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Psychiatry > Pharmacology of Antidepressants and mood stabilisers > Flashcards

Pharmacology of Antidepressants and mood stabilisers Flashcards

1
Q

what do drugs need to be in order to diffuse effectively though the BBB

A

hydophobic/ lipophilic

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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 is dysthymia

A

a prolonged period of depressed mood

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4
Q

what are the types of antidepressant drugs

A 
monoamine oxidase inhibitors 
monoamine reuptake inhibitors:
- tricyclics 
-selective serotonin reuptake inhibitors
-noradrenaline reputake inhibitors

atypical drugs )post synaptic receptor effects)

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5
Q

name 3 monoamine neurotransmitters

A

noradrenaline (NA)
5-HT (serotonin)
dopamine

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6
Q

what do monoamines contain

A

a single amine group

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7
Q

what does glutamate act on

A

NMDA receptors

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8
Q

what the seronin (5-HT) involved in

A 
rostral area: 
mood 
sleep 
feeding 
behaviour
sensory perception

anaglesia - caudal raphe

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9
Q

what is the base monoamine for serotonin

A

tryptophan

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10
Q

what are the steps in sertonergic synapses

A 
tryptophan 
(tryptophan hydroxylase) 
5-OH- tryptophan 
(L-AA decarboxylase 
5-HT 
post synaptic
specific transporter
(back into cell) 
(MAO)
5-HIAA
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11
Q

where do the noradrenaline projection pathways originate

A

locus coeruleus

lateral tegmental area

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12
Q

what is the monoamine for noradrenaline

A

tyrosine

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13
Q

what are the steps in noradrenergic synpases

A 
tyrosine 
(tyrosine hydroxylase) 
DOPA
(L-AA decarboxylase)
DA 
(DA beta- hydroxylase) 
NA
(alpha/ beta receptor)
specific transporter 
MAO 
MHPG
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14
Q

name two MAO inhibitors

A

phenelzine
moclobemide

(monoamine oxidase inhibitors)

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15
Q

what do MAO inhibitors do

A

block the metabolism of monoamine transmitters so they build up in synaptic cleft, increasing their activity

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16
Q

how do MAO inhibitors work

A

irreversible (phenelzine) or reversible (moclobemide) inhibitors of MAO-A or B

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17
Q

what are the side effects of MAO inhibitors

A

‘cheese reaction’/ hypertensive crisis (are vasopressors so can get malignant hypertension, have to avoid food high to tyrosine (cheese, wine) as unable to break it down when taking these drugs, get release of NA, HTPsive crisis)
potentiates effects of other drugs (barbiturates) by decreasing their metabolism
insomnia
postural hypotension
peripheral oedema

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18
Q

what do tricyclic antidepressants do

A

block specific transporters that take the neurotransmitters back up into the cell

block the reuptake of monoamines mainly (noradrenaline and 5-HT) into presnaptic terminals

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19
Q

give 4 examples of tricyclic antidepressatns

A

imipramine
dosulepin
amitriptyline
lofepramine

20
Q

what are the common side effects of tricyclic antidepressants

A

anticholinergics- blurred vision, dry mouth, constipation, urinary retention
sedation
weight gain
cardiovascular- postural hypotension, tachycardia, arrhythmias
cardiotoxic in overdose

21
Q

what type of antidepressant do you not give in ischaemic heart diease

A

tricyclic

22
Q

what does SSRI stand for

A

selective serotonin reuptake inhibitors

23
Q

give 4 examples of SSRIs

A

fluoxetine
citalopram/ escitalopram
sertraline
paroxetine

24
Q

how do SSRIs work

A

selectively inhibit reuptake of serotonin (5-HT) from the synaptic cleft

25
Q

what are the common side effects of SSRIs

A 
nausea 
headache
sweating/ vivid dreams 
worsened anxiety 
sexual dysfunction 
hyponatraemia (in elderly) 
transient increase in self harm/ suicidal ideation in <25s

discontinuation effects

26
Q

how do dual reuptake inhibitors/ SNRIs (venlafaxine, duloxetine) work

A

block the re uptake of monoamines (noradrenaline and 5-HT) into presynaptic terminals

27
Q

what are the side effects of dual uptake inhibitors/ SNRIs

A

similar to SSRIs

more limited range of SEs that tricyclics as lack major receptor blocking actions

28
Q

name two atypical antidepressant drugs

A

mirtazapine (mixed receptor effects)

buproprion (dopamine uptake inhibitor)

29
Q

how does mirtazapine work

A

mixed receptor effects (blocks alpha2, 5-HT2 and 5-HT3)

30
Q

what are the side effects of mirtazapine

A

weight gain + sedation

BUT can block SSRI serotenergic SEs if given with SSRIs (headaches, nausea etc)

31
Q

how long do most antidepressants take to work

A

several weeks

32
Q

what is the worry in giving young adults/ teenagers anti depressants

A

transient increase in suicidal/ aggressive ideas

33
Q

what are the treatment goals in bipolar disorder

A

acute:
To reduce mood in episodes of mania
To raise mood in episodes of depression

long term:
To stabilise mood and prevent recurrence of both mania and depression (prophylaxis)

achieve these with mood stabilisers such as lithium

34
Q

what form is lithium usually given as

A

lithium carbonate

35
Q

what is the mode of action of lithium

A

may block phosphatidylinositol pathway or inhibit glycogen synthase kinase 3beta
(glucose metabolism post synapse)

36
Q

does lithium dosage need to be monitored

A

yes 12 hours post dose blood levels must be measured- narrow theraputic window

37
Q

how is lithium metabolised

A

it is not- is an element

38
Q

what is the worry with lithium in dehydration

A

renal tubules cant distinguish it from sodium so retain in when dehydrated- can reach toxic dose

39
Q

what are the side effects of lithium

A 
dry mouth/ strange taste 
polydipsia and polyuria 
tremor 
hypothyroidism 
reduced renal function (long term)
nephrogenic diabetes insipidus 
weight gain
40
Q

what are the toxic effects of lithium

A 
vomiting 
diarrhoea 
ataxia/ course tremor 
drowsiness 
convulsions 
coma
41
Q

what is lithium used for

A

the treatment of bipolar disorder- mood stabiliser, prophylaxis of mania and bipolar disorder

42
Q

what anticonvulsants are used as mood stabilisers (long term treatment for

A

valporic acid, lamotrigine, carbamazepine

43
Q

what are the SEs of anticonvulsants used as mood stabilisers

A

valproate and carbamazepines: drowsiness, ataxia, cardiovascular effects, induces liver enzymes

valproate= TERATOGENIC (neural tube defects)

lamotrigine- small risk of steven johnsons syndrome

44
Q

what antipsychotics can be used as mood stabilisers

A

quetiapine, aripiprazole, olanzapine, lurasidone

45
Q

what is the mode of action of antpsychotics used as mood stabilisers

A

dopamine antagonism and 5-HT antagonism

46
Q

what are the side effects of antipsychotics used as mood stabilisers

A

sedation
weight gain
metabolic syndrome
extra-pyramidal side effects (aripiprazole)

Psychiatry (27 decks)

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