Pharmacology

Question 1

What drugs can cross the BBB?

Answer 1

Small, lipophilic drugs

Question 2

What are some clinical uses of antidepressants?

Answer 2

Depression
Dysthymia
Anxiety
Panic disorders, OCD, PTSD, PMS dysmorphic, bulimia, neuropathic pain

Question 3

3 categories of antidepressant drugs

Answer 3

Monoamine oxidase inhibitors
Monoamine reuptake inhibitors
Atypical drugs

Question 4

What is a type of monoamine reuptake inhibitor? (4)

Answer 4

Tricyclics
Non-selective reuptake
Selective serotonin reuptake
Noradrenaline reuptake

Question 5

3 examples of monoamines

Answer 5

Dopamine, NA, 5-HT

Question 6

Depression results from a functional deficit of ________ in particular _____ and ______

Answer 6

Monoamine transmitters

Serotonin, NA

Question 7

Precursor for serotonin

Answer 7

Typtophan

Question 8

Precursor for NA

Answer 8

Tyrosine

Question 9

What does MAO do?

Answer 9

It metabolizes NA and 5-HT

Question 10

Examples of MAO inhibitors

Answer 10

Phenelzine

Moclobemide

Question 11

Mode of action for MAO inhibitors

Answer 11

Irreversible (phenelzine) or reversible (moclobemide) inhibitors of MAO-A and B

Question 11

Mode of action for MAO inhibitors

Answer 11

Irreversible (phenelzine) or reversible (moclobemide) inhibitors of MAO-A and B

Question 12

What are side effects of MAO inhibitors?

Answer 12

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

Question 13

People on MAOinhibitors can’t have

Answer 13

Cheese, gravy

Question 14

Tricyclic anti-depressants common side effects

Answer 14

Anti-cholinergic, sedation, weight gain, cardiotoxic

Question 15

When do you take tricyclic antidepressants?

Answer 15

At night before bed

Question 16

Example of SSRI

Answer 16

Fluoxetine, citalopram, sertraline

Question 17

SE of SSRIs

Answer 17

Nausea, headache, worsened anxiety, increase in self-harm, sweating/vivid dreams, hyponatraemia in the elderly

Question 18

Which anti-depressant drugs are more NA selective? 5-HT selective? Non-selective?

Answer 18

NA: Reboxetine, protiptylline
5-HT: Sertraline, fluoxetine, citalopram
Non: amitriptyline

Question 19

What drug should be avoided in people with IHD that is now depressed?

Answer 19

Tricyclic

Question 20

Lithium mode of action

Answer 20

May block phosphatidylinositol pathway or inhibit glycogen synthase kinase 3B - not sure but causes numerous unwanted affects down the line

Question 21

Monitoring of someone on lithium

Answer 21

12 hour post-dose blood levels

Target range 0.4-1

Question 22

Does lithium get metabolized?

Answer 22

No, you can’t metabolize an element

Question 23

To the renal tubules, lithium and _____ are indistinguishable

Answer 23

Sodium

Question 24

Antipsychotic drugs

Answer 24

Quetiapine, aripiprazole, olanzapine, lurasidone

Question 25

MAOi examples

Answer 25

Phenelzine | Moclobemide

Question 26

3 MOA reuptake inhibitors

Answer 26

Tricyclics SSRI SNRI

Question 27

SNRI example

Answer 27

Venlafaxine, duloxetine

Question 28

What do TCAs do?

Answer 28

Block the reuptake of monoamines into presynaptic terminals (NA and 5-HT)

Question 29

SSRI discontinuation effects

Answer 29

FINISH - flu-like, insomnia, nausea, imbalance, sensory disturbance, hyperarousal

Question 30

Triad of symptoms in serotonin syndrome

Answer 30

``` Autonomic instability (hypertension, tachycardia, hyperthermia, sweating) Neuromuscular abnormality (tremor, clonus, hypertonicity, hyperreflexia) Mental state changes (delirium, agitation, pressured speech, hyper vigilance, confusion, coma) ```

Question 31

AVOID in panic disorder

Answer 31

BZD

Question 32

First line panic disorder treat

Answer 32

SSRI

Question 33

2nd line panic disorder

Answer 33

Imipramine, clomipramine

Question 34

GAD treatment

Answer 34

BZD 2-4 weeks 1st line: SSRI 2nd line: SNRI or pregabalin

Question 35

Pharmacological effects of BZD

Answer 35

``` Reduce anxiety and aggression Hypnosis/sedation Muscle relaxation Anticonvulsant Anterograde amnesia ```

Question 36

Lithium requires what post dose?

Answer 36

Blood monitoring | 0.4-1

Question 37

Lithium side effects

Answer 37

``` Dry mouth/strange taste Polydipsia and polyuria Tremor Hypothyroidism Long term reduced renal function Nephrogenic DI Weight gain ```

Question 38

Prophylaxis in bipolar disorder

Answer 38

1st - lithium | 2nd - valproate (not in women of child bearing), olanzapine

Question 39

Treat neuroleptic malignant syndrome

Answer 39

Discontinue drug | Add an agonist (bromocriptine)

Question 40

What drug prolongs the QT interval?

Answer 40

Clozapine