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Pharmacology > !Neuropharm Antidepressants > Flashcards

!Neuropharm Antidepressants Flashcards

1
Q

Selective serotonin reputable inhibitor (SSRI)

A

For depression, anxiety, OCD, buimia, PTSD

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2
Q

Specific SSRI such as ___ can even be used to improve cognitive recognition post stroke

A

Escitalopram

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3
Q

Examples of SSRI

A

Fluozetine, paroxetine, sertraline, citalopram, escitalopram, vilazonone, vortioxetine

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4
Q

MOA SSRI

A

Selectively inhibiting reputable of serotonin by presynaptic cells leading to an increased availability of serotonin in the synaptic gap, allowing it to repeatedly stimulate the post synaptic receptors

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5
Q

Side effect of SSRI

A 
Sexual dysfunction (erectile dysfunction, anorgasmia, decreased libido)
Serotonin syndrome
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6
Q

What is serotonin syndrome

A

SSRI combined with other medications promoting serotonin availability

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7
Q

How does serotonin syndrome present

A

Hyperthermia, hypertension, myoclonus, mydriasis, overactive bowels, mental agitation

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8
Q

How can you treat serotonin syndrome

A

Cyproheptadine

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9
Q

Indications forSSRI

A

Depression and anxiety (social phobia, panic disorder, PTSD)

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10
Q

MOA SSRI

A

Inhibit the reputable of the NT serotonin by the presynaptic cells . Serotonin stays in synaptic gap longer and may repeatedly stimulate the receptors of the post synaptic cell

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11
Q

How long do u have to take SSRI before effect

A

4-8 weeks

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12
Q

Examples of SSRI

A

Paroxetine, sertraline, escitalopram, fluoxetine, citalopram, vortioxetine, vilazonone

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13
Q

Paroxetine

A

SSRI for social phobia

Panic attacks, depression OCD and PTSD

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14
Q

Sertraline

A

SSRI for PTSD(soldier says SIR)

Anxiety disorders, depression, OCD, panic disorder

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15
Q

Escitalopram

A

Cognitive recovery post stroke also for depression and anxiety treatment

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16
Q

Fluoxetine

A

SSRI for depression , OCD, bulimia and panic disorder

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17
Q

Side effects SSRI

A

Sexual dysfunction, serotonin syndrome,

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18
Q

What drugs taken with SSRI cause serotonin syndrome

A

TCAs, SNRIs, MAOIs (any medication increasing serotonin availability)

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19
Q

How treat serotonin syndrome

A

Hyperthermia, hypertension, myoclonus, mydriasis, overactive bowels and mental agitation

Treat with cyproheptadine

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20
Q

What does cyproheptadine do

A

Acts as a serotonergic (5-HT2) receptor antagonist

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21
Q

Fluoxetine (prozac)

A

SSRI maintains mental balance in the brain by decreasing the reputable of serotonin back into presynaptic cell
increase serotonin in synaptic cleft which bind to postsynaptic receptors and create more transmission

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22
Q

Serotonin

A

NT involved in transmission of nerve impulses

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23
Q

Indication for fluoxetine (Prozac)

A

Depression
-believed to be a defiency in freely available serotonin in brain

OCD, panic disorder, premenstrual dysphoric disorder

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24
Q

Side effects fluoxetine

A

Sexual dysfunction, CNS stimulation, wight gain, serotonin syndrome

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25
Q

What is CNS stimulation

A

Headache, nervousness, anxiety, insomnia

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26
Q

Contradictions for fluoxetine

A

Do not take with monoamine oxidase inhibitors (MAO-Is) as it increases the available pool of serotonin int he brain and increases the risk of developing serotonin syndrome

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27
Q

Contradiction 2 for fluoxetine

A

SSI decrease aggregation of platelets and increase GI bleeding risk up to 3 times . Patients should be advised to avoid anticoagulants and antiplatelets while taking these medication s

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28
Q

Considerations for fluoxetine

A

Suicide risk

Delayed onset of action

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29
Q

Why SSRI increase suicide risk

A

Side effects violent behavior , mania or aggression which can increase siucidal thoughts or actions suicide risk increases during the initial phase of starting on the meds

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30
Q

How long does it take SSRI to work

A

1-3 week weeks

Longer if depression more severe

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31
Q

Serotonin norepinephrine reputable inhibitors (SNRIs)

A

Class of drug indicated for the use of major depression, diabetic peripheral neuropathy, panic and anxiety.

