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D&T2 Exam 1 > Mood Disorders - Egleton > Flashcards

Mood Disorders - Egleton Flashcards

1
Q

what is the biogenic Amine hypothesis

A

mood disorders result from abnormalities monoaminergic neurotransmission

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2
Q

what happens to the neurotransmission for depression

A

reduced

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3
Q

what happens to the neurotransmission for mania

A

increased

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4
Q

what are some supportive evidence for the biogenic amine hypothesis

A

reserpine causes depression
antidepressants block repute of 5-HT/NE
MAO inhibitors increase monoamine neurotransmission

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5
Q

what are three problems with biogenic amine hypothesis

A

TCA’s don’t correlate with observed antidepressant effects

MAO and TCA have immediate effects, yet relief of depression takes weeks

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6
Q

How do TCA’s work

A

inhibition of presynaptic reuptake for both serotonergic and noradernergic neurons

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7
Q

How do SSRI works

A

specific serotonin reuptake inhibitors

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8
Q

how does SNRI work

A

combo reuptake inhibitors for both serotonergic and noradrenergic neurons

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9
Q

MAOI how does it wokr

A

monamine oxidase inhibitors in both serotonergic and noradrenergic neurons

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10
Q

what drug is used for first line drugs for depression and most anxiety disorders

A

SSRIs

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11
Q

what are some characteristics all SSRI’s share

A

WIDE THERAPEUTIC WINDOW

fewer autonomic side effects and less sedation then TCA’s

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12
Q

why might the reasons for SSRI have rapid inhibitoin effect but the effects of SSRI is not evident for 3-6 weeks after

A

gradual “ down regulation” or decrease in some postsynaptic serotonin receptor in response to large amounts of serotinin

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13
Q

name a SSRI durg

A

Fluoxetine (prozac)

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14
Q

what are 3 pharmacokinetics for SSRI

A
  • well absorbed in gut
  • hepatic cytochrome p450 metabolism
  • large protein binding
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15
Q

what is the most common adverse effect of SSRI

A

nausea
diarrhea
abdominal pain

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16
Q

what are other SSRI adverse side effects

A

Jitters

Sexual dysfunction

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17
Q

5-HT

A

serotonin

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18
Q

what is the black box warning for antidperessents

A

increase risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders

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19
Q

what is the black box warning for Fluoxetine

A

FDA approved for treatment of

  • OCD in children less than 7 years
  • MMD in children greater than equal to 8 years
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20
Q

SSRI’s should not be concurrently used with what other drug? if done what does this cause

A 
MAO - monoamine oxidase inhibitors
Serotonin syndrome ( severe hypertension)
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21
Q

what is another drug that can cause serotonin syndrome

A

Linezolid ( some MAO-I activity )

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22
Q

If you want to discontinue SSRI in a patient and want to start them on MAOI what should you do

A

allow 1-3 months of washout of SSRi

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23
Q

what are side effects of Fluoxetine

A

free anticholinergic effects
orthostatic hypotension
weight gain

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24
Q

what does Fluoxetine inhibit

A

cytochrome P450 isozymes

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25
Q

what other disorders does Fluoxetine treat

A

Bulimia nervosa

anorexia nervosa

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26
Q

what is the mechanism of action for SNRI ( serotonin norepinephrine reuptake inhibitors )

A

NE and 5-HT reuptake inhibits ( SNRI)

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27
Q

what are three drugs for SNRI

A

Duloxetine
Venlafaxine
Desvenlafaxine

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28
Q

what are side effects of SNRI

A

nausea; constipation; abdominal pain ( especially Duloxetin)
Anxiety; Akathisia, agitation- “Jitters”
sexual side effects

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29
Q

what do TCA increase and decrease

A

increase: mood, appetite
decrease: depression, anxiety

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30
Q

what is the mechanism of action for TCA’s

A

inhibition of presynaptic neurotransmitter reuptake ( norepinephrine and serotonin)

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31
Q

what do secondary and tertiary amines do for TCA’s

A

secondary: block NE reuptake
tertiary: block 5-HT

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32
Q

When do you use TCA to treat depression

A 
NOT first line
treat enuresis (night time bed wetting for children)
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33
Q

what are side effects for TCA

A 
orthostatic hypotension
weight gain ( alpha 1 receptor antagonism)
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34
Q

TCA when combines with depressants and sedative worsen what

A

worsen sedation

35
Q

TCA when combined with alpha-methyldopa and beta-adrenergic blockers worsen what

A

hypotension

36
Q

TCA when combined with quinidine, thioridazine adds waht

A

additive cardiotoxicity

37
Q

TCA when combined with antihistamines adds what

A

additive anticholinergic toxicity

38
Q

TCA + MAO inhibitor cause what

A

rare severe CNS toxcity

39
Q

what can acute poisonings of TCA cause? treatment options?

