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Pharmacology > L19 and 20: Affective Disorders > Flashcards

L19 and 20: Affective Disorders Flashcards

1
Q

Duloxetine (Cymbalta) and Venlafaxine (Effexor) belong to which drug class?
A. SSRI
B. SNRI
C. Serotonin Modulator
D. Tricyclic Antidepressant
E. MAOI
F. Atypical Anti-depressant

A

B. SNRI

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2
Q

Which drug is the only Serotonin Modulator?
A. Duloxetine
B. Sertraline
C. Trazadone
D. Esketamine

A

C. Trazadone

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3
Q

Impramine and Amitriptyline belongs to which drug class?
A. SSRI
B. SNRI
C. Serotonin Modulator
D. Tricyclic Antidepressant
E. MAOI
F. Atypical Anti-depressant

A

D. Tricyclic Antidepressant

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4
Q

Buproipion, Mirtazapine, Brexanolone, and Esketamine belong to which drug class?
A. SSRI
B. SNRI
C. Serotonin Modulator
D. Tricyclic Antidepressant
E. MAOI
F. Atypical Anti-depressant

A

F. Atypical Anti-depressant

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5
Q

Phenelzine and Selegiline belong to which drug class?
A. SSRI
B. SNRI
C. Serotonin Modulator
D. Tricyclic Antidepressant
E. MAOI
F. Atypical Anti-depressant

A

E. MAOI

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6
Q

According to the neurotropic hypothesis of major depression, nerve growth factors such as ____ are critical in the regulation
of neural plasticity, resilience, and
neurogenesis

A

BDNF - brain-
derived neurotrophic factor

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7
Q

True or False: Depression is associated with the GAIN of neurotrophic support and
effective antidepressant
therapies DECREASE neurogenesis
and synaptic connectivity.

A

False - Depression is associated with the LOSS of neurotrophic support and effective antidepressant
therapies INCREASE neurogenesis
and synaptic connectivity.

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8
Q

According to the monoamine hypothesis of depression, depression is related to a
deficiency in the amount or function of cortical and limbic ___, ___ and ___

A

Serotonin (5-HT)
NE
DA

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9
Q

True or False: According to the monoamine hypothesis of depression, all classes of antidepressants appear to
enhance the synaptic availability of 5-HT, norepinephrine, or dopamine

A

True

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10
Q

According to the monoamine hypothesis of depression, AMINE levels increase immediately with antidepressant use, but
maximum beneficial effects of most
antidepressants are not seen for many weeks

A

True

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11
Q

Fibromyalgia and chronic pain can be treated with which drug class?
A. SSRI
B. SNRI
C. MAOI

A

B. SNRI

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12
Q

Which atypical antidepressant is most effective at treating post-partum depression?
A. Buproipion
B. Mirtazapine
C. Brexanolone
D. Esketamine

A

C. Brexanolone

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13
Q

True or False: Esketamine acts on Gluaminergic system

A

True

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14
Q

MAOI’s act on ___ and ____ systems

A

Serotonin and NE systems

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15
Q

How can stress disturb HPA Axis, leading to major depressive disorder?

A
  • Elevates cortisol
  • Fails to suppress ACTH in response to dexamethasone challenge
  • Chronically elevated CRH
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16
Q

True or False: In Major Depressive Disorder, you can have diminished thyrotropin release in response to thyrotropin-releasing-hormone

A

True

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17
Q

___ and ___ increase BDFN

A

Glutamine and Monamines

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18
Q

True or False: Elevated monoamines can lead to decrease HPA Steroid abnormalities (aka: decrease cortisol level)

A

True

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19
Q

Cortisol binding to glucocorticoids receptors in the ___ will inhibit BDNF
A. hypothalamus
B. thalamus
C. hippocampus

A

C. hippocampus

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20
Q

The response to antidepressant drug treatment generally has a “therapeutic lag” lasting ___weeks before a measurable therapeutic effect becomes evident. What is hypothesized to cause this lag?

A

3–4 wks

This lag is related to delayed PS changes

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21
Q

When depression improves, first ____ improves, then ____, then ___

A

sleep; mood; cognition

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22
Q

Why are antidepressants not good as a monotherapy for treating bipolar?

A

Can induce a switch from a depressed episode to a manic or hypomanic episode in some
patients

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23
Q

Buproprion and some tricyclic antidepressants can reduce ___ threshold

A

seizure

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24
Q

MAOI’s block MAO, preventing breakdown of…
A. DA
B. NE
C. 5-HT

A

B. NE/C. 5-HT

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25
Q

SSRI’s and SNRI’s block ___

SNRI’s block ___ and ___

Tricyclic antidepressants block ___, ____, and _____

A

SERT
SERT and NET
SERT, NET, and alpha-1 adrenergic receptor

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26
Q

___represent a chemically
diverse class of agents that
have as their primary action
the inhibition of the
serotonin transporter

A

SSRIs

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27
Q

Which class the most common
antidepressants in clinical
use?

A

SSRI’s

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28
Q

True or False: SSRI’s have high
affinity for monoamine
receptors but lack the
affinity for histamine,
acetylcholine, and α
adrenoceptors that is seen
with the tricyclic
antidepressants (TCAs)

A

True

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29
Q

True or False: SSRI’s block SERT and NET

A

False - just SERT; little to no effect on NET

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30
Q

What are the SSRI drugs
(Effective for Sadness, Panic, Compulsions)

A
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31
Q

AE’s associated with SSRI’s?

A

GI Disturbances
- note: most serotonin receptors are in gut

32
Q

Using an SSRI with Selegiline (MAOI) is not good because it can cause what condition?

