Pharm U3 antidepressants

Question 1

reserpine - use and side effects

Answer 1

hypertension or schizophrenia. side effect: depression

Question 2

what is depression associated with?

Answer 2

decreased functional amine-dependent synaptic transmission (too little CNS NE and/or 5-HT

Question 3

how does cocaine treat depression symptoms?

Answer 3

blocks NE reuptake (most antidepressive drugs block re-uptake of both NE and 5-HT)

Question 4

placebo effect: true or false

Answer 4

most agree that meds are beneficial over placebo for patients with very severe depression

Question 5

HDRS scores

Answer 5

hamilton depression rating scale (mild 8-13; moderate 14-18; severe 19-22; very severe >23)

Question 6

MAOIs - mechanism and example

Answer 6

irreversibly inhibits monoamine oxidase (breakdown of neurotransmitter inside) - tranylcypromine and phenelzine

Question 7

tricyclics - mechanism and examples

Answer 7

inhibitors of both NE and 5-HT reuptake to a varying degree - imipramine and amitriptyline

Question 8

SSRIs - mechanism and examples

Answer 8

selective serotonin reuptake inhibitors = fluoxetine and citalopram

Question 9

SNRIs - mechanism and examples

Answer 9

serotonin-NE reuptake inhibitors (little difference from SSRIs)… - duloxetine and venlafaxine

Question 10

atypicals - mechanism and examples

Answer 10

inhibit 5-HT uptake transporter, and also several proposed other mechanisms (DA reuptake inhibition, agonist, and/or antagonist at serotonin receptor sub-types, **NE reuptake inhibition, antipsychotics) - bupropion and mirtazapine

Question 11

what is used to treat bipolar disorder

Answer 11

lithium salts, followed by carbamazepine and valproate

Question 12

MAOa vs MAOb

Answer 12

MAOa oxidizes mainly NE, 5-HT, tyramine

MAOb oxidizes mainly DA, phenyethylamine

Question 13

tranylcypromine
phenelzine
what do they inhibit, what are they used for?

Answer 13

tranylcypromine: inhibits both A and B - used for depression
phenelzine: inhibits both A and B - used for depression

Question 14

MAOi side effects, life-threatening side effects

Answer 14

SE: anticholinergic, pronounced orthostatic hypotension, sexual dysfunction, weight gain, sedation varies.
Life threatening: liver MAO also inhibited so dangerous with TYRAMINE (don’t eat fermented foods or take certain other drugs)

Question 15

MAOI + SSRI

Answer 15

serotonin syndrome

Question 16

biogenic amine hypothesis

Answer 16

depression = too little CNS NE and/or 5-HT (amounts and/or activity)

Question 17

what are the tricyclics?

Answer 17

desipramine, imipramine, amitriptyline, nortriptyline

Question 18

problem with tricyclics

Answer 18

“dirty drugs” - many side effects because they block several other neurotransmitter receptors besides NE and 5-HT

Question 19

side effects of tricyclics

Answer 19

antimuscarinic (blurred vision, constipation, confusion), alpha antagonist (orthostatic hypotension), histamine antagonist (sedation and additive sedative effects with alcohol), sympathomimetic (tremor, insomnia), CARDIAC-ARRHYTHMIAS, CONDUCTION DEFECTS - ESPECIALLY AT OVERDOSE, seizures

Question 20

how are antidepressants prescribed to people?

Answer 20

different ratios and drug combinations for different people - personalized medicine

Question 21

what are the SSRIs and SNRIs?

Answer 21

fluoxetine, paroxetine, citalopram, duloxetine, venlafaxine

Question 22

what are the main differences between SSRIs and tricyclics?

Answer 22

SSRIs have longer duration, some SSRIs inhibit P450 enzymes, SSRIs much safe in OD (no seizures or cardiac arrythmia), less side effects, but more nausea and complaints of decreased sexual function

Question 23

side effects of SSRIs

Answer 23

drug-drug interactions with fluoxetine and paroxetine

Question 24

serotonin syndrome

Answer 24

hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status, vital signs (potentially lethal)

Question 25

what causes serotonin syndrome?

Answer 25

SSRI and MAOI interaction - increased stores of 5-HT and inhibited reuptake - marked increases of serotonin in synapses

Question 26

what are the atypical antidepressants?

Answer 26

mirtazapine and bupropion

Question 27

what is unique about bupropion?

Answer 27

atypical: only agent with notable selectivity for DA uptake transporter, potential side effect of lowering seizure threshold, useful in improving nicotine abstinence in quitting smokers

Question 28

ketamine

Answer 28

NMDA receptor antagonist produces rapid antidepressant response within hours - effective in treatment resistant depressed patients

Question 29

uses of antidepressants

Answer 29

depression, anxiety, PTSD, chronic pain, enuresis, bulimia, pre-menstrual dystrophic disorder, alcoholism

Question 30

side effects of lithium

Answer 30

drowsiness, weight gain, tremor, polydipsia, polyuria

Question 31

early warning of Li OD

Answer 31

nausea with vomiting

Question 32

MAO lithium

Answer 32

causes depletion of IP3 and DAG which are important second messengers for both alpha-adrenergic and muscarinic-cholinergic transmission