Pharmacology - Antidepressants Flashcards
what types of drugs can most effectively cross the blood brain barrier?
hydrophobic/lipophillic
what antidepressant should be avoided in people with ischaemic heart disease?
imipramine
it is cardiotoxic in high doses
what mood stabilising drug needs to have therapeutic drug monitoring?
lithium
how is lithium metabolised?
it ISNT.
it is an element so is not metabolised
what is the effect of dehydration on lithium levels?
increases lithium levels
which mood stabiliser needs to be avoided in people who plan to get pregnant soon?
valproic acid
teratogenic
what are the three main classes of antidepressant drugs?
monoamine oxidase inhibitors
monoamine reuptake inhibitors
atypical drugs
what are the four types of monoamine reuptake inhibitors?
tricyclics
other non selective reuptake inhibitors
SSRI’s
noradrenaline reuptake inhibitors
what are the three monoamine neurotransmitters?
dopamine
noradrenaline
5-HT
what is another name for 5-HT?
serotonin
name two monoamine oxidase inhibitors
phenelzine
moclobemide
what neurotransmitters are affected by monoamine oxidase inhibitors?
all monoamine neurotransmitters - not selective
what is the mode of action of monoamine oxidase inhibitors?
inhibitors of MOA
can be reversible or irreversible
which monoamine oxidase inhibitor is reversible?
moclobemide
phenelzine is irreversible
what is a very serious potential side effect of monoamine oxidase inhibitors?
hypertensive crisis
name three potential side effects of monoamine oxidase inhibitors
insomnia
postural hypotension
peripheral oedema
name a tricyclic antidepressant
imipramine
what is the mode of action of tricyclic antidepressants?
block the reuptake of monoamines into presynaptic terminals
what group of side effects can tricyclics cause?
anti cholinergic effects
name four anti cholinergic side effects tricyclics can have
blurred vision
dry mouth
constipation
urinary retention
name four side effects tricyclics may have
sedation
weight gain
postural hypotension
tachycardia
what effect can tricyclics have in overdose?
cardiotoxic effects
name four SSRI’s
fluoxetine
citalopram
escitalopram
sertraline
what is the mode of action of SSRI’s?
selectively inhibit reuptake of serotonin from the synaptic cleft
name six common side effects associated with SSRI’s
nausea headache worsened anxiety sweating vivid dreams sexual dysfunction
what is a potential side effect of SSRI’s seen in patients under 25?
a transient increase in self harm/suicidal ideation
what is a possible side effect of SSRI’s in the elderly?
hyponatraemia
name two dual reuptake inhibitors?
venlafaxine
duloxetine
what is the mode of action of dual reuptake inhibitors?
block the reuptake of monoamines into presynaptic terminals
what are the side effects of dual reuptake inhibitors like in comparison to other antidepressants?
similar to SSRI’s
less than tricyclics
name an atypical antidepressant
mirtazapine
name two potential side effects of mirtazapine
weight gain
sedation
what side effect can mirtazapine have when given with SSRI’s?
can block serotonergic side effects
name three types of drug that can be given as mood stabilisers in bipolar disorder
lithium
anti convulsants
anti psychotics
what is lithium normally given as?
lithium carbonate
what monitoring needs to be done with giving lithium and why?
12 hour post dose blood levels
it has a narrow therapeutic index
what is the target range for lithium?
0.4-1 mmol/L
name five possible side effects of lithium
dry mouth polydipsia tremor hypothyroidism weight gain
what effects can long term lithium use have on the kidneys?
reduced renal function
nephrogenic DI
what anti convulsant drugs can be used in the long term management of bipolar disorder?
valproic acid
lamotrigine
carbamazepine
name four side effects of valproate and cabamazepine
drowsiness
ataxia
CV effects
induces liver enzymes
what is there a risk of when giving valproate in females?
teratogenicity
can cause neural tube defects
what is there a small risk of with lamotrigine?
Stevens Johnson syndrome
name four anti psychotics that can be given for bipolar disorder
quetiapine
aripiprazole
olanzapine
lurasidone
what is the mode of action of anti psychotics in bipolar disorder?
dopamine and 5-HT antagonism
name three possible side effects of anti psychotics
sedation
weight gain
metabolic syndrome
