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Clinical Pharmacy > MDD > Flashcards

MDD Flashcards

1
Q

Most common mood disorder

A

Depression

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2
Q

Classified as a unipolar mood disorder

A

Major depression

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3
Q

Classified as when an emotional state, such as sadness, becomes chronic and uncontrollable.

A

Major depression

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4
Q

Have an unclear nature of how they occur due to the difficult availabilty of human brain tissue for neurochemical measurement until patients are post-mortem.

A

Mood disorders

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5
Q

Range of greater prevalence of women than men with regards to epidemiology of MDD according to age in adolescence - mid 50’s

A

1.7 - 2.7 times

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6
Q

In 65-80 y.o. people, what percentage does MDD occur in men and women?

A

Men : 9.6%
Women: 20.4 %

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7
Q

Other prevalence of MDD

A

Comorbid substance abuse
Suicide attempts
Death occuring frequently

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8
Q

Hereditary epidemiology degree of liability

A

37% hereditary liability wherein 8-18% with MDD have atleast a degree relative with a history of depression

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9
Q

Environmental epidemiology percentsage

A

63% of the variance in liability was due to an individual-specific environment.

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10
Q

Epigenetic factors of MDD

A
  1. Genome
  2. Environment
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11
Q

2-3 times increase in lifetime risk of developing MDD among first degree relatives with 37% heritability

A

Genome factor

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12
Q

2 types of environmental factor in the epigenetic mechanism of MDD which are 63%

A

Aversive
Protective

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13
Q

Aversive factors

A

Prenatal factors
Childhood trauma
Stress
Medical illness
Drug abuse

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14
Q

Protective

A

Social support
Coping
Exercise

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15
Q

MDD equation

A

Genome + environment = MDD

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16
Q

Clinical presentations of mdd

A

Affective symptoms
Cognitive symptoms
Somatic - vegetative symptoms

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17
Q

Pathophysiology of MDD

A

Brain network level
- regional brain volumes
- cognitive control circuit

Molecular level
- neurotransmission
- neuropasticity
- stress hormones
- inflammation

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18
Q

Symptoms reported by MDD patients consistently reflect changes in which transmitters?

A

Brain monoamine neurotransmitters (NTs)

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19
Q

Symptoms reported by MDD patients consistently reflect changes in which transmitters?

A

Brain monoamine neurotransmitters (NTs)

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20
Q

Decreased levels of these amines are typically present in the brains of depressed patients.

A

5-HT, DA, NE

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21
Q

Hypothesis where decreased levels and functional deficiencies of 5-HT, DA, and NE, are typically present in the brains of depressed patients.

A

Monoamine hypothesis (Biogenic Amine Hypothesis)

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22
Q

Primary Hypotheses for the development of MDD

A
  1. Monoamine Hypothesis
  2. Neural Plasticity Hypothesis
  3. Neuroinflammatory hypothesis
  4. Hypothalamic-pituitary-adrenal (HPA) axis
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23
Q

Regulates neuronal plasticity

A

Brain-derived neurotrophic factor

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24
Q

Might impact the development of synaptic structures, such as axons and dendrites, and their growth and remodeling.
might enhance the long-term synaptic transmission function of the hippocampus through pre- and post-synaptic pathways

A

Brain-derived neurotrophic factor (BDNF)

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25
Q

pathogenesis of depression is significantly influenced by what?

A

neuroplasticity and remodeling

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26
Q

An inflammation-related disease that worsens as inflammation increases and progresses.

A

Depression

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27
Q

glial cell activation in the brains of depressed patients results in the release of what

A

pro-inflammatory cytokines

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28
Q

examples of pro-inflammatory cytokines

A

Interleukin-6 (IL-6)
Interleukin 1 beta (IL-1B)
TNF-alpha

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29
Q

pro-inflammatory cytokines can lead to what

A

neuroinflammation and neuronal death

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30
Q

glial cells also produce what substances?

A

Nitric oxide synthase
Cyclooxygenase-2 (COX-2)

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31
Q

emerged as a novel target for the treatment of depression

A

Neuroinflammation

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32
Q

HPA dysfunction in Px with depression have high _?

