Pharmacology - Antidepressants

Question 1

what types of drugs can most effectively cross the blood brain barrier?

Answer 1

hydrophobic/lipophillic

Question 2

what antidepressant should be avoided in people with ischaemic heart disease?

Answer 2

imipramine

it is cardiotoxic in high doses

Question 3

what mood stabilising drug needs to have therapeutic drug monitoring?

Answer 3

lithium

Question 4

how is lithium metabolised?

Answer 4

it ISNT.

it is an element so is not metabolised

Question 5

what is the effect of dehydration on lithium levels?

Answer 5

increases lithium levels

Question 6

which mood stabiliser needs to be avoided in people who plan to get pregnant soon?

Answer 6

valproic acid

teratogenic

Question 7

what are the three main classes of antidepressant drugs?

Answer 7

monoamine oxidase inhibitors
monoamine reuptake inhibitors
atypical drugs

Question 8

what are the four types of monoamine reuptake inhibitors?

Answer 8

tricyclics
other non selective reuptake inhibitors
SSRI’s
noradrenaline reuptake inhibitors

Question 9

what are the three monoamine neurotransmitters?

Answer 9

dopamine
noradrenaline
5-HT

Question 10

what is another name for 5-HT?

Answer 10

serotonin

Question 11

name two monoamine oxidase inhibitors

Answer 11

phenelzine

moclobemide

Question 12

what neurotransmitters are affected by monoamine oxidase inhibitors?

Answer 12

all monoamine neurotransmitters - not selective

Question 13

what is the mode of action of monoamine oxidase inhibitors?

Answer 13

inhibitors of MOA

can be reversible or irreversible

Question 14

which monoamine oxidase inhibitor is reversible?

Answer 14

moclobemide

phenelzine is irreversible

Question 15

what is a very serious potential side effect of monoamine oxidase inhibitors?

Answer 15

hypertensive crisis

Question 16

name three potential side effects of monoamine oxidase inhibitors

Answer 16

insomnia
postural hypotension
peripheral oedema

Question 17

name a tricyclic antidepressant

Answer 17

imipramine

Question 18

what is the mode of action of tricyclic antidepressants?

Answer 18

block the reuptake of monoamines into presynaptic terminals

Question 19

what group of side effects can tricyclics cause?

Answer 19

anti cholinergic effects

Question 20

name four anti cholinergic side effects tricyclics can have

Answer 20

blurred vision
dry mouth
constipation
urinary retention

Question 21

name four side effects tricyclics may have

Answer 21

sedation
weight gain
postural hypotension
tachycardia

Question 22

what effect can tricyclics have in overdose?

Answer 22

cardiotoxic effects

Question 23

name four SSRI’s

Answer 23

fluoxetine
citalopram
escitalopram
sertraline

Question 24

what is the mode of action of SSRI’s?

Answer 24

selectively inhibit reuptake of serotonin from the synaptic cleft

Question 25

name six common side effects associated with SSRI's

Answer 25

``` nausea headache worsened anxiety sweating vivid dreams sexual dysfunction ```

Question 26

what is a potential side effect of SSRI's seen in patients under 25?

Answer 26

a transient increase in self harm/suicidal ideation

Question 27

what is a possible side effect of SSRI's in the elderly?

Answer 27

hyponatraemia

Question 28

name two dual reuptake inhibitors?

Answer 28

venlafaxine | duloxetine

Question 29

what is the mode of action of dual reuptake inhibitors?

Answer 29

block the reuptake of monoamines into presynaptic terminals

Question 30

what are the side effects of dual reuptake inhibitors like in comparison to other antidepressants?

Answer 30

similar to SSRI's | less than tricyclics

Question 31

name an atypical antidepressant

Answer 31

mirtazapine

Question 32

name two potential side effects of mirtazapine

Answer 32

weight gain | sedation

Question 33

what side effect can mirtazapine have when given with SSRI's?

Answer 33

can block serotonergic side effects

Question 34

name three types of drug that can be given as mood stabilisers in bipolar disorder

Answer 34

lithium anti convulsants anti psychotics

Question 35

what is lithium normally given as?

Answer 35

lithium carbonate

Question 36

what monitoring needs to be done with giving lithium and why?

Answer 36

12 hour post dose blood levels it has a narrow therapeutic index

Question 37

what is the target range for lithium?

Answer 37

0.4-1 mmol/L

Question 38

name five possible side effects of lithium

Answer 38

``` dry mouth polydipsia tremor hypothyroidism weight gain ```

Question 39

what effects can long term lithium use have on the kidneys?

Answer 39

reduced renal function | nephrogenic DI

Question 40

what anti convulsant drugs can be used in the long term management of bipolar disorder?

Answer 40

valproic acid lamotrigine carbamazepine

Question 41

name four side effects of valproate and cabamazepine

Answer 41

drowsiness ataxia CV effects induces liver enzymes

Question 42

what is there a risk of when giving valproate in females?

Answer 42

teratogenicity can cause neural tube defects

Question 43

what is there a small risk of with lamotrigine?

Answer 43

Stevens Johnson syndrome

Question 44

name four anti psychotics that can be given for bipolar disorder

Answer 44

quetiapine aripiprazole olanzapine lurasidone

Question 45

what is the mode of action of anti psychotics in bipolar disorder?

Answer 45

dopamine and 5-HT antagonism

Question 46

name three possible side effects of anti psychotics

Answer 46

sedation weight gain metabolic syndrome