Pharmacology of antidepressants and mood stabilisers

Question 1

What are the clinical uses of antidepressant drugs?

Answer 1

Moderate/severe depression
Dysthymia
GAD
Panic disorder
OCD
PTSD
Premenstural dysphoric disorder
Bulimia nervosa
Neuropathic pain

Question 2

What is included in the monoamine reuptake inhibitor group of drugs?

Answer 2

Tricyclics
SNRIs
SSRIs

Question 3

What are the three classes of antidepressant drugs?

Answer 3

MOI (monoamine oxidase inhibitors)
MRI (monoamine reuptake inhibitors)
Atypical drugs (post-synaptic receptor effects)

Question 4

What are the two hypotheses why antidepressant medication lead to similar response?

Answer 4

1-Monoamine hypothesis

2-Neurotransmitter receptor hypothesis

Question 5

What is noradrenaline responsible for?

Answer 5

Arosal, emotion

Question 6

What is serotonin responsible for?

Answer 6

Mood, sleep ,feeding, behaviour and sensory perception

Question 7

What is the typical half-life of antipsychotics?

Answer 7

Months

Question 8

Why do you tend not to combine antidepressants?

Answer 8

Clinically actions very similar therefore you just get more SE

Question 9

If SSRI alone for treatment of depression is not working what is added in?

Answer 9

Mirtazapine

Question 10

TRUE/FALSE

In general the more severe the depression the more effective the antidepressant

Answer 10

TRUE

Question 11

What drug is St Johns wort similar to?

Answer 11

MOI inhibitor

Question 12

St Johns wort can interact with the OCP and reduce its efficacy TRUE/FALSE

Answer 12

TRUE

Question 13

In what type of depression is MOI inhibitors considered?

Answer 13

Anergic bipolar depression

Question 14

Name two MOI inhibitors and their mode of action

Answer 14

Phenelzine- Irreversible
Moclobemide-Reversible

…inhibitors of MAO

Question 15

What can you not eat/drink when on MOI inhibitors?

Answer 15

Cheese
red wine/alcohol free beer
gravy, venison, game
Large amounts of caffeine

Question 16

What biologically is the hypertensive crisis caused by?

Answer 16

Inhibition of MAO-O in gut (&liver) by irreversible inhibitors preventing breakdown of dietary tyramine

As tyramine is a potent releaser of norepinephrine –> Elevated BP

Question 17

What is hypertensive crisis due to tyramine treated with?

Answer 17

Phentolamine infusion

Question 18

TRUE/FALSE

MOI inhibitors can potentiate other drugs by decreasing their metabolism

Answer 18

TRUE

Question 19

S/E of MOI inhibitors

Answer 19

Insomnia
Peripheral oedema
Postural hypotension

Question 20

What type of pain are tricyclics used in?

Answer 20

Neuropathic

Question 21

What is our fav tricyclic?

Answer 21

Amitriptyline

Question 22

How do tricyclics work?

Answer 22

Block the reuptake of monoamines into presynaptic terminals

Question 23

What are the SE of tricyclics?

Answer 23

Anticholinergic
Sedation (if drowsy don’t drive)
Wt gain
Cardiovascular

Question 24

Are tricyclics cardiotoxic in overdose?

Answer 24

Yes

Question 25

What is the only licences SSRI for <18?

Answer 25

Fluoxetine

Question 26

Which is the best SSRI?

Answer 26

Escitalopram

Question 27

Which SSRI is safest in cardiac problems?

Answer 27

Sertraline

Question 28

Which SSRI is safest in epilepsy?

Answer 28

Citalopram

Question 29

Which are the two classes of antidepressants that are taken at night because they are sedating?

Answer 29

TRICYCLICS (amitriptyline) | NASA ( mirtazapine)

Question 30

What are the common SE of SSRIs?

Answer 30

``` Headache Nausea GI upset Sweating/vivid dreams/anxiety Confusion/dizziness Sexual dysfunction ```

Question 31

What is there a risk of when on fluoxetine and drinking high amounts of caffeine?

Answer 31

Serotonin syndrome

Question 32

If prescribe someone with anxiety an SSRI transiently what will there be?

Answer 32

An increase in anxiety

Question 33

What is often a cause of admission of elderly patients as a result of being on an SSRI?

Answer 33

Hyponatraemia

Question 34

Why should SSRIs not be given to young people?

Answer 34

Risk of suicidal thoughts (however much safer in overdose)

Question 35

What are two examples of SNRIs?

Answer 35

Venlafaxine | Duloxetine

Question 36

What are three uses of Duloxetine?

Answer 36

Depression Neuropathic pain Bladder instability

Question 37

How do SNRIs work?

Answer 37

Block the reuptake of monoamines into presynaptic terminals

Question 38

What is the important SE of SNRIs?

Answer 38

Hypertension/cardiac arrhythmias

Question 39

In theory when would mirtazapine be used 1st line in depression?

Answer 39

If patient has insomnia and poor appetite

Question 40

Why is mirtazapine often added into other treatments?

Answer 40

Reduce the sick/headaches S/E