Pharmacology of Antidepressants and Mood Stabilisers Flashcards
antidepressants are used for depression of what severity?
moderate to severe
antidepressants are used for what other clinical conditions aside from depression?
anxiety dysthymia panic disorders - OCD/PTSD bulimia nervosa neuropathic pain
main MoA of antidepressants? how do they do this?
increase levels of monoamines in the body by:
inhibiting monoamine oxidase OR
inhibiting monoamine/serotonin reuptake into the cell (more for the body)
what are the neurotransmitters for monamine?
noradrenaline
5-HT
dopamine
if your monoamine levels drop, your mood goes __
down
what particular chemicals do people lack in depression?
serotonin (5-HT)
NA
name the 2 main serotonin systems
rostral
caudal raphe
what areas of the brain does the rostral pathway cover?
limbic
subcortical
cerebral cortex
name the 2 noradrenaline projection pathways?
lateral tegmental area
locus coeruleus
which noradrenaline pathway covers msot of the brain?
locus choeruleus
the rostral serotonin pathway is responsible for what functions?
mood
sleep
feeding behaviour
sensory perception
the locus coeruleus is responsible for what function
arousal
emotion
how do MAO inhibitors work
conc of moonoamines goes up presynaptically as less is taken up
give an example of MAO inhibitors?
phenelzine
moclobemide
which MAO inhibitors are irreversible in action?
phenelzine
what food should be avoided in MAO inhibitors and why?
“cheese reaction” - MAO prevents breakdown of dietary tyramine = increased BP + headaches
other yeast products eg gravy/wines
side effects of MAO inhibitors?
hypertensive crisis - cheese and tyramine
postural hypotension
insomnia
peripheral oedema
MoA of tricyclics?
block reuptake of MAO (less serotonin and NA removed)
give examples of tricyclics?
amitryptiline
imipramine
dosulepin
lofepramine
side effects of tricyclics?
anti-cholinergic effects sedation weight gain postural HT, tachy, arrhythmia constipation
what are anti-cholinergic effects
blurred vision
dry mouth
urinary retention
name anti-histaminergic side effects
sedation
weight gain
what kind of drug is fluoxetine?
SSRI
give examples of SSRIs
fluoxetine
citalopram
SSRIs inhibit serotin reuptake at…
the synaptic cleft
side effects of SSRIs?
nausea headache sweating/vivid dreams anxiety worse sexual dysfunction increased self harm if young
main electrolyte disturbance from SSRIs?
hyponatraemia
how can SSRIs make you sick?
too much serotonin (5-HT3) in the body can cause nausea
duloxetine is an example of…
SNRI (serotonin noradrenaline reuptake inhibitor)
too much 5-HT2 can cause….
headaches
what does mirtazapine block?
alpha 2 receptors
5HT2
5HT3
side effects of mirtazapine?
histaminergic side effects eg weight gain and sedation
antidepressants can be combined safely T or F
F, tend to make side effects worse
1st and 2nd line antidepressants
1.SSRI
2, another SSRI
lithium is given for what disorder and as what compound?
BPAD
lithium carbonate
gold standard Tx for bipolar disorder?
lithium carbonate 400mg
main problem with lithium as a drug?
narrow therapeutic index
common side effects of lithium?
ITS A SALT: dry mouth/strange taste? polydipsia/polyuria tremor reduced renal function nephrogenic DI weight gain
lithium can cause what thyroid problem?
hypothyroidism
someone who has lithium poisoning will present with…
vomiting diarrhoea ataxia/coarse tremor drowsiness convulsions coma
what teratogenic defects does valproate cause?
neural tube defects
examples of anti-psychotics?
quetiapine
aripiprazole
olanzapine
lurasidone
what SSRI is really bad for withdrawal if removed immediately?
paroxetine
antidepressants with a ___ effect tend to cause weight gain
sedative (eg tricyclics)
