Mania, Depression, Neurodegenerative disorders Flashcards

Question

Duloxetine | side effects and contraindications

Answer 1

``` Longest acting SNRI ➡️ no withdrawal symptoms No side effects due to no other receptor blockers S/E: 1. Due to 🔼 5HT 2. Duloxetine and milnacipran: Anticholinergic S/E: mydriasis CI: Close angled glaucoma ```

Answer 2

``` DoC for: 1. all forms of depression 2. Premenstrual syndrome 3. Neurosis: • OCD, phobia • PTSD, generalised anxiety disorder GAD • anorexia, bulimia 4. It is used in hot flashes (DoC: hormone replacement therapy) 5. Premature ejaculation because delayed ejaculation S/E When used against anxiety, BZD for 1 month ```

Answer 3

1. Fluoxetine and Norfluoxetine 2. Fluroxamine: OCD, anxiety disorders 3. Paroxetine: 🔽 t1/2 4. Citalopram and escitalopram 5. Vilazodone: major depression

Answer 4

``` Fluoxetine: Very long acting SSRI t1/2 = 50 hr No withdrawal syndrome symptoms DoC for most uses of SSRIs Its prodrug is Norfluoxetine (t1/2 = 250 hr) ```

Answer 5

``` Short acting SSRI Short t1/2 No active metabolite ➡️ max withdrawal symptoms Teratogenic Max: • enzyme inhibition • erectile dysfunction H1 🅱️ ➡️ sedation ➡️ used in depression associated with insomnia (night time dosing) ```

Answer 6

Short t1/2 SSRI Allosterically 🅱️ transporter by building the SERT receptor at a site other than 5HT binding site Use: Major depressive disorder Premenstrual dysphoric disorder S/E: Discontinuation syndrome on abrupt stoppage ➡️: • initially dizziness, paresthesia,… • 1-2 days later diminishes sexual function and interest for a few weeks

Answer 7

``` All are SSRIs 1. Citalopram: Used in premenstrual syndrome agitation 2. Escitalopram: derived from citalopram Most specific SSRI 3. Vilazodone: 5HT1A stimulant also Treatment of major depression ```

Answer 8

5HT2: 1. 🧠: transient anxiety, insomnia, vivid dreams 2. Spinal cord: ED, anorgasmia, delayed ejaculation 3. 5HT3: 🤢 and 🤮 4. 5HT4: loose stools 5. Akathesia 6. Bleeding: least with citalopram, sertraline 7. QT prolongation: citalopram 8. Withdrawal symptoms

Answer 9

``` Maximum with Paroxetine Not seen in fluoxetine 1. 🤢 2. Paresthesia 3. Flu-like symptoms 4. Insomnia, fatigue ```

Answer 10

``` Antidepressants 1. Trazadone: S/E: • Sedation: used with SSRI or SNRI to prevent insomnia • Priapism: used in erectile dysfunction DoC phenylephrine intracavernosal route at base 2. Nefazadone: S/E: hepatotoxic ```

Answer 11

``` Mirtazapine (& mianserin) Mechanism: NaSSA drug • 5HT2 🅱️ • α2 🅱️ ➡️ 🔼NE • 5HT1A 🅱️ ➡️ 🔼 5HT • H2 🅱️➡️ sedation • 5HT3 🅱️ ➡️ anti emetic effect DoC hot depression with insomnia (night dose) Nor-Adrenergic Specific Serotonergic Antidepressants ```

Answer 12

``` Mechanism: Reuptake 🅱️ 🔼 release of both dopamine and NE S/E: 1. Maximum anxiety: Not used for treatment of anxiety disorders 2. Seizure at high doses ```

Answer 13

1. Atypical depression 2. Obesity 3. ADHD 4. Peripheral neuropathy 5. Smoking 🚬 dependence

Answer 14

``` Recently approved antidepressant Mechanism: NMDA 🅱️ Route: intranasal Use: Major depression ```

Answer 15

Recently approved antidepressant Mechanism: GABA2 modulatory action Use: postpartum depression IV continuous infusion for 60 hours 📝: Progesterone metabolite (Allopregnolone) is an anxiolytic antidepressant Postpartum 🔽 in progesterone ➡️ depression

