Pharmacological Management Of Anxiety Disorders and Depression Flashcards
What is the function of the 5HT2-a receptor?
Located in the limbic system, involved in anxiety and panic attacks.
In the sleep centre, involved in insomnia and disruption of slow wave sleep.
In the basal ganglia, involved in muscle restlessness.
What is the function of the 5-HT1a receptor?
Autoreceptor responsible for the delayed effect of anxiolytics, which eventually become desensitised over time.
What is the function of the 5HT3 receptor?
Present in the hypothalamus and gut to cause vomiting, diarrhoea and muscle cramps.
What is the function of the 5HT2-C receptor?
Located in the spinal cord and activation causes sexual dysfunction.
What is the action of SSRIs?
Reduce the reuptake of serotonin in the synaptic cleft by SER/serotonin transporters on the presynaptic neurons to increase availability and reduce psychological symptoms.
How is serotonin synthesised?
Dietary protein, in the form of the amino acid tryptophan -> serotonin
Where is serotonin stored/found in the body?
-> Platelets
-> Neurons in the CNS
-> Enterochromaffin cells in the gut
What are the general side effects of SSRIs?
They increase bleeding time, with possible risk in pregnant women for post-partum haemorrhage.
Prolonging of the QT interval
Vomiting, diarrhoea and muscle cramps
Arthralgia (joint pain)
What is the first line SSRI commonly used in anxiety and depression?
Citalopram or Fluoxetine
Followed by Escitalopram, Paroxetine and Sertraline.
What are the contraindications for SSRIs?
Poorly controlled epilepsy and QT interval prolongation.
How are the catecholeamines synthesised?
Dietary protein in the form of phenylalanine -> tyrosine -> levadopa -> dopamine -> noradrenaline - > adrenaline
What is the action of SNRIs?
Block action of SER and NE transporters on the presynpatic neurons to increase availability of serotonin and noradrenaline.
Which SNRIs are first line treatment for anxiety and depression?
Venlafaxine and Duloxetine
What is the action of venlafaxine?
It has a wider use than duloxetine; major depression, GAD, social anxiety and panic disorder. It is an SNRI with a greater affinity for serotonin than noradrenaline.
What is the action of duloxetine?
Potent inhibitor of serotonin, noradrenaline and a lesser inhibitor of dopamine. It’s given for major depressive disorder and anxiety.
It decreases the transmission of painful stimuli; Increases vasoconstriction, hypertension and muscle contraction.