crisis can occur when combined with high tyramine foods or sympathomimetics Aged cheeses, sour cream, wines, beer, canned or processed meats, fermented foods, coffee, chocolate Amphetamines, ephedrine, other decongestants

Answer 43

Atropine-like side effects, - postural hypotension, - hyperphagia - weight gain.

Answer 44

The irreversible MAOIs can cause liver damage, and are contraindicated in patients with hepatic impairments.

Answer 45

The most important factor that limits the use of the MAOIs is their potentially fatal interaction with specific foods types that are rich in certain amines, especially tyramine, such as cheese (with the exception of Cottage cheese), yeast products, processed meats, beef liver, broad beans and beer. They can interact with the MAOIs to cause a hypertensive crisis.