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Justin Lyle Cards > Neuro 7 > Flashcards

Neuro 7 Flashcards

1
Q

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

A

TRUE

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2
Q

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

A
  1. anorexia 2. malnourishment 3. decreased albumin
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3
Q

antidepressants are metabolized _____________________, and inhibit _______________

A

hepatically; CYP metabolism

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4
Q

antidepressants are metabolized _________________, and excreted _______________

A

hepatically; renally

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5
Q

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

A
  1. lithium 2. anticonvulsants
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6
Q

what are the 2 isotypes of MAOIs

A
  1. MAO-A 2. MAO -B
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7
Q

MAO-A type are primarily found in the

A

brain, gut, placenta, and liver

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8
Q

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

A

NE; dopamine

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9
Q

MOA-B are present in the _______________ & _____________ neurons

A

serotonin; histamine

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10
Q

what is the fx of monoamine oxidase

A

breaks down catecholamines

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11
Q

MOA of MAOIs

A
  1. Inhibit MAO (enzyme that breaksdown 5HT, NE, DA) –> allows accumulation of NT over period of weeks –> down-regulation of adrenergic and serotonin receptors
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12
Q

why are MAOIs rarely used?

A
  1. toxicity 2. potentially lethal food and drug interactions with tyramine (fermented foods/aged foods: cheese, fava beans, red wine, avacados)
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13
Q

MAOI is typically only used under what conditions

A
  1. depression that is unresponsive to newer anti-depressant drugs 2. some parkinsons patients (there is some benefit)
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14
Q

adverse effects of MAOI

A
  1. orthostatic hypotn 2. weight gain 3. high incidence of sexual dysfx 4. sedation vs insomnia or restlessness
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15
Q

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

A

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

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16
Q

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

A

Tricyclic antidepressants, SSRIs, and SNRIs

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17
Q

imipramine is what type of drug (Tofranil)

A

tricyclic antidepressant

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18
Q

Fluoxitine (Prozac) is what type of drug

A

SSRI

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19
Q

what is the MOA of imipramine (tofranil)

A

non-selective axon terminal reuptake inhibitor of NE and serotonin

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20
Q

what is the prototype tricyclic antidepressant

A

imiramine (Tofranil)

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21
Q

what are the adverse effects of imiramine (Tofranil)

A
  1. increased BP and HR 2. insomina, anxiety, agitation, and sedation 3. anti-cholinergic effects 4. orthostatic hypotension 5. weight gain 6. sexual dysfunction
22
Q

what is the most common anti-depressant currently in use

A

SSRIs

23
Q

what is the primary MOA of SSRIs

A

they inhibit the serotonin transporter

24
Q

adverse effects of SSRIs

A
  1. GI upset 2. diminished sexual fx/interest 3. HA 4. insomnia or hypersomnia
25
Q

most SSRIs are what teratogenic category

A

C

26
Q

what type of drug is reboxatine

A

selective NE reuptake inhibitor

27
Q

what type of drug is venkafaxine (effexor)

A

serotonin-NE reuptake inhibitor (SNRI)

28
Q

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

A
  1. pain disorders 2. fibromyalgia 3. generalized anxiety d/o 4. stress urinary incontinence 5. vasomotor sx of menopause
29
Q

what type of med is trazadone

A

serotonin receptor antagonist

30
Q

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

A

anti-depressant; SSRIs

31
Q

currently trazodone is used off label as a _____________________

A

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

32
Q

adverse effects of trazodone

A
  1. sedation 2. gi upset
33
Q

MOA of trazodone

A

5HT2 receptor antagonist

34
Q

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

A

atypical

35
Q

MOA of mirtazapine (Remeron)

A
  1. presynaptic Alpha2 antagonist (NE and serotonin neruons) 2. inhibitor of auto-receptors that increase the release of NE and serotonin
36
Q

when would you expect mirtazapine (Remeron) to be prescribed

A

major depressive d/o that is unresponsive to other agents

37
Q

T/F: mirtazapine has sexual side effects

A

FALSE

38
Q

MOA of lithium for depression tx

A
  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
39
Q

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

A

lithium

40
Q

adverse effects of lithium

A
  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
41
Q

lithium is c/i in who?

A

sick sinus syndrome b/c of SA node depression

42
Q

which anti-depressant has the best adverse effect profile?

A

SSRIs

43
Q

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

A

dopamine

44
Q

parkinsonism sx

A
  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)
45
Q

tx of parkinsons

A
  1. D2 stimulation 2. sx management 3. levodopa/carbidopa 4. dopamine agonists 5. MAOIs 6. COMT inhibitors
46
Q

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

A

levodopa

47
Q

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

A

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

48
Q

what will decrease the absorption of levodopa

A

food

49
Q

levodopa is absorbed in the ___________________

A

small intestine

50
Q

how much of levodopa enters the brain?

A

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

Justin Lyle Cards (27 decks)

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