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Psychiatry > Pharmacology of Anti-Depressant Medication > Flashcards

Pharmacology of Anti-Depressant Medication Flashcards

1
Q

What is the mechanism of action of SSRI’s

selective serotonin reuptake inhibitors

A

Selectively inhibit the reuptake of serotonin from the synaptic cleft, increasing the concentration of synaptic serotonin

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2
Q

Give some examples of SSRI’s

A 
Fluoxetine 
Sertraline
Citalopram
Paroxetine
Escitalopram
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3
Q

List the common side effects of SSRI’s

A 
Anxiety 
Agitation
Nausea
Headache
GI upset
Sexual dysfunction 
>risk of suicide in <25y/o
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4
Q

What side effect of SSRI’s is a problem in the elderly?

A

Hyponatraemia

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5
Q

What time of day should SSRI’s be given and why?

A

Morning

Can have insomnia effects

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6
Q

Which SSRI has the most severe discontinuation effect?

A

Paroxetine

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7
Q

What neurological illness can SSRI’s negatively impact?

A

Epilepsy

They can increase occurrence of seizures

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8
Q

What is the mechanism of action in Tricyclic antidepressants?
(TCA’s)

A

Block the reuptake of monoamines, mainly 5-HT and noradrenaline, at the presynaptic terminals
They act on a multitude of terminals unlike SSRI’s

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9
Q

List some examples of TCA’s

A 
Amitriptyline
Clomipramine
Imipramine
Lofepramine
Dusolepin
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10
Q

What can TCA’s treat

A 
Depression (especially effective if insomnia) 
(usually not first line due to S/E's)
OCD
Anxiety
Migraine prophylaxis
Neuropathic Pain
Nocturnal Enuresis
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11
Q

List some common side effects of TCA’s

A 
Anti-cholinergic effects
Sedation
Weight gain
Arrhythmias
Cardiotoxic
Postural Hypotension
Seizures
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12
Q

Name a more selective TCA

A

Clomipramine

Only acts on 5-HT terminals

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13
Q

What patients should you avoid prescribing a TCA

A

Those with high suicidal risk

TCA’s are VERY toxic in an overdose

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14
Q

Describe the mechanism of action in monoamine oxidase inhibitors? (MAOI’s)

A

These work by acting on the enzyme monoamine oxidase, to prevent the breakdown of monoamines in the presynaptic cleft. This increases the monoamine concentration.
MAOI’s can be irreversible or reversible

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15
Q

Give some examples of an MAOI

A

Phenelzine
Tranylcypromine
Moclobemide

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16
Q

What serious reaction must patients be warned about when taking MAOIs.

A

“Cheese reaction”

MAOIs interact with tyramine foods e.g. cheese, red wine, herring, game etc which can cause a hypertensive crisis

17
Q

Which anti-depressants must you discontinue before you put a patient on MAOI

A

SSRIs and TCAs

18
Q

List some other side effects of MAOIs

A

Insomnia
Postural Hypotension
Peripheral Oedema

19
Q

When are MAOIs used to treat depression?

A

3rd Line after SSRIs and TCAs

20
Q

Describe the mechanism of action is SNRI’s

serotonin and noradrenaline reuptake inhibitors

A

These drugs act on the persynpatic terminals to block the reuptake of noradrenaline and 5-HT but they lack major receptor blockings unlike TCA’s so have less effect

21
Q

Give some examples of SNRI’s

A

Venlafaxine

Duloxetine

22
Q

What are some of the side effects of SNRI’s

A

NO CHOLINERGIC EFFECTS
Insomnia
Cardiac arrhythmias
Similar to SSRIs but more severe

23
Q

What can duloxetine also treat

A

Neuropathic pain and bladder instability

24
Q

Which anti-depressant drug works well alongside SNRI’s as a dual therapy?

A

Mirtazapine

25
Q

What class does mirtazapine fall into?

A

NaSSA

Noradrenaline and Specific serotonergic antidepressant

26
Q

What is the mechanism of action for NaSSA

A

It increases the activity of noradrenaline and 5-HT by blocking receptors in the negative feedback loops

27
Q

When is mirtazapine used first line for depression?

A

When patient also suffers from insomnia and/or poor appetite

28
Q

Mirtazapine should be taken at night. True/False

A

True.

It has extreme drowsiness effects

29
Q

List some side effects of mirtazapine (NaSSA)

A 
Hunger and weight fain
Drowsiness 
Constipation
Dizziness and falls
Dry moth
Weird dreams 
GI Upset when taken with alcohol
30
Q

Which drugs should SNRIs NOT be given alongside

A

MAOI’s

31
Q

What drug class is buproprion?

A

Dopamine Uptake inhibitor

Psychiatry (15 decks)

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