A

seizures
no antidote
do not use Phenytoin

40
Q

with TCA tolerance to what effects occurs within a short time

A

anticholinergic effects

41
Q

Does TCA have many drug drug interactions

A

yes

42
Q

what does Amoxapine block

A

blocks NE

43
Q

what drug has the highest seizure risk for all anti-depressents

A

Maprotiline

44
Q

Mechanism of action for MAOI

A

inhibition of MAO resulting in increased stores of monoamines

45
Q

are MAIO selective for type of MAO

A

NOT selective for MAO-A or MAO-B

46
Q

why are MAOI used

A

highly resistant depression after TCA, SSRI falied

47
Q

what are the three drugs for MAOI

A

Tranylcypromine
Phenelzine
Isocarboxazid

48
Q

what should you not eat if you take MAOI

A

Tyramine: cheeses, chicken liver, beef, red wine

49
Q

what are some side effects of MAOI

A

hypertension, cardiac arrhythmias,

50
Q

MAOI lead to reduced breakdown of what

A

catecholamines and thus increased release : blurred vision, dryness of mouth

51
Q

what are symptoms of acute poisoning of MAOI

A

hallucinations
agitation
convulsions

52
Q

MAOI can treat what

A

hypertensive crisis

53
Q

MAOI drug interaction with sympathomimetics

A

hypertensive crisis

54
Q

MAOI drug interaction Meperidine (opiate analgesic)

A

fever, delirium, hypertension, hypotension

55
Q

MAOI drug interaction oral hypoglycemics

A

further lowering of serum glucose

56
Q

MAOI drug interaction L-Dopa

A

hypertensvie crisis

57
Q

MAOI drug interaction TCA

A

fever, seizures, delirium

58
Q

name other second generation drugs for anti-depressents

A

Buporpion ( wellbutrin, zyban)

59
Q

what are side effects of Buporpion

A 
sexual dysfunction
agitation
insomnia
nausea
weight loss
seizures
60
Q

what drug is used for smoking cessation

A

Bupriopion ( zyban)

61
Q

what is the mechanism of action for Hypericum

A

inhibitor of MAO and 5-HT reuptake

62
Q

Another name for hypericum

A

St. John Wort

63
Q

What happens when Hypericum and SSRI are taken together

A

hypertensive crisis

64
Q

Trazodone don’t have what side effects

A

no anticholinergic side effects

65
Q

Trazodone have what side effects

A

Priapism - can lead to permanent impotence

persistent clitoral erection in women

66
Q

mechanism of action for Nefazodone

A

blocks NE and 5-HT

67
Q

what are side effects of Nefazodone when it blocks alpha 1 receptor

A

sedation

68
Q

MIrtazapine MOA

A

tetracyclic antidepressent

stimulates NE and 5-HT by blocking alpha2 and 5HT-1 receptors

69
Q

what medication might you give to an anorexic nervosa patient and why

A

Mirtazapine

increases appetite and weight gain early in therapy

70
Q

what medications should be avoided with high suicide risk patients

A

TCA

MAOI

71
Q

what medications should be avoided with sensitivity to anticholinergic side effects

A

TCA

72
Q

what medications should be avoided with eating disorder and depression

A

bupropion

73
Q

what medications should be taken with depression and chronic pain

A

SSRI

74
Q

what medications should be taken with weight gain on another anti-depressent

A

bupropion or SSRi

avoid mirtazapine

75
Q

what medications should be taken with sexual dysfunction

A

bupropion

nefazodne

76
Q

what drug is used to treat mania? a characteristic

A

Lithium

- low therapeutic index

77
Q

What is monitored if a person is on Lithium

A

serum or urine levels daily during treatment of acute mania

78
Q

what are side effects of lithium

A

weight gain
polyuria, polydipsia ( by inhibiting ADH)
hypothyroidism

79
Q

Lithium is contraindicated with what

A

renal disease

80
Q

MOA for carbamazepine

A

block NA channel

81
Q

MOA for valproic acid

A

bock NA channels, increases GABA

82
Q

MOA for Lamotrigine

A

block Na channels

inhibit glutamate release

83
Q

Lamotrigine needs to be tritrated slowlydue to risk of what

A

Steven-Johnson syndrome

84
Q

Fish oil Omega-3 fatty acids deceases what activity

A

MOA-B

D&T2 Exam 1 (22 decks)

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