Mood Disorders - Egleton Flashcards
what is the biogenic Amine hypothesis
mood disorders result from abnormalities monoaminergic neurotransmission
what happens to the neurotransmission for depression
reduced
what happens to the neurotransmission for mania
increased
what are some supportive evidence for the biogenic amine hypothesis
reserpine causes depression
antidepressants block repute of 5-HT/NE
MAO inhibitors increase monoamine neurotransmission
what are three problems with biogenic amine hypothesis
TCA’s don’t correlate with observed antidepressant effects
MAO and TCA have immediate effects, yet relief of depression takes weeks
How do TCA’s work
inhibition of presynaptic reuptake for both serotonergic and noradernergic neurons
How do SSRI works
specific serotonin reuptake inhibitors
how does SNRI work
combo reuptake inhibitors for both serotonergic and noradrenergic neurons
MAOI how does it wokr
monamine oxidase inhibitors in both serotonergic and noradrenergic neurons
what drug is used for first line drugs for depression and most anxiety disorders
SSRIs
what are some characteristics all SSRI’s share
WIDE THERAPEUTIC WINDOW
fewer autonomic side effects and less sedation then TCA’s
why might the reasons for SSRI have rapid inhibitoin effect but the effects of SSRI is not evident for 3-6 weeks after
gradual “ down regulation” or decrease in some postsynaptic serotonin receptor in response to large amounts of serotinin
name a SSRI durg
Fluoxetine (prozac)
what are 3 pharmacokinetics for SSRI
- well absorbed in gut
- hepatic cytochrome p450 metabolism
- large protein binding
what is the most common adverse effect of SSRI
nausea
diarrhea
abdominal pain
what are other SSRI adverse side effects
Jitters
Sexual dysfunction
5-HT
serotonin
what is the black box warning for antidperessents
increase risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders
what is the black box warning for Fluoxetine
FDA approved for treatment of
- OCD in children less than 7 years
- MMD in children greater than equal to 8 years
SSRI’s should not be concurrently used with what other drug? if done what does this cause
MAO - monoamine oxidase inhibitors Serotonin syndrome ( severe hypertension)
what is another drug that can cause serotonin syndrome
Linezolid ( some MAO-I activity )
If you want to discontinue SSRI in a patient and want to start them on MAOI what should you do
allow 1-3 months of washout of SSRi
what are side effects of Fluoxetine
free anticholinergic effects
orthostatic hypotension
weight gain
what does Fluoxetine inhibit
cytochrome P450 isozymes
what other disorders does Fluoxetine treat
Bulimia nervosa
anorexia nervosa
what is the mechanism of action for SNRI ( serotonin norepinephrine reuptake inhibitors )
NE and 5-HT reuptake inhibits ( SNRI)
what are three drugs for SNRI
Duloxetine
Venlafaxine
Desvenlafaxine
what are side effects of SNRI
nausea; constipation; abdominal pain ( especially Duloxetin)
Anxiety; Akathisia, agitation- “Jitters”
sexual side effects
what do TCA increase and decrease
increase: mood, appetite
decrease: depression, anxiety
what is the mechanism of action for TCA’s
inhibition of presynaptic neurotransmitter reuptake ( norepinephrine and serotonin)
what do secondary and tertiary amines do for TCA’s
secondary: block NE reuptake
tertiary: block 5-HT
When do you use TCA to treat depression
NOT first line treat enuresis (night time bed wetting for children)
what are side effects for TCA
orthostatic hypotension weight gain ( alpha 1 receptor antagonism)
TCA when combines with depressants and sedative worsen what
worsen sedation
TCA when combined with alpha-methyldopa and beta-adrenergic blockers worsen what
hypotension
TCA when combined with quinidine, thioridazine adds waht
additive cardiotoxicity
TCA when combined with antihistamines adds what
additive anticholinergic toxicity
TCA + MAO inhibitor cause what
rare severe CNS toxcity
what can acute poisonings of TCA cause? treatment options?
seizures
no antidote
do not use Phenytoin
with TCA tolerance to what effects occurs within a short time
anticholinergic effects
Does TCA have many drug drug interactions
yes
what does Amoxapine block
blocks NE
what drug has the highest seizure risk for all anti-depressents
Maprotiline
Mechanism of action for MAOI
inhibition of MAO resulting in increased stores of monoamines
are MAIO selective for type of MAO
NOT selective for MAO-A or MAO-B
why are MAOI used
highly resistant depression after TCA, SSRI falied
what are the three drugs for MAOI
Tranylcypromine
Phenelzine
Isocarboxazid
what should you not eat if you take MAOI
Tyramine: cheeses, chicken liver, beef, red wine
what are some side effects of MAOI
hypertension, cardiac arrhythmias,
MAOI lead to reduced breakdown of what
catecholamines and thus increased release : blurred vision, dryness of mouth
what are symptoms of acute poisoning of MAOI
hallucinations
agitation
convulsions
MAOI can treat what
hypertensive crisis
MAOI drug interaction with sympathomimetics
hypertensive crisis
MAOI drug interaction Meperidine (opiate analgesic)
fever, delirium, hypertension, hypotension
MAOI drug interaction oral hypoglycemics
further lowering of serum glucose
MAOI drug interaction L-Dopa
hypertensvie crisis
MAOI drug interaction TCA
fever, seizures, delirium
name other second generation drugs for anti-depressents
Buporpion ( wellbutrin, zyban)
what are side effects of Buporpion
sexual dysfunction agitation insomnia nausea weight loss seizures
what drug is used for smoking cessation
Bupriopion ( zyban)
what is the mechanism of action for Hypericum
inhibitor of MAO and 5-HT reuptake
Another name for hypericum
St. John Wort
What happens when Hypericum and SSRI are taken together
hypertensive crisis
Trazodone don’t have what side effects
no anticholinergic side effects
Trazodone have what side effects
Priapism - can lead to permanent impotence
persistent clitoral erection in women
mechanism of action for Nefazodone
blocks NE and 5-HT
what are side effects of Nefazodone when it blocks alpha 1 receptor
sedation
MIrtazapine MOA
tetracyclic antidepressent
stimulates NE and 5-HT by blocking alpha2 and 5HT-1 receptors
what medication might you give to an anorexic nervosa patient and why
Mirtazapine
increases appetite and weight gain early in therapy
what medications should be avoided with high suicide risk patients
TCA
MAOI
what medications should be avoided with sensitivity to anticholinergic side effects
TCA
what medications should be avoided with eating disorder and depression
bupropion
what medications should be taken with depression and chronic pain
SSRI
what medications should be taken with weight gain on another anti-depressent
bupropion or SSRi
avoid mirtazapine
what medications should be taken with sexual dysfunction
bupropion
nefazodne
what drug is used to treat mania? a characteristic
Lithium
- low therapeutic index
What is monitored if a person is on Lithium
serum or urine levels daily during treatment of acute mania
what are side effects of lithium
weight gain
polyuria, polydipsia ( by inhibiting ADH)
hypothyroidism
Lithium is contraindicated with what
renal disease
MOA for carbamazepine
block NA channel
MOA for valproic acid
bock NA channels, increases GABA
MOA for Lamotrigine
block Na channels
inhibit glutamate release
Lamotrigine needs to be tritrated slowlydue to risk of what
Steven-Johnson syndrome
Fish oil Omega-3 fatty acids deceases what activity
MOA-B
