Neuro 7 Flashcards
T/F: anti-depressants are tightly bound to plasma proteins
TRUE
d/t anti-depressants being tightly bound to plasma proteins, you must caution these meds in what patients?
- anorexia 2. malnourishment 3. decreased albumin
antidepressants are metabolized _____________________, and inhibit _______________
hepatically; CYP metabolism
antidepressants are metabolized _________________, and excreted _______________
hepatically; renally
anti-depressants can be used with ______________ & ______________ in the treatment of bipolar d/o
- lithium 2. anticonvulsants
what are the 2 isotypes of MAOIs
- MAO-A 2. MAO -B
MAO-A type are primarily found in the
brain, gut, placenta, and liver
MOA-A type are present in the ____________ & __________ neurons
NE; dopamine
MOA-B are present in the _______________ & _____________ neurons
serotonin; histamine
what is the fx of monoamine oxidase
breaks down catecholamines
MOA of MAOIs
- Inhibit MAO (enzyme that breaksdown 5HT, NE, DA) –> allows accumulation of NT over period of weeks –> down-regulation of adrenergic and serotonin receptors
why are MAOIs rarely used?
- toxicity 2. potentially lethal food and drug interactions with tyramine (fermented foods/aged foods: cheese, fava beans, red wine, avacados)
MAOI is typically only used under what conditions
- depression that is unresponsive to newer anti-depressant drugs 2. some parkinsons patients (there is some benefit)
adverse effects of MAOI
- orthostatic hypotn 2. weight gain 3. high incidence of sexual dysfx 4. sedation vs insomnia or restlessness
it is important that if someone is taking a MAOI, no other drugs are given that _____________________.
promote the release of NE; thus intraop if need pressor, have to use direct vasoconstricting drug like phenylephrine
what are your different anti-depressant drug categories that are “amine reuptake inhibitors”
Tricyclic antidepressants, SSRIs, and SNRIs
imipramine is what type of drug (Tofranil)
tricyclic antidepressant
Fluoxitine (Prozac) is what type of drug
SSRI
what is the MOA of imipramine (tofranil)
non-selective axon terminal reuptake inhibitor of NE and serotonin
what is the prototype tricyclic antidepressant
imiramine (Tofranil)
what are the adverse effects of imiramine (Tofranil)
- increased BP and HR 2. insomina, anxiety, agitation, and sedation 3. anti-cholinergic effects 4. orthostatic hypotension 5. weight gain 6. sexual dysfunction
what is the most common anti-depressant currently in use
SSRIs
what is the primary MOA of SSRIs
they inhibit the serotonin transporter
adverse effects of SSRIs
- GI upset 2. diminished sexual fx/interest 3. HA 4. insomnia or hypersomnia
most SSRIs are what teratogenic category
C
what type of drug is reboxatine
selective NE reuptake inhibitor
what type of drug is venkafaxine (effexor)
serotonin-NE reuptake inhibitor (SNRI)
Venkafaxine (Effexor) is used in the tx of depression, but it is also beneficial for
- pain disorders 2. fibromyalgia 3. generalized anxiety d/o 4. stress urinary incontinence 5. vasomotor sx of menopause
what type of med is trazadone
serotonin receptor antagonist
trazodone was previously used as a __________________, but was replaced by ____________________
anti-depressant; SSRIs
currently trazodone is used off label as a _____________________
hypnotic (highly sedating, not associated with tolerance or dependence)
adverse effects of trazodone
- sedation 2. gi upset
MOA of trazodone
5HT2 receptor antagonist
mirtazapine (remeron) and lithium are ______________________ type anti-depressants
atypical
MOA of mirtazapine (Remeron)
- presynaptic Alpha2 antagonist (NE and serotonin neruons) 2. inhibitor of auto-receptors that increase the release of NE and serotonin
when would you expect mirtazapine (Remeron) to be prescribed
major depressive d/o that is unresponsive to other agents
T/F: mirtazapine has sexual side effects
FALSE
MOA of lithium for depression tx
- ill defined 2. sustained lithium exposure stimulates gluatmate reuptake (reducing excitatory effects) 3. inhibits second messenger (IP3 and DAG) formation, and glycogen synthase kinase-3
__________________ is used as an anti-depressant, but it is not metabolized, it excreted entirely in the urine
lithium
adverse effects of lithium
- tremor 2. choreoathetosis 3. motor hyperactivity 4. ataxia 5. dysarthria 6. aphasia 7. hypothyroidism 8. polyuria, polydipsia, and loss of responsiveness to ADH 9. edema 10. questionable teratogenicity
lithium is c/i in who?
sick sinus syndrome b/c of SA node depression
which anti-depressant has the best adverse effect profile?
SSRIs
parkinsonism is a progressive dz, due to a lack of ____________________ in the brain
dopamine
parkinsonism sx
- muscle rigidity, bradykinesia, tremor, postural instability 2. cognitive declination with dz advancement 3. affective d/o’s like anxiety or depression 4. personality changes 5. autonomic dysfx (sexual dysfx, choking, sweating abnorm, sensory issues)
tx of parkinsons
- D2 stimulation 2. sx management 3. levodopa/carbidopa 4. dopamine agonists 5. MAOIs 6. COMT inhibitors
__________________ is a drug used with parkinson’s dz, it is the immediate metabolic precursor to dopamine
levodopa
T/F: dopamine given IV for parkinsons has the greatest effect
false; dopamine given IV does not cross the BBB, thus has no effect
what will decrease the absorption of levodopa
food
levodopa is absorbed in the ___________________
small intestine
how much of levodopa enters the brain?
1-3%; thus rest is metabolized peripherially and does not cross BBB
