Pharmacology: Antidepressants and Mood Stabilisers

Question 1

What prescribed drugs can exacerbate/worsen depression

Answer 1

steroids

Question 2

How do more anti depressents likely work

Answer 2

• blocking re uptake of monoamine neurotransmitter
• preventing breakdown of monoamine neurotranmitters
• as a result the is and increase neurotransmitter availability (in the short term)

Question 3

Name examples of SSRIs

Answer 3

Fluoxetine, paroxetine, citalopram, escitalopram, sertraline, fluvoxamine

Question 4

When are SSRIs used

Answer 4

depression
panic disorders
PTSD
OCD
chronic pain
eating disorders
stroke
premature ejactuation

Question 5

How do SSRIs work

Answer 5

Inhibit the reuptake of the monoamine serotonin (5HT) within the synapse

Question 6

How long do SSRIs take to work

Answer 6

2-3 weeks

Question 7

What are the clinical aspects to remember when prescribing SSREs

Answer 7

Can usually be started at therapeutic dose from day one
relatively safe in overdose
Fluoxetine etc inhibit CYP450 which causes interactions with other drugs which work via the same pathway

Question 8

What are the most common side effects realting to SSRIs

Answer 8

Sexual dysfunction
GI side effects
short term anxiety
in young people there is increased risk of self harm in first few weeks

Question 9

How can sexual dysfunction due to SSRI’s be reversed

Answer 9

by 5ht antagonists

eg Trazodone

Question 10

What are the adverse effects of tricyclics

Answer 10

Constipation
dry mouth
cardiac function
postural hypotension
(all due to unwanted receptor activity, typically anticholinergic)

Question 11

name some monoamine oxidase inhibitors

Answer 11

Phenelzine, isocarboxazid, tranylcyprromide

Question 12

What does MAO A metabolise

Answer 12

NA, 5 HT and tyramine

Question 13

what does MAO B metabolise

Answer 13

DA, tyramine, phenylethylamine

Question 14

When are MAOIs used

Answer 14

Atypical depression

Third/fourth line treatment

Question 15

What is the main adverse affect of MAOI

Answer 15

cancause hypertensive crises due to now increased levels of tyramine (which releases NA)

Question 16

What are the symptoms of a hypertensive crisis

Answer 16

flushing
headache
increased BP
rarely CVA

Question 17

how is a hypertensive crisis treated

Answer 17

alpha blockade
eg phentolamine
chlorpomazine

Question 18

What antidepressant can result in extra pyramidal side effects

Answer 18

Paroxetine - due to affect on DA

Question 19

What anti psychotic can be antidepressant at low doses

Answer 19

flupentixol

Question 20

Why should antidepressants be stopped slowly

Answer 20

there is a potential to develop a discontinuity syndrome (SSRI’s particularly) if stopped suddenly
shivering, anxiety, headache, dizziness

Question 21

Name examples of SNRIs

Answer 21

venlafaxine

duloxetine

Question 22

Name an NSSA

Answer 22

mirtazapine

Question 23

What drugs all work on GABA receptors

Answer 23

Ethanol
Benzodiazepines
Baclofen
Valproate
Pregabalin
Gabapentin

Question 24

What are mood stabilisers

Answer 24

‘anti convulsant drugs- are more effective at treating mania than depression

Question 25

Name mood stabilisers

Answer 25

Carbamazepine
Valproate
Lamotrigine
Lithium

Question 26

name atypical antipsychotics

Answer 26

Olanzapine

risperidone

Question 27

How does lamotrigine work

Answer 27

blocking sodium channels

reduces excitability and cell firing

Question 28

Why is lithium not as commonly used now?

Answer 28

high incidence of adverse effects and toxic in overdose
poor adherence
requires blood monitoryin

Question 29

How do first generation anti psychotics work

Answer 29

on D2 receptors- DA blockade

Question 30

What is the main side effect in typical antipsychotics

Answer 30

movement disorders

hyperprolactinaemia

Question 31

name a typical antipsychotic

Answer 31

haloperadol