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Psychiatry > Pharmacology of antidepressants and mood stabilisers > Flashcards

Pharmacology of antidepressants and mood stabilisers Flashcards

1
Q

What properties do drugs need to have to pass through the BBB?

A

Lipophilic/ hydrophobic

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2
Q

What are the clinical uses of antidepressants?

A 
Moderate to severe depression 
Dysthymia
Generalised anxiety disorder
Panic disorder
OCD
PTSD
Premenstrual dysphoric disorder
Bulimia nervosa
Neuropathic pain
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3
Q

What are the different types of antidepressant drugs?

A

Monoamine oxidase inhibitors
Monoamine reuptake inhibitors; tricyclics, non-selective reuptake inhibitors, SSRIs, NA reuptake inhibitors
Atypical; post-synaptic receptor effects

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4
Q

What are the monoamine neurotransmitters involved in depression?

A

NA
5-HT
Dopamine

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5
Q

Is there an excess or deficit of monoamine nTs in depression?

A

Deficit

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6
Q

What is 5-HT involved in within the brain?

A 
Mood
Sleep
Feeding behaviour
Sensory perception 
Analgesia
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7
Q

What is the base amino acid of serotonin?

A

Tryptophan

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8
Q

What enzyme will break up 5-HT into 5-HIAA?

A

MAO

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9
Q

What are example of monoamine oxidase inhibitors?

A

Phenelzine

Moclobemide

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10
Q

What are the side effects of monoamine oxidase inhibitors?

A

Hypertensive crisis due to lack of breakdown of tyramine
Potentiates other drugs such as barbiturates
Insomnia
Postural hypotension
Peripheral oedema

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11
Q

Examples of tricyclic antidepressants

A

Imipramine
Dosulepin
Amitriptyline
Lofepramine

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12
Q

What is the mode of action of tricyclic antidepressants?

A

Block reuptake of monoamines (mainly NA and 5-HT) into presynaptic terminals

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13
Q

What are common side effects of tricyclic antidepressants?

A 
Anticholinergic; blurred vision, dry mouth, constipation, urinary retention
Sedation 
Wt gain
CV; postural hypotension, tachycardia
Cardiotoxic in overdose
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14
Q

Should you give a tricyclic to someone who has ischaemia heart disease or a recent MI?

A

No

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15
Q

Examples of SSRIs?

A

Fluoxetine
Citalopram
Escitalopram
Sertraline

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16
Q

Common side effects of SSRIs?

A 
Nausea
Headache
Sweating
Vivid dreams
Worsened anxiety
Sexual dysfunction 
Hyponatraemia
Transient increase in self-harm/ suicidal ideation in <25 years
Discontinuation effects
17
Q

What is the mode of action of SSRIs?

A

Selectively inhibit reuptake of serotonin from the synaptic cleft

18
Q

What is the mode of action of mirtazapine?

A

Blocks alpha, 5-HT2 and 5-HT3 receptors

19
Q

SE of mirtzapine

A

Wt gain

Sedation

20
Q

What is an example of a dopamine uptake inhibitor?

A

Bupropion

21
Q

Should antidepressants be used in mild depression?

A

No - large placebo response

22
Q

What is the caution of prescribing antidepressants in young adults/ teenagers?

A

Transient increase in suicidal ideation

Aggressive ideas

23
Q

What is the goals of acute treatment in bipolar?

A

Reduce mood in mania

Increase mood in depression

24
Q

What is the goal of long term treatment in bipolar disorder?

A

Stabilise mood and prevent recurrence of both mania and depression (prophylaxis)

25
Q

What is the mode of action of lithium as a mood stabiliser?

A

Blocks phosphatidylinositol pathway (second messenger system) or inhibit glycogen synthase kinase 3-beta

26
Q

Does lithium require therapeutic monitoring?

A

Yes; 12 hour post dose levels must be monitored due to narrow therapeutic index

27
Q

Common side effects of lithium that occur at therapeutic levels?

A 
Dry mouth/ strange taste
Polydipsia and polyuria 
Tremor
Hypothyroidism
Long term reduced renal function 
Nephrogenic diabetes insipidus
Wt gain
28
Q

What are the toxic effects of lithium overdose?

A 
Vomiting
Diarrhoea
Ataxia
Drowsiness
Convulsions
Coma
29
Q

Which anticonvulsants are used as mood stabilisers in bipolar?

A

Valproic acid
Lamotrigine
Carbamazepine

30
Q

What are the SE of valproate and carbamazepine?

A

Drowsiness
Ataxia
CV effects
Induces liver enzymes

31
Q

Can valproate be given in pregnancy?

A

No; neural tube defects

32
Q

What is the risk with lamotrigine?

A

SJS

33
Q

Which antipsychotics can be given as mood stabilisers?

A

Quetiapine
Aripiprazole
Olanzapine
Lurasidone

34
Q

What is the mode of action of antipsychotics?

A

Dopamine antagonism + 5-HT antagonism

35
Q

SE of antipsychotics?

A

Sedation
Wt gain
Metabolic syndrome
Aripiprazole; extra-pyramidal SE

Psychiatry (35 decks)

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