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32
Q

Examples of SNRI

A

Duloxetine

Venlafaxine

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33
Q

Duloxetine

A

SNRI for diabetic peripheral neuropathy and depression

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34
Q

Venlafaxine

A

Panic and anxiety disorders

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35
Q

MOA SNRI

A

Inhibiting reputable of the NT serotonin and norepinephrine thus increasing their bioavailability, yielding increased NT

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36
Q

Side effects SNRI

A

Increase NE
Nausea , vomiting , decreased libido and anorgasmia

Bad compliance

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37
Q

Indications for SNRI

A

Depression, diabetic peripheral neuropathy, panic and anxiety

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38
Q

Which SNRI for diabetic peripheral neuropathy

A

Deluxetine

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39
Q

Other indications for duloxetine

A

Anxiety, chronic pain and fibromyalgia

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40
Q

Which SNRI for panic and anxiety

A

Venlafaxine

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41
Q

Venlafaxine

A

Works on serotonergic and noradrenergic receptors

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42
Q

MOS SNRI

A

Inhibits reputable of serotonin and NE

Increases in NT by increasing availability of extracellular concentrations of serotonin and NE

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43
Q

Side effects SNRI

A

Hypertension, insomnia, nausea and vomiting, decreased libido

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44
Q

Why get insomnia with SNRI

A

Increasing circulating NE

45
Q

Bupropion

A

Atypical antidepressant for smoking cessation often combined with SSRI for depression therapy

46
Q

MOA bupropion

A

Increased availability of dopamine and NE

47
Q

How does bupropion lead to smoking cessation

A

Blocking nicotonic acetylcholine receptors in the brain

48
Q

Side effects bupropion

A

Insomnia, tachycardia, seizure(lowers seizure threshold)

49
Q

Indication s for bupropion

A

Depression and smoking cessation

50
Q

Smoking cessation and bupropion

A

Reduce severity of nicotine cravings and ithdrawal symptoms

51
Q

MOA bupropion

A

Increase dopamine and NE

Block of nicotonic acetylcholine receptors in brain

52
Q

Side effects of bupropion

A

Tachycardia insomnia, seizure , epilepsy

53
Q

Tricyclics antidepressants (TCAs) overview

A

Three ring chemical structure

Wide range of presentations, including depression, bed wetting, OCD, fibromyalgia

54
Q

MOA TCA

A

Lipi soluble and rapidly absorbed and exhibit their effects by blocking serotonin and NE reputable transporters leading to increased availability of serotonin and NE

55
Q

Side effects TCA

A

Convulsion, coma, cardiotoxicity (arrhythmias), anti histamine and anticholinergic effects of this drug , adverse CNS stimulant effects, such as mania, agitation, seizure, confusion and tremor.
Impaired gastric motility, dry mouth, blurry vision, increased temp, urinary impairment
Postural hypotension

56
Q

MOA TCA

A

Blocks serotonin and NE reputable by blocking 5-HT and NE
Elevated synaptic concentrations of the neurotransmitters
*no affinity for dopamine transporters thus limited effect on dopamine

57
Q

TCA is lipid soluble. Significance?

A

Rapidly absorbed

58
Q

Side effects TCA

A 
Adverse CNS effects
Anticholinergic
Antihistamine
Tri-c: convulsion, coma, cardiotoxicity
Blocks alpha1 receptors
59
Q

Adverse CNS effects TCA

A

CNS stimulation

Confusion, mania, agitation, tremor, seizures, sedation

60
Q

Anticholinergic TCA

A

Impaired gastric motility, dry mouth, blurry vision, increased temp, and urinary impairment

61
Q

Cholinergic actions eye

A

Contraction muscle of iris (miosis)

Contraction of ciliary muscles (accommodation for near vision

62
Q

Anticholinergic actions eyes

A

Relaxation of circular muscle of iris (mydriasis)

Relaxation of ciliary muscles (cycloplegia, loss of accommodation)

63
Q

Cholinergic effects heart

A

Bradycardia

Decrease HR

64
Q

Anticholinergic actions heart

A

Tachycardia increased HR

65
Q

Cholinergic actions urinalysis bladder

A

Contraction of muscles in urinary bladder
Relaxation of sphincter bladder
Urination

66
Q

Anticholinergic actions urinary bladder

A

Relaxation of muscles
Contraction of sphincter
Urinary retention

67
Q

TCA antihistamine

A

Seizures and arrhythmias

Mostly mimic anticholinergic effects

68
Q

Tri-c : convulsion, coma, cardiotoxicity TCA

A

Cardiac-na channel block (widening QRS, QT prolongation and torsades de points)hyperpyrexia and respiratoy depression

69
Q

Tca blocks alpha1 receptors

A

Postural hypotension

70
Q

Indications for tCA

A

Major depression, bed wetting, fibromyalgia, OCD

71
Q

Suffix of TCA

A

Iptyline or ipramine

72
Q

TCA examples

A

Amitriptyline, desipramine, clomipramine, imipramine, nortiptyline

73
Q

Amitriptyline

A

For depression and first line for fibromyalgia and chronic pain

74
Q

Amitriptyline has more __ effects than other TCA. Causing what

A

Anticholinergic

Stiffness, nausea, constipation, nervousness, dizziness, tremor, blurred vision, urinary retention and changes in sexual function

75
Q

Desipramine

A

TCA for OCD, also depression and anxiety disorders

76
Q

Imipramine

A

TCA for nocturnal enuresis (bed wetting)

77
Q

Why is imipramine used for bed wetting

A

Decrease the delta wave stage of sleep (when bed wetting occurs)

78
Q

Nortriptyline

A

TCA for depression, less side effects than 1st generation TCA medications.