A

Serotonin Syndrome

33
Q

Which two drug classes are first choice for major depressive disorder (unipolar depression)?

If either of these classes are not sufficient, try ____ or ___

With psychotic features, add

A

SSRI or SNRI

buproprion or mirtazapine

aripipirazole

34
Q

True or False: SSRI’s are first choice for all anxiety disorders

A

TRUE

35
Q

SSRI’s + Venlafaxine (SNRI) are approved to treat ___
Clomipramine (TCA) + SSRI’s can treat ___

A

social anxiety
OCD

36
Q

Which two drugs are used to treat PMDD?

A

Sertraline and Fluoxetine

37
Q

True or False: In addition to be used for treating PMDD, Fluoxetine (Prozac) can be used to treat bulimia

A

True

38
Q

True or False: Buproprion can treat obesity

A

True

39
Q

____, an SSRI, prolongs the duration of
action of certain benzodiazepines,
leading to protracted sedation

A

Fluoxetine

40
Q

All of the SNRI’s and TCA’s bind ___ and ___

A

SERT and NET

41
Q

True or False: Unlike TCA’s, SNRI’s do not have much affinity for other receptors

A

True

42
Q

True or False: Venlafaxine’s in vivo effects are similar to imipramine (TCA) –but with more favorable AE profile

A

True

43
Q

True or False: NSRI’s are not associated with orthostatic hypotension, sedation, or weight gain, or dry mouth, but TCA’s are

A

True

44
Q

Which two SNRI’s increase serotonergic and adrenergic synaptic activity by blocking SERT and NET?

A

Venlafaxine and Duloxetine

45
Q

Which drug class is good for treating someone with depression + chronic pain or second choice for perimenstrual symptoms?

A

SNRI’s

46
Q

Using ____ or ______ (such as tramadol) with SNRI’s may increase CV side effects

A

vasoconstrictors; mixed-acting opiates

47
Q

Which SNRI can be used to treat…
1. Postherpatic Neuralgia
2. Chronic Back Pain
3. Fibromyalgia

A. Duloxetine
B. Bupropion
C. Venlafaxine

A

C. Venlafaxine

48
Q

True or False: Duloxetine can treat chronic joint and muscle pain, as well as fibromyalgia

A

True

49
Q

SNRI

A
50
Q

Trazadone’s primary metabolite, ____, is a potent 5-HT2 antagonist

A

m-cpp

51
Q

True or False: Trazadone has BBW for hepatotoxicity

A

False - this is the case for Nefazodone

52
Q

Which 5-HT Receptor Modulator inhibits 5-HT2a-R and form m-cpp, which blocks 5-HT2A,2C receptors?

A

Trazadone

53
Q

True or False: Trazadone has modest H1 and alpha adrenergic receptor blockade

A

True

54
Q

True or False: Tricyclic antidepressants are used primarily to depression that is unresponsive to SSRI’s/SNRI’s!! Overdose is often LETHAL

A

True

55
Q

Imipramine and Amitriptyline acts by variable blockade of ___ and ___. Like SNRI’s causes blockade of ___ nervous system and ___ receptors

A

NET/SERT; autonomic; histamine

56
Q

Off-target effects of TCA’s?

A
57
Q

Abrupt discontinuation of TCA can result in ____ rebound

A

cholinergic rebound

58
Q

What is the function of tetra/unicyclic antidepressants?

A

MDD that is not responsive to other agents

59
Q

True or False: Buproprion has been used for weight loss and smoking cessation

A

True

60
Q

____ causes release of NE/DA and does NOT have sedation as a side effect
A. Amoxapine
B. Buproprion
C. Mirtazapine
D. Vilazodone

A

B. Buproprion

61
Q

______ leads to increased released of NE and 5-HT, also sedates (histamine receptor)
A. Amoxapine
B. Buproprion
C. Mirtazapine
D. Vilazodone

A

C. Mirtazapine

62
Q

True or False: Buproprion and TCA’s lower seizure threshold

A

True

63
Q

Why does Mirtazapine have sedative properties?
A. Strong a1 adrenergic receptor block
B. Strong H1 block
C. Strong D2 block

A

B. Strong H1 block

64
Q

___ is the exception, as it is unlikely to cause sedation, but IS likely to cause dry mouth
A. Levadopa
B. Mirtazapine
C. Buproprion

A

C. Buproprion

65
Q

Which drug can increased buproprion toxicity? AE?

A

Levadopa (thus, parkinson’s patients should not take buprioprion)

  • Seizures and SJS
66
Q

MAO’s?

A
67
Q

___ blocks MAO-A and B while ____ blocks MAO-B only and can be used to treat PD
A. selegiline; phenelzine
B. phenelzine; selegiline

A

B. phenelzine; selegiline

68
Q

____, found in many foods and drinks, can cause HTN crisis in patient taking a MAOI

A

Tyramine

69
Q

MAOI can cause Serotonin Syndrome. How?

A
70
Q

How to treat MAOI induced Serotonin Syndrome?

A
71
Q

True or False: Merperidine alone (or with a MAOI) can cause malignant hyperthermia

A

True

72
Q

How does ketamine work?

A

Inhibits NMDA receptor
- Downstream Effect: reduced release of GABA-A receptor; disinhibition of glutamatergic neurons + BDNF release

73
Q

First line drug class for Postpartum depression?

A

SSRI

74
Q

____ is a positive allosteric modulator of GABA-A receptors and plays a role in post-partum depression

A

Allopregnenolone

75
Q

_____a GABA-A receptive positive modulator that can be used to treat post-partum depression, but also known to cause sedation, dizziness, LOC

A

Brexanolone

Pharmacology (53 decks)

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