Neuro 7

Question 1

T/F: anti-depressants are tightly bound to plasma proteins

Answer 1

TRUE

Question 2

d/t anti-depressants being tightly bound to plasma proteins, you must caution these meds in what patients?

Answer 2

1. anorexia 2. malnourishment 3. decreased albumin

Question 3

antidepressants are metabolized _____________________, and inhibit _______________

Answer 3

hepatically; CYP metabolism

Question 4

antidepressants are metabolized _________________, and excreted _______________

Answer 4

hepatically; renally

Question 5

anti-depressants can be used with ______________ & ______________ in the treatment of bipolar d/o

Answer 5

1. lithium 2. anticonvulsants

Question 6

what are the 2 isotypes of MAOIs

Answer 6

1. MAO-A 2. MAO -B

Question 7

MAO-A type are primarily found in the

Answer 7

brain, gut, placenta, and liver

Question 8

MOA-A type are present in the ____________ & __________ neurons

Answer 8

NE; dopamine

Question 9

MOA-B are present in the _______________ & _____________ neurons

Answer 9

serotonin; histamine

Question 10

what is the fx of monoamine oxidase

Answer 10

breaks down catecholamines

Question 11

MOA of MAOIs

Answer 11

1. Inhibit MAO (enzyme that breaksdown 5HT, NE, DA) –> allows accumulation of NT over period of weeks –> down-regulation of adrenergic and serotonin receptors

Question 12

why are MAOIs rarely used?

Answer 12

1. toxicity 2. potentially lethal food and drug interactions with tyramine (fermented foods/aged foods: cheese, fava beans, red wine, avacados)

Question 13

MAOI is typically only used under what conditions

Answer 13

1. depression that is unresponsive to newer anti-depressant drugs 2. some parkinsons patients (there is some benefit)

Question 14

adverse effects of MAOI

Answer 14

1. orthostatic hypotn 2. weight gain 3. high incidence of sexual dysfx 4. sedation vs insomnia or restlessness

Question 15

it is important that if someone is taking a MAOI, no other drugs are given that _____________________.

Answer 15

promote the release of NE; thus intraop if need pressor, have to use direct vasoconstricting drug like phenylephrine

Question 16

what are your different anti-depressant drug categories that are “amine reuptake inhibitors”

Answer 16

Tricyclic antidepressants, SSRIs, and SNRIs

Question 17

imipramine is what type of drug (Tofranil)

Answer 17

tricyclic antidepressant

Question 18

Fluoxitine (Prozac) is what type of drug

Answer 18

SSRI

Question 19

what is the MOA of imipramine (tofranil)

Answer 19

non-selective axon terminal reuptake inhibitor of NE and serotonin

Question 20

what is the prototype tricyclic antidepressant

Answer 20

imiramine (Tofranil)

Question 21

what are the adverse effects of imiramine (Tofranil)

Answer 21

1. increased BP and HR 2. insomina, anxiety, agitation, and sedation 3. anti-cholinergic effects 4. orthostatic hypotension 5. weight gain 6. sexual dysfunction

Question 22

what is the most common anti-depressant currently in use

Answer 22

SSRIs

Question 23

what is the primary MOA of SSRIs

Answer 23

they inhibit the serotonin transporter

Question 24

adverse effects of SSRIs

Answer 24

1. GI upset 2. diminished sexual fx/interest 3. HA 4. insomnia or hypersomnia

Question 25

most SSRIs are what teratogenic category

Answer 25

C

Question 26

what type of drug is reboxatine

Answer 26

selective NE reuptake inhibitor

Question 27

what type of drug is venkafaxine (effexor)

Answer 27

serotonin-NE reuptake inhibitor (SNRI)

Question 28

Venkafaxine (Effexor) is used in the tx of depression, but it is also beneficial for

Answer 28

1. pain disorders 2. fibromyalgia 3. generalized anxiety d/o 4. stress urinary incontinence 5. vasomotor sx of menopause

Question 29

what type of med is trazadone

Answer 29

serotonin receptor antagonist

Question 30

trazodone was previously used as a __________________, but was replaced by ____________________

Answer 30

anti-depressant; SSRIs

Question 31

currently trazodone is used off label as a _____________________

Answer 31

hypnotic (highly sedating, not associated with tolerance or dependence)

Question 32

adverse effects of trazodone

Answer 32

1. sedation 2. gi upset

Question 33

MOA of trazodone

Answer 33

5HT2 receptor antagonist

Question 34

mirtazapine (remeron) and lithium are ______________________ type anti-depressants

Answer 34

atypical

Question 35

MOA of mirtazapine (Remeron)

Answer 35

1. presynaptic Alpha2 antagonist (NE and serotonin neruons) 2. inhibitor of auto-receptors that increase the release of NE and serotonin

Question 36

when would you expect mirtazapine (Remeron) to be prescribed

Answer 36

major depressive d/o that is unresponsive to other agents

Question 37

T/F: mirtazapine has sexual side effects

Answer 37

FALSE

Question 38

MOA of lithium for depression tx

Answer 38

1. 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

Question 39

__________________ is used as an anti-depressant, but it is not metabolized, it excreted entirely in the urine

Answer 39

lithium

Question 40

adverse effects of lithium

Answer 40

1. 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

Question 41

lithium is c/i in who?

Answer 41

sick sinus syndrome b/c of SA node depression

Question 42

which anti-depressant has the best adverse effect profile?

Answer 42

SSRIs

Question 43

parkinsonism is a progressive dz, due to a lack of ____________________ in the brain

Answer 43

dopamine

Question 44

parkinsonism sx

Answer 44

1. 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)

Question 45

tx of parkinsons

Answer 45

1. D2 stimulation 2. sx management 3. levodopa/carbidopa 4. dopamine agonists 5. MAOIs 6. COMT inhibitors

Question 46

__________________ is a drug used with parkinson's dz, it is the immediate metabolic precursor to dopamine

Answer 46

levodopa

Question 47

T/F: dopamine given IV for parkinsons has the greatest effect

Answer 47

false; dopamine given IV does not cross the BBB, thus has no effect

Question 48

what will decrease the absorption of levodopa

Answer 48

food

Question 49

levodopa is absorbed in the ___________________

Answer 49

small intestine

Question 50

how much of levodopa enters the brain?

Answer 50

1-3%; thus rest is metabolized peripherially and does not cross BBB