Neuro 4

Question 1

When do anti-depressants increase the risk of suicide?

Answer 1

in patients < 25years

Question 2

What is major depressive disorcer MDD?

Answer 2

unipolar debilitating depression

Question 3

What is dysthmia?

Answer 3

less severe form of depression, can function but just not at your best

Question 4

discontinuation syndrome of SSRI SNRI and TCA

Answer 4

dizziness and paresthesia for 1-2 days post DC for 1 week or more

Question 5

discontinuation syndrome of MAOIs

Answer 5

delirium with psychoses, excitement, confusion

Question 6

Anti depressant kinetics

Answer 6

inhibit CYP metabolism - beware of drug to drug interactions
highly protein bound - issue in anorexia/malnourished
absorption is rapid

Question 7

4 types of antidepressants

Answer 7

MAOIs
amine reuptake inhibitors
serotonin receptor antagonists
atypical heterogenous drugs

Question 8

Name a MAOI

Answer 8

tranylcypromine (parnate)

Question 9

how to MAOIs work?

Answer 9

cause build up of endogenous catecholamines
also antihistamine antagonists
down regulation of adrenergic and serotonin receptors

Question 10

when do we actually use MAOIs?

Answer 10

only for depression unresponsive to newer drugs

Question 11

where are MAO-A receptors?

Answer 11

NE and dopamine neurons

Question 12

where are MAO-B receptors?

Answer 12

serotonin and histamine neurons

Question 13

SE of MAOIs?

Answer 13

orthostatic hypotensin
weight gain
sexual dysfunction (high incidence)
sedation vs insomnia / restlessness

Question 14

why can’t you eat tyramines when taking MAOIs?

Answer 14

They cause endogenous catecholamine release which an lead to HTN crisis

Question 15

What types of Amine reputake inhibitors are there?

Answer 15

tricyclic antidepressants
SNRIs
SSRIs

Question 16

Mech of action of trazadone?

Answer 16

5HT2 antagonist

Question 17

how do tricyclic antidepressants work?

Answer 17

non selective NE and serotonin reuptake inhibitors

Question 18

TCA side effects?

Answer 18

sexual dysfunction
anticholinergic
excitatory symptoms

Question 19

name a TCA

Answer 19

imipramine (tofranil)

Question 20

name two SNRIs

Answer 20

reboxatine
venlafaxine (effexor)

Question 21

SSRI pregancy class?

Answer 21

Class C

Question 22

SSRI pregnancy class?

Answer 22

Class C

Question 23

name a SSRI

Answer 23

fluoxetine (prozac)

Question 24

SSRI SE

Answer 24

sexual dysfunction
GI upset
HA, insomnia, hypersonmia

Question 25

name two atypical heterogenous antidepressants

Answer 25

mirtazapine ( remeron) lithium

Question 26

how does mirtazapine (remeron) work?

Answer 26

presynaptic alpha 2 antagonist increases NE and serotonin release no sexual side effects not really used, reserved for unresponsive MDD

Question 27

how does lithium work?

Answer 27

ill defined mechanism but does do glutamate reuptake

Question 28

how is lithium metabolised/excreted?

Answer 28

not metabolized, it is excreted entirely in urine

Question 29

AE of Lithium?

Answer 29

motor hyper activity hypothyroidism polyuria and polydypsia

Question 30

when is Lithium contraindicated?

Answer 30

sick sinus syndrome

Question 31

main toxicty of anti depressants?

Answer 31

can cause seizure and CV collapse

Question 32

What anti depressants cause CNS depression (sedation)?

Answer 32

TCAs

Question 33

what antidepressants toxicty can cause CNS stimulation?

Answer 33

SSRIs and MAOIs

Question 34

what antidepressants toxicty can cause HTN?

Answer 34

TCAs

Question 35

waht andidepressants toxicty won't affect BP?

Answer 35

SSRIs

Question 36

what antidepressants toxicty has variable BP effects depending on diet?

Answer 36

MAOIs

Question 37

which antidepressants toxicty cause anti cholinergic effects?

Answer 37

MAOIs and TCAs

Question 38

which antideprssants toxicity have no ANS effects?

Answer 38

SSRIs

Question 39

Lithium's toxic CNS effects?

Answer 39

hypothyroidism weight gain mental confusion withdrawl

Question 40

Lithium's toxic ANS effects?

Answer 40

nephrogenic diabetes insipidus (blocks ADH)

Question 41

the following are all seen in what condition? tardive dyskinesia tardive dystonia tardive akathisia rabbit syndrome neuroleptic malignant syndrome

Answer 41

Parkinson's disease

Question 42

autonomic dysfunction seen in Parkinson's disease

Answer 42

sexual dysfunction sphincters choking sweat abnormalities sensory issues

Question 43

main issue in parkinsons disease?

Answer 43

lack of dopamine in the brain

Question 44

ways to treat parkinsons disease

Answer 44

D2 stimulation symptom mgmt levodopa/carbidopa MOAI?? COMT inhibitor??

Question 45

how much of levodopa actually reaches brain?

Answer 45

1-3% the rest is metabolized to dopamine peripherally

Question 46

what does carbidopa do?

Answer 46

inhibits dopa decarboxylase inhibitor

Question 47

adding carbidopa decreases levodopa dose by how much?

Answer 47

75%

Question 48

AE of levodopa?

Answer 48

anorexia, N/V, cardiac arrhythmias, tardive dyskenesia

Question 49

how many pts on levodopa develop tardive dyskenesia?

Answer 49

80% who have been on it for >10 years

Question 50

when does benefit of levodopa decrease?

Answer 50

after 3-4 years

Question 51

name dopamine agonists for parkinsons treatment

Answer 51

pramipexole ropinirole rotigotine

Question 52

what do pramipexole and ropinirole have in common?

Answer 52

can be used for monotherapy in parkinsons can be used in advanced disease allows for decreased doses of levodopa

Question 53

Dreceptor for pramipexole?

Answer 53

D3

Question 54

receptor for ropinirole?

Answer 54

D2

Question 55

how is pramipexole excreted?

Answer 55

unchanged

Question 56

how is ropinirole excreted?

Answer 56

metabolized in the liver

Question 57

when would you DC any of the dopamine agonists in parkinsons?

Answer 57

cardiac arrhythmias