Pharmacology of Antidepressants and Mood Stabilisers

Question 1

antidepressants are used for depression of what severity?

Answer 1

moderate to severe

Question 2

antidepressants are used for what other clinical conditions aside from depression?

Answer 2

anxiety
dysthymia
panic disorders - OCD/PTSD
bulimia nervosa
neuropathic pain

Question 3

main MoA of antidepressants? how do they do this?

Answer 3

increase levels of monoamines in the body by:
inhibiting monoamine oxidase OR
inhibiting monoamine/serotonin reuptake into the cell (more for the body)

Question 4

what are the neurotransmitters for monamine?

Answer 4

noradrenaline
5-HT
dopamine

Question 5

if your monoamine levels drop, your mood goes __

Answer 5

down

Question 6

what particular chemicals do people lack in depression?

Answer 6

serotonin (5-HT)

NA

Question 7

name the 2 main serotonin systems

Answer 7

rostral

caudal raphe

Question 8

what areas of the brain does the rostral pathway cover?

Answer 8

limbic
subcortical
cerebral cortex

Question 9

name the 2 noradrenaline projection pathways?

Answer 9

lateral tegmental area

locus coeruleus

Question 10

which noradrenaline pathway covers msot of the brain?

Answer 10

locus choeruleus

Question 11

the rostral serotonin pathway is responsible for what functions?

Answer 11

mood
sleep
feeding behaviour
sensory perception

Question 12

the locus coeruleus is responsible for what function

Answer 12

arousal

emotion

Question 13

how do MAO inhibitors work

Answer 13

conc of moonoamines goes up presynaptically as less is taken up

Question 14

give an example of MAO inhibitors?

Answer 14

phenelzine

moclobemide

Question 15

which MAO inhibitors are irreversible in action?

Answer 15

phenelzine

Question 16

what food should be avoided in MAO inhibitors and why?

Answer 16

“cheese reaction” - MAO prevents breakdown of dietary tyramine = increased BP + headaches

other yeast products eg gravy/wines

Question 17

side effects of MAO inhibitors?

Answer 17

hypertensive crisis - cheese and tyramine
postural hypotension
insomnia
peripheral oedema

Question 18

MoA of tricyclics?

Answer 18

block reuptake of MAO (less serotonin and NA removed)

Question 19

give examples of tricyclics?

Answer 19

amitryptiline
imipramine
dosulepin
lofepramine

Question 20

side effects of tricyclics?

Answer 20

anti-cholinergic effects
sedation
weight gain
postural HT, tachy, arrhythmia
constipation

Question 21

what are anti-cholinergic effects

Answer 21

blurred vision
dry mouth
urinary retention

Question 22

name anti-histaminergic side effects

Answer 22

sedation

weight gain

Question 23

what kind of drug is fluoxetine?

Answer 23

SSRI

Question 24

give examples of SSRIs

Answer 24

fluoxetine

citalopram

Question 25

SSRIs inhibit serotin reuptake at...

Answer 25

the synaptic cleft

Question 26

side effects of SSRIs?

Answer 26

``` nausea headache sweating/vivid dreams anxiety worse sexual dysfunction increased self harm if young ```

Question 27

main electrolyte disturbance from SSRIs?

Answer 27

hyponatraemia

Question 28

how can SSRIs make you sick?

Answer 28

too much serotonin (5-HT3) in the body can cause nausea

Question 29

duloxetine is an example of...

Answer 29

SNRI (serotonin noradrenaline reuptake inhibitor)

Question 30

too much 5-HT2 can cause....

Answer 30

headaches

Question 31

what does mirtazapine block?

Answer 31

alpha 2 receptors 5HT2 5HT3

Question 32

side effects of mirtazapine?

Answer 32

histaminergic side effects eg weight gain and sedation

Question 33

antidepressants can be combined safely T or F

Answer 33

F, tend to make side effects worse

Question 34

1st and 2nd line antidepressants

Answer 34

1.SSRI | 2, another SSRI

Question 35

lithium is given for what disorder and as what compound?

Answer 35

BPAD | lithium carbonate

Question 36

gold standard Tx for bipolar disorder?

Answer 36

lithium carbonate 400mg

Question 37

main problem with lithium as a drug?

Answer 37

narrow therapeutic index

Question 38

common side effects of lithium?

Answer 38

``` ITS A SALT: dry mouth/strange taste? polydipsia/polyuria tremor reduced renal function nephrogenic DI weight gain ```

Question 39

lithium can cause what thyroid problem?

Answer 39

hypothyroidism

Question 40

someone who has lithium poisoning will present with...

Answer 40

``` vomiting diarrhoea ataxia/coarse tremor drowsiness convulsions coma ```

Question 41

what teratogenic defects does valproate cause?

Answer 41

neural tube defects

Question 42

examples of anti-psychotics?

Answer 42

quetiapine aripiprazole olanzapine lurasidone

Question 43

what SSRI is really bad for withdrawal if removed immediately?

Answer 43

paroxetine

Question 44

antidepressants with a ___ effect tend to cause weight gain

Answer 44

sedative (eg tricyclics)