Pharmacology - Antidepressants Flashcards

1
Q

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

A

hydrophobic/lipophillic

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2
Q

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

A

imipramine

it is cardiotoxic in high doses

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3
Q

what mood stabilising drug needs to have therapeutic drug monitoring?

A

lithium

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4
Q

how is lithium metabolised?

A

it ISNT.

it is an element so is not metabolised

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5
Q

what is the effect of dehydration on lithium levels?

A

increases lithium levels

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6
Q

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

A

valproic acid

teratogenic

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7
Q

what are the three main classes of antidepressant drugs?

A

monoamine oxidase inhibitors
monoamine reuptake inhibitors
atypical drugs

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8
Q

what are the four types of monoamine reuptake inhibitors?

A

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

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9
Q

what are the three monoamine neurotransmitters?

A

dopamine
noradrenaline
5-HT

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10
Q

what is another name for 5-HT?

A

serotonin

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11
Q

name two monoamine oxidase inhibitors

A

phenelzine

moclobemide

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12
Q

what neurotransmitters are affected by monoamine oxidase inhibitors?

A

all monoamine neurotransmitters - not selective

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13
Q

what is the mode of action of monoamine oxidase inhibitors?

A

inhibitors of MOA

can be reversible or irreversible

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14
Q

which monoamine oxidase inhibitor is reversible?

A

moclobemide

phenelzine is irreversible

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15
Q

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

A

hypertensive crisis

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16
Q

name three potential side effects of monoamine oxidase inhibitors

A

insomnia
postural hypotension
peripheral oedema

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17
Q

name a tricyclic antidepressant

A

imipramine

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18
Q

what is the mode of action of tricyclic antidepressants?

A

block the reuptake of monoamines into presynaptic terminals

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19
Q

what group of side effects can tricyclics cause?

A

anti cholinergic effects

20
Q

name four anti cholinergic side effects tricyclics can have

A

blurred vision
dry mouth
constipation
urinary retention

21
Q

name four side effects tricyclics may have

A

sedation
weight gain
postural hypotension
tachycardia

22
Q

what effect can tricyclics have in overdose?

A

cardiotoxic effects

23
Q

name four SSRI’s

A

fluoxetine
citalopram
escitalopram
sertraline

24
Q

what is the mode of action of SSRI’s?

A

selectively inhibit reuptake of serotonin from the synaptic cleft

25
Q

name six common side effects associated with SSRI’s

A
nausea 
headache 
worsened anxiety 
sweating 
vivid dreams 
sexual dysfunction
26
Q

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

A

a transient increase in self harm/suicidal ideation

27
Q

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

A

hyponatraemia

28
Q

name two dual reuptake inhibitors?

A

venlafaxine

duloxetine

29
Q

what is the mode of action of dual reuptake inhibitors?

A

block the reuptake of monoamines into presynaptic terminals

30
Q

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

A

similar to SSRI’s

less than tricyclics

31
Q

name an atypical antidepressant

A

mirtazapine

32
Q

name two potential side effects of mirtazapine

A

weight gain

sedation

33
Q

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

A

can block serotonergic side effects

34
Q

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

A

lithium
anti convulsants
anti psychotics

35
Q

what is lithium normally given as?

A

lithium carbonate

36
Q

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

A

12 hour post dose blood levels

it has a narrow therapeutic index

37
Q

what is the target range for lithium?

A

0.4-1 mmol/L

38
Q

name five possible side effects of lithium

A
dry mouth 
polydipsia 
tremor 
hypothyroidism 
weight gain
39
Q

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

A

reduced renal function

nephrogenic DI

40
Q

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

A

valproic acid
lamotrigine
carbamazepine

41
Q

name four side effects of valproate and cabamazepine

A

drowsiness
ataxia
CV effects
induces liver enzymes

42
Q

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

A

teratogenicity

can cause neural tube defects

43
Q

what is there a small risk of with lamotrigine?

A

Stevens Johnson syndrome

44
Q

name four anti psychotics that can be given for bipolar disorder

A

quetiapine
aripiprazole
olanzapine
lurasidone

45
Q

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

A

dopamine and 5-HT antagonism

46
Q

name three possible side effects of anti psychotics

A

sedation
weight gain
metabolic syndrome