79
Q

Why does nortriptyline have less influence on hypotension than other TCA

A

Stilll blocks a1, but less?

Nortriptyline keeps blood pressure NORmal

80
Q

Tricyclic antidepressants (TCA)

A

Older generation of antidepressants that block the reputable of norepinephrine and serotonin.

81
Q

Why aretricyclic antidepressants called dirty drugs

A

Cause a wide variety of side effects

82
Q

Side effects of tricyclic antidepressants

A 
Antimuscarinic
Alpha blocking
Antihistamininc 
Cardiac arrhythmias 
Lower seizure threshold 
Long QQT-lead to torsades
83
Q

How do we treat tricyclic antidepresssant toxicity

A

Sodium bicarbonate

84
Q

How does sodium bicarbonate treat tricyclic antidepressant toxicity

A
  1. Alkalinization of the plasma can increase protein binding of them and decrease their bioavailability
  2. Sodium load is thought to reverse the Na channel blocking effects of TCA
85
Q

Monoamine oxidase inhibitors (MAOIs)

A

Group of drugs that work by inhibiting the breakdown of the neurotransmitters serotonin, NE and dopamine, thereby increasing their availability

86
Q

Indication for MAOI

A

Atypical depression by also anxiety and panic disorders

87
Q

___, a monoamine oxidase type B inhibitor, may be effective int he treatment of parkinson disease

A

Selegiline

88
Q

What food should u avoid with MAOI

A

Tyramine-containing foods, such as large amounts of wine and cheese , as the combination of MAOIs with excess tyramine can lead to a hypertensive crisis
Severe increase in bp occurs due to the release of large amounts of amine NT (serotonin, NE and dopamine) triggered by excess tyramine

89
Q

What drugs should not be used with MAOI

A

SSRI, TCA< meperidine, dextromethorphan, St. John’s wort, as this may lead to serotonin syndrome

90
Q

Wine and cheese and MAOI

A

Tyramine is metabolized by monoamine oxidase, and when foods high in tyramine are combined with therapy that inhibits MAO, excess stored monoamine are released.

91
Q

What foods are high n tyramine

A

Wine cheese, red wine, beer, soy, over ripened bananas, cured smoked aged or pickled meats

92
Q

What will tyramine rich food and MAOI lead to

A

Hypertensive crisis

-severe bp increase which can lead to stroke

93
Q

What other drugs should not be given with MAOI

A

SSRI, TCA, meperidine, and dextromethorphan

94
Q

What happens when have MAOI and serotonin drug

A

Risk of serotonin syndrom e

95
Q

Monoamine oxidase inhibitors (MAO-Is)

A

Group of drugs that work by inhibiting the breakdown of the NT serotonin, NE and dopamine, thereby increasing their availability

96
Q

Indication for monoamine oxidase inhibitors

A

Atypical depression, but have been used for anxiety and panic disorders, bulimia, personality disorders and Parkinson’s disease (selegiline)
MAO “takes pride in shanghai”

97
Q

MAO-Is meds

Takes Pride in shanghai

A

Tranylcypromine
Phenelzine
Isocarboxasid
Selegiline

98
Q

What should we not give MAO-Is with

A

Tyramine containing food——hypertensive crisis

99
Q

What happens in hypertensive crisis

A

Severe increase in bp occurs due to the release of large amounts of amine NT (serotonin, NE and dopamine),triggered by excess tyramine

100
Q

What drugs should MAO-Is not be given with

A

SSRI, TCA, meperadine, dextromethorphan, St. John’s wart may lead to serotonin syndrome

101
Q

Indication for MAO-is

A

Atypical depression

102
Q

MOA MAO-Is

A

Increased levels of amine NT (serotonin, NE, dopamine)

103
Q

Tranylcyrpomine

A

Nonselective
Major depression
Mood disorders

104
Q

Phenelzine

A

Nonselective

Failed first and second lines of treatments for depression

105
Q

Isocarboxazid

A

Non selective MAO-I indicated for depression, anxiety and panic disorders

106
Q

Selegiline

A

Selectively inhibits MAO-B at low doses which metabolizes dopamine over NE and serotonin. This leads to increased levels of dopamine availability.

107
Q

Selegiline is typically used with what

A

L Dopa for parkinsons treatment as it enhances effects of L dopa treatment and decreases motor complications

108
Q

At high doses, selegiline loses its selectivity for ___

A

MAO-B

Pharmacology (52 decks)

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