Pharmacology Flashcards
What drugs can cross the BBB?
Small, lipophilic drugs
What are some clinical uses of antidepressants?
Depression
Dysthymia
Anxiety
Panic disorders, OCD, PTSD, PMS dysmorphic, bulimia, neuropathic pain
3 categories of antidepressant drugs
Monoamine oxidase inhibitors
Monoamine reuptake inhibitors
Atypical drugs
What is a type of monoamine reuptake inhibitor? (4)
Tricyclics
Non-selective reuptake
Selective serotonin reuptake
Noradrenaline reuptake
3 examples of monoamines
Dopamine, NA, 5-HT
Depression results from a functional deficit of ________ in particular _____ and ______
Monoamine transmitters
Serotonin, NA
Precursor for serotonin
Typtophan
Precursor for NA
Tyrosine
What does MAO do?
It metabolizes NA and 5-HT
Examples of MAO inhibitors
Phenelzine
Moclobemide
Mode of action for MAO inhibitors
Irreversible (phenelzine) or reversible (moclobemide) inhibitors of MAO-A and B
Mode of action for MAO inhibitors
Irreversible (phenelzine) or reversible (moclobemide) inhibitors of MAO-A and B
What are side effects of MAO inhibitors?
Cheese reaction - hypertensive crisis caused by inhibition of MAO in gut by irreversible inhibitors preventing breakdown of dietary tyramine and by multiple drugs that potentiate amine transmission
Insomnia
Postural hypotension
Peripheral oedema
People on MAOinhibitors can’t have
Cheese, gravy
Tricyclic anti-depressants common side effects
Anti-cholinergic, sedation, weight gain, cardiotoxic
When do you take tricyclic antidepressants?
At night before bed
Example of SSRI
Fluoxetine, citalopram, sertraline
SE of SSRIs
Nausea, headache, worsened anxiety, increase in self-harm, sweating/vivid dreams, hyponatraemia in the elderly
Which anti-depressant drugs are more NA selective? 5-HT selective? Non-selective?
NA: Reboxetine, protiptylline
5-HT: Sertraline, fluoxetine, citalopram
Non: amitriptyline
What drug should be avoided in people with IHD that is now depressed?
Tricyclic
Lithium mode of action
May block phosphatidylinositol pathway or inhibit glycogen synthase kinase 3B - not sure but causes numerous unwanted affects down the line
Monitoring of someone on lithium
12 hour post-dose blood levels
Target range 0.4-1
Does lithium get metabolized?
No, you can’t metabolize an element
To the renal tubules, lithium and _____ are indistinguishable
Sodium
Antipsychotic drugs
Quetiapine, aripiprazole, olanzapine, lurasidone
MAOi examples
Phenelzine
Moclobemide
3 MOA reuptake inhibitors
Tricyclics
SSRI
SNRI
SNRI example
Venlafaxine, duloxetine
What do TCAs do?
Block the reuptake of monoamines into presynaptic terminals (NA and 5-HT)
SSRI discontinuation effects
FINISH - flu-like, insomnia, nausea, imbalance, sensory disturbance, hyperarousal
Triad of symptoms in serotonin syndrome
Autonomic instability (hypertension, tachycardia, hyperthermia, sweating) Neuromuscular abnormality (tremor, clonus, hypertonicity, hyperreflexia) Mental state changes (delirium, agitation, pressured speech, hyper vigilance, confusion, coma)
AVOID in panic disorder
BZD
First line panic disorder treat
SSRI
2nd line panic disorder
Imipramine, clomipramine
GAD treatment
BZD 2-4 weeks
1st line: SSRI
2nd line: SNRI or pregabalin
Pharmacological effects of BZD
Reduce anxiety and aggression Hypnosis/sedation Muscle relaxation Anticonvulsant Anterograde amnesia
Lithium requires what post dose?
Blood monitoring
0.4-1
Lithium side effects
Dry mouth/strange taste Polydipsia and polyuria Tremor Hypothyroidism Long term reduced renal function Nephrogenic DI Weight gain
Prophylaxis in bipolar disorder
1st - lithium
2nd - valproate (not in women of child bearing), olanzapine
Treat neuroleptic malignant syndrome
Discontinue drug
Add an agonist (bromocriptine)
What drug prolongs the QT interval?
Clozapine
