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Pharm Penultimate Exam > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Hypothesis for the source of depression

A
  1. Monoamine Hypothesis

2. Loss of neurotrophic support

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2
Q

What does reserpine do?

A

Depletes monoamines

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3
Q

What transmitter is associated with explanaiton of the neurotrophic hypothesis

A

BDNF

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4
Q

Five types of anti-depressants

A
  1. SSRIs
  2. SNRIs (pure or TCA)
  3. 5HT2 Antagonist
  4. Tetra/Unicyclic Antidepressants
  5. MAOIs
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5
Q

Important SSRIs to remember

A

Fluoxetine, Paroxetine, Fluvoxamine (Inhibit 450s)

Sertraline, Citalopram, Escitalopram

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6
Q

There are toxicity concerns when SSRIs are distributed with…

A

TCAs

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7
Q

Indications or SSRIs?

A

MDD
Anxiety Disorders (GAD, Panic, Social, OCD, PTSD)
Premenopausal Dysphoric disturbance
Eating disorder (Bulimia only)

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8
Q

Adverse Effects of SSRIs (6)

A 
Sexual Dysfunction
Weight Gain
Serotonin Syndrome
Adolescent suicide
Withdrawl syndrome
Newborn Effects
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9
Q

Symptoms of Serotonin Syndrome

A

Cog – Delirium, Coma
Autonomic – HTN, Tachy
Somatic – Myoclonus, hyperreflexia, tremor

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10
Q

Effects of SSRIs on newborns?

A

Persistant Pulmonary HTN
Neonatal abstinence syndrome
COngenital malformations (no strong evidence)

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11
Q

Three important SNRIs

A

Duloxetine
Venlafaxine
Des-venlafaxine

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12
Q

Name the five SNRI Tricyclic Antidepressants

A 
Imipramine (anticholinergic)
Amitryptyline (hits many receptors, sedating)
Nortryptyline
Clomipramine
Desipramine
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13
Q

Which TCAs effect 5HT more than NE?

A

Imipramine, Amitryptyline

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14
Q

Which TCAs effect NE more than 5HT?

A

Desipramine, Nortriptyline

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15
Q

TCAs are used to treat…

A 
MDD not responsive to SSRIs
Anxiety disorders
Pain (diabetic neuropathy, fibromyalgia)
Enuresis
Insomnia
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16
Q

Adverse effects of SNRIs

A 
Cardiotoxicity (TCAs can block Na channels)
Sexual Dysfxn
Weight Loss
Serotonin Syndrome (esp. when TCA+MAOI)
Suicidal Thoughts
Withdrawl
Sedation
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17
Q

5HT2 Antagonists are also called… the important one is…

A

SARI (Serotonin antagonist and reuptake inhibitor)

Trazodone

18
Q

Active metabolite of Trazodone

A

mCPP

19
Q

People takin Trazodone can’t drink…

A

grapefruit juice

it blocks CYP3A4

20
Q

Trazodone adverse effects

A

Hypotension from adrenergic receptor blockade

21
Q

Trazodone uses…

A

depression (mostly replaces by SSRIs)
hypnotic
anxiety

22
Q

Name the unicyclic antidepressant and its mode of action

A

Buproprion
DA and NE reuptake inhibitor
Also a nAChR antagonist

23
Q

Adverse effects of Buproprion

A

Few Sexual Side Effects
Insomnia
Anorexia
Seizures

24
Q

Uses for Buproprion

A

AD, supplement to SSRI, smoking cessation

25
Q

Name the tetracyclc antidepressant and its MOA

A

Mirtazapine
Stimulates NE, 5HT release. Blocks 5HT receptor
affects many other receptors

26
Q

Use ot mirtazapine

A

Refractory MDD

27
Q

Three important MAOIs

A

Selegiline (MAO-B irreversible)
Tranylcypromine (non selective, irrev.)
Phenelzine (non-selective, irrev)

28
Q

uses for MAOIs?

A

refractory MDD, anxiety, PARKINSONS

29
Q

MAOI adverse effects at therapeutic concentrations

A 
Orthostatic HTN
Weight Gain
Sexual Dysfxn
CNS activation
Sedation
30
Q

Sx and Tx of TCA overdose

A

Sx – arrythmia, symp. activation, anticholinergic, seizures

Tx - cardiac monitoring, HCO3

31
Q

Sx and Tx of MAOI overdose

A

Sx – hyperadrenergic, psychosis, confusion/fever/delirium, seizures
Tx - Cardiac monitoring, HCO3

32
Q

What happens when a person on an MAOI gets a bunch of tyramine

A

Malignant HTN, Stroke, MI

33
Q

Drug classes for bipolar disorder

A

Lithium Carbonate
Atypical Antipsychotics
Antiepileptics
Benzodiazepines

34
Q

Two proposed mechanisms by which Lithium may work?

A

Inositol Depletion

GSK-3 inhibition

35
Q

Plasma lithium levels must be continuously monitored. While monitoring, you should consider…

A

Diuretic Use (can reduce clearance)
Na in Diet
Exercise (dehydration can increase levels)

36
Q

Side effects of Lithium

A

Tremor (treat with beta blockers)
Low Thyroid Fxn
Edema (Na interactions)
Arrythmias (Lithium depresses the sinus node)

37
Q

What happens to people who overdose on lithium

A

Coma
N,V,Diarrhea
Ataxia, Nystagmus, Slurred Speech, Spasms

38
Q

How to treat an acute manic episode

A

Valproate
2nd place – carbamazepine
SEVERE – antipsychotic/benzodiazepine

39
Q

How to do maintenence therapy for BD

A

Lithium (+Benzo in severe)
Lamotrigine
Risperidone

40
Q

Atypical antipsychotics that may be used in bipolar disorder

A

Aripiprazole, olanzapine, papliperidone

Quetiapine, Risperidone, Ziprasidone

41
Q

Two antiepeleptics used in treatment of bipolar disorder

A

Carbamazepine, Valproate

Pharm Penultimate Exam (12 decks)

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