A

Glucocorticoid levels

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33
Q

Primary function of the HPA axis

A

regulate the stress response

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34
Q

hormone released by hypothalamus when we are stressed

A

corticotropin-releasing hormone (CRH)

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35
Q

Signals the pituitary gland to secrete a hormone called adrenocorticotropic hormone into the bloodstream

A

Corticotropin-releasing hormone

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36
Q

Site where the ACTH travels down and prompts the release of a hormone called cortisol from the cortex, or outer layer, of the adrenal glands

A

Adrenal glands

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37
Q

helps mobilize energy like glucose so the body has enough power to cope with prolonged stressor

A

Cortisol

38
Q

senses high levels of cortisol in the blood

A

receptors in areas of brain like hypothalamus and hippocampus

39
Q

mechanisms involved when cortisol levels in the blood are high

A

negative feedback mechanism which shuts off the stress response

40
Q

Neurotransmitters

A
  1. Glutamate
  2. GABA
  3. Dopamine
  4. Adrenaline
  5. Serotonin
  6. Oxytocin
  7. Acetylcholine
41
Q

main excitatory neurotransmitter in the CNS

A

Glutamate

42
Q

main inhibitory neurotransmitter
reduces the activity of the CNS
blocks certain signals from the brain

A

GABA

43
Q

most thrilling neurotransmitter
plays a major role in the brain’s reward system
proved critical to CNS functions such as movement, pleasure, attention, mood, and motivation

A

Dopamine

44
Q

responsible for body’s fight or flight response
body’s defense mechanisms against stress

A

Adrenaline (epinephrine)

45
Q

promotes satisfaction after eating and keeps appetite in check

A

Serotonin

46
Q

love hormone

A

Oxytocin

47
Q

two main actions of oxytocin in the body

A
  1. contraction of the womb during childbirth
  2. Lactation
48
Q

directly affects muscles.
triggers an action potential or command in the muscle fiber.
makes muscle contract instead of sending signals to a brain cell

A

Acetylcholine

49
Q

A deficit in the concentration of the brain’s NE, Dopamine, and/or serotonin resulting in depression

A

Neurochemical dysregulation

50
Q

Antidepressant therapies focus on what ?

A

Increasing monoamine neurotransmitter levels within the synapses

51
Q

Lipid soluble and can penetrate the BBB.
Binds and inhibits the catecholamine pump on the storage vesicles in central and peripheral adrenergic neurons

A

Reserpine

52
Q

Inhibits uptake of norepinephrine, dopamine, and serotonin into presynaptic storage vesicles

A

Reserpine

53
Q

reserpine in combination with these may have additive orthostatic hypotensive effects when used with beta-blockers due to catecholamine depletion.

A

Beta-blockers

54
Q

may also interfere with reflex tachycardia, worsening the orthostasis

A

Beta-blockers

55
Q

cause of secretion of pro-inflammatory cytokines which causes immunosuppression and inflammation

A

Chronic cortisol release in the body

56
Q

results to neuronal atrophy of the hippocampus resulting in no cell growth consequently causing a reduction of the hippocampal brain-derived neurotrophic factor (BDNF)

A

Neuroendocrine dysregulation

57
Q

Depressed individual’s post-mortem brains have shown a widespread decrease in what neurotransmitter receptor subtype??

A

serotonin or 5HT-1a receptor subtype

58
Q

where does the 5 HT-1a receptor subtype bind?

A

Frontal. temporal, and limbic cortex

59
Q

what is found in the frontal cortex of some suicide victims with depression?

A

NE receptor alterations

60
Q

Alterations in NE systems may be linked to what?