Answer 16

Prodrug of dopamine DoC in Parkinson’s disease Always combined with carbidopa (peripheral decarboxylation 🅱️) On-off phenomena present, reduced when used along with Entecapone (COMT 🅱️) CI: psychosis, closed angle glaucoma

Answer 17

``` 🔼 dopamine Stimulates: 1. D1 receptor: Renal vasodilation ➡️ hypotension 2. D2 receptor: • Limbic system: psychosis • Striatum: dyskinesia • CTZ area: 🤢,🤮 3. Mydriasis 4. Worsens melanoma and periodic ulcer disease Carbidopa affects the S/E differently ```

Answer 18

``` Due to declining dopamine in 🧠 Wearing off phenomena Symptoms correspond to amount of dopamine loss Rx: 1. DoC: COMT inhibitors entecapone 2. MAO B 🅱️ 3. D2 receptor agonist ```

Answer 19

Rasagiline Selegiline Safinamide Use: 1. Rx of on-off phenomena 2. DoC for young onset Parkinson’s disease Inhibit neurodegeneration bcz antioxidant effect

Answer 20

1. Psychosis 2. Dyskinesia The above side effects are due to D2 stimulation in 🧠 Seligine metabolises to amphetamine So its S/E: insomnia, agitation

Answer 21

``` 🔼 bioavailability of levodopa 1. Entecapone: only peripheral COMT 🅱️ 2. Tolcapone: Long acting central and peripheral 🅱️ Use: Entecapone along with levodopa against on-off phenomena ```

Answer 22

``` S/E: 1. Diarrhea 2. 🔼 dopamine: • Entecapone has peripheral S/E - Mydriasis Worsens melanoma and periodic ulcer disease • Tolcapone has both central and peripheral S/E - 🤢,🤮, hypotension, psychosis,… 3. Tolcapone is hepatotoxic ```

Answer 23

1. Pramiprexole: oral 2. Ropinirole: oral 3. Rotigotine: transcranial patch Uses: 1. Young onset Parkinson’s disease Longer acting than levodopa ➡️ 🔽 on-off phenomena 2. Rx off on-off phenomena along with levodopa 3. DoC in restless leg syndrome

Answer 24

``` 1. D2 agonist: • 🤢, 🤮 • Psychosis • Dyskinesia (< levodopa) 2. Fatigue 3. Somnolence 🥱 4. Peripheral edema 5. Impulse control disorder: gambling 🎰/ sexual ```

Answer 25

• D2 agonist Subcutaneous type • Rescue therapy (last resort) in on-off phenomena S/E: severe 🤢, 🤮 (Rx: trimetho benzamide, NOT ondansetron bcz 🔼 risk of severe hypotension)

Answer 26

``` Mechanism: • mainly NMDA 🅱️ • 🔼 dopamine levels Use: 1. Mild Parkinson’s disease 2. Levodopa induced dyskinesia S/E: 1. Ankle edema 2. Livedoreticularis: purple colored pigmentation over skin ```

Answer 27

1. Cholinergics 2. NMDA 🅱️: Memantine - add on drug 3. Memory enhancers/Nootropic: Not FDA approved • Piracetam, • Piribedil • Citicoline, • Cerebrolysin

Answer 28

1. Tacrine: hepatotoxic 2. Rivastigmine: mild/moderate 3. Galantamine: mild/ moderate 4. Donepezil: severe (DoC)

Answer 29

1. Riluzole 2. Edaravone: free radical scavenger 3. Baclofen: muscle relaxant

Answer 30

``` Mechanism: 1. 🔽 glutamate release 2. Inhibit NMDA and Kainate 3. Inhibit Na+ channels Use: 🅱️ neurodegeneration to delay Alzheimer’s disease S/E: 1. Hepatotoxic 2. 🤢, diarrhea ```

Answer 31

``` Mechanism: Free radical scavenger ➡️ neurodegeneration Use: Rx of ALS, acute stroke S/E: 1. Hypersensitivity (due to sodium bisulphite in solution) 2. Headache 3. Contusion ```

Answer 32

(1) intrauterine growth retardation, (2) microcephaly, (3) poor coordination, (4) underdevelopment of midfacial region (appear- ing as a flattened face), and (5) minor joint anomalies. More severe cases may include congenital heart defects and mental retardation.