A

Attention or concentration difficulties as well as sleep and arousal disturbances in depression

61
Q

T/F: depressed individuals have also been found to have abnormalities in cerebral blood flow and glucose metabolism

A

T

62
Q

Duration of symptoms to be present for diagnosis

A

2 weeks

63
Q

feelings most commonly seen

A

sadness and despair
irritability and hopelessness

64
Q

symptoms

A
  1. depressed or irritable mood
  2. loss of interests and pleasures - includes interpersonal relationships
  3. significant weight gain or loss (5%0 in a month
  4. sleep disturbances: insomnia/hypersomnia
  5. psychomotor agitation or retardation: restlessness or agitation
  6. fatigue or loss of energy
  7. feelings of worthlessness or exccessive guilt: pessimistic/negative outcomes are perceived
  8. poor concentration or indecisiveness
  9. resent thoughts of suicide/death
65
Q

Affective symptoms of depression

A

feeling of sadness
loss of interest normally pleasurable activities
change in appetite and sleep
loss of energy
problems with concentration and decision-making

66
Q

cognitive symptoms

A

difficulty remembering,
diff. speaking
diff. understanding
problems of concentrations
loss of motivation

67
Q

somatic-vegetative

A

digestive issues
heart palpitations or arrythmias
shortness of breath or trouble breathing
NV
Change in body temperature

68
Q

main objective of Tx

A

complete remission of depression with full functional recovery and the development of resilience

69
Q

Examples of psychological therapy

A
  1. cognitive behavioral therapy
  2. interpersonal therapy
  3. acceptance and commitment therapy
  4. mindfulness-based cognitive therapy
70
Q

First line pharmacotherapy

A
  • SSRIs, NaSSAs, NDRIs, SNRIs, NARIs
  • melatonin agonist serotonin modulator
71
Q

Second line pharmacotherapy

A

TCAs, MAOIs

72
Q

3 Phases for treatment with MDD

A
  1. Acute Phase
  2. Continuation Phase
  3. Maintenance Phase
73
Q

First-line treatment antidepressant due to safety in overdose and tolerability

A

SSRIs

74
Q

An SNRI that potentiates the activity of NE and 5-HT by blocking their reuptake.
Reported frequently during TCA therapy.

A

TCA

75
Q

A generation SNRI that inhibits 5-HT in low doses and inhibits NE at high doses

A

Venlafaxine

76
Q

a new generation SNRI that is a primary active metabolite of venlafaxine

A

Desvenlafaxine

77
Q

A new generation SNRI with both 5-HT and NE reuptake inhibition across all doses

A

Duloxetine

78
Q

A mixed serotonergic medication with dual action on serotonergic neurons, acting as both 5-HT antagonists and 5-HT reuptake inhibitors

A

Trazodone and Nefazodone

79
Q

blocks b-adrenergic and histaminergic receptors (sedation and dizziness)

A

Trazodone

80
Q

the long-acting release of this was approved by FDA

A

Trazodone

81
Q

A mixed 5-HT which was declined due to hepatotoxic effect

A

Nefazodone

82
Q

Block box labeling requirement from FDA warning describing rare cases of liver failure

A

Nefazodone

83
Q

A serotonin andd A-adrenergic receptor antagonist that Enhances central noradrenergic and serotonergic activity through antagonism of central presynaptic a-adrenoceptor auto receptors and heteroceptors

A

Metazapine

84
Q

Antagonizes 5HT receptors as well as Histamine receptors
Helps lower anxiety and GI effects

A

Metazapine

85
Q

Increases the concentration of NE, 5-HT, and DA within the neural synapse through inhibition of the MAO enzymes. Chronic therapy causes changes in receptor sensitivity.

A

MAOIs

86
Q

Nonselective MAOis

A

Phenelzine and Tranylcypromine

87
Q

Transdermal patch which allows inhibition of MAO-A and MAO-B in the brain, yet has reduced effects on MAO-A in the gut.

A

Selegilineb

88
Q

Substrates of MAO-A

A

Serotonin, Norepinephrine, Dopamine, Tyramine

89
Q

Tissue localization of MAO-A

A

Brain, gut, liver, placenta, skin

90
Q

Substrates of MAO-B

A

Dopamine, Phenylethylamine

91
Q

Tissue localization of MAO-B

A

Brain, platelets, lymphocytes

Clinical Pharmacy (2 decks)

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