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Psychiatry > Pharmacology of Antidepressants and Mood Stabilisers > Flashcards

Pharmacology of Antidepressants and Mood Stabilisers Flashcards

1
Q

What are some uses of antidepressants?

A

Moderate/severe depression, dysthymia, generalised anxiety disorder, panic disorder, OCD, PTSD, premenstrual dysphoric disorder, bulimia, neuropathic pain

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2
Q

What are some common groups of antidepressants?

A

Monoamine oxidase inhibitors, monoamine reuptake inhibitors and atypical drugs

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3
Q

What are some examples of monoamine reuptake inhibitors?

A

Tricyclics, SSRIs and noradrenaline reuptake inhibitors

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4
Q

What is the monoamine hypothesis?

A

Depression results from a functional deficit of monoamine transmitters, especially 5-HT and noradrenaline

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5
Q

What effect can drugs that deplete stores of monoamines have?

A

Cause low mood

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6
Q

What does the CSF of depressed patients show?

A

Reduced levels of monoamines or metabolites

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7
Q

What are the serotonin (5-HT) projection pathways?

A

Rostral = mood, sleep, feeding behaviour, sensory perception

Caudal raphe = analgesia

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8
Q

What is the noradrenaline projection pathway?

A

Locus coeruleus = arousal and emotion

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9
Q

What are some examples of monoamine oxidase inhibitors?

A 
Phenelzine = irreversible
Moclobemide = reversible
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10
Q

What is the action of monoamine oxidase inhibitors?

A

Inhibit MAO-A and B

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11
Q

What are the side effects of monoamine oxidase inhibitors?

A

Hypertensive crisis, insomnia, postural hypotension, peripheral oedema, potentiate effects of other drugs by decreasing their metabolism

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12
Q

How do monoamine oxidase inhibitors cause hypertensive crisis?

A

Irreversible inhibition of MAO-A in the gut prevents breakdown of dietary tyramine

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13
Q

What are some examples of tricyclics?

A

Imipramine, dosulepin, amitriptyline, lofepramine

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14
Q

What is the mode of action of tricyclics?

A

Block reuptake of mainly noradrenaline and 5-HT into presynaptic terminals

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15
Q

What are the anticholinergic side effects of tricyclics?

A

Blurred vision, dry mouth, constipation, urinary retention

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16
Q

What are some general side effects of tricyclics?

A

Sedation, weight gain, postural hypotension, tachycardia, arrhythmia, cardiotoxic in overdose

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17
Q

What are some examples of SSRIs?

A

Fluoxetine, citalopram/escitalopram, sertraline

18
Q

What is the action of SSRIs?

A

Selectively inhibit reuptake of 5-HT from the synaptic cleft

19
Q

What are the side effects of SSRIs?

A

Nausea, headache, worsened anxiety, sexual dysfunction, sweating, vivid dreams
Transient increase in self harm/suicide in <25 y/o
Hyponatraemia in elderly

20
Q

What are some features of dual reuptake inhibitors (SNRIs)?

A

Agents = venlafaxine, duloxetine
Block reuptake of noradrenaline and 5-HT into the presynaptic cleft
Similar side effects to SSRIs

21
Q

What are some noradrenaline selective antidepressants?

A

Reboxetine, maprotiline, despiramine, protriptyline, nortriptyline

22
Q

What are some examples of non-selective antidepressants?

A

Amitriptyline, imipramine, clomipramine

23
Q

What are some examples of 5-HT selective antidepressants?

A

Venlafaxine, paroxetine, fluvoxamine, sertraline, fluoxetine, citalopram

24
Q

What are some examples of atypical antidepressants?

A

Mirtazapine and bupropion = mixed receptor effects

25
Q

What are some features of mirtazapine?

A

Blocks alpha2, 5-HT2 and 5-HT3
Side effects = weight gain, sedation
Can block serotonergic side effects if given with SSRIs

26
Q

What is the action of bupropion?

A

Dopamine uptake inhibitor

27
Q

What are some features of current antidepressants?

A

Most have similar clinical efficacy = 40-70%
Most have delayed onset of action = several weeks
Clearer evidence for usefulness in more severe cases
Caution in young adults due to transient increases in suicidal tendencies

28
Q

What drug is used to treat bipolar affective disorder?

A

Lithium = usually given as lithium carbonate

29
Q

What are the proposed actions of lithium?

A

may block phosphatidylinositol pathway, inhibit glycogen synthase kinase 3beta or modulate no signalling

30
Q

Why must the 12 hour post dose blood levels of lithium be monitored?

A

Has narrow therapeutic index = target range is 0.4-1.0 mmol/L with higher end of range being associated with better response

31
Q

What are the side effects of lithium?

A

Dry mouth, strange taste, polydipsia, polyuria, tremor, hypothyroidism, long term reduced renal function, nephrogenic diabetes insipidus, weight gain

32
Q

What are the toxic effects of lithium?

A

Vomiting, diarrhoea, ataxia, course tremor, drowsiness, altered conscious level, convulsions, coma

33
Q

What are some anticonvulsants used as mood stabilisers in bipolar disorder?

A

Valporic acid, lamotrigine and carbamazepine

34
Q

What is the mode of action of anticonvulsants?

A

Unclear = may potentiate GABA transmission and therefore block overactive pathways

35
Q

What are the side effects of valproate and carbamazepine?

A

Drowsiness, ataxia, CV effects, induces liver enzymes

36
Q

What is the most concerning side effect of valproate?

A

Teratogenicity = neural tube defects

37
Q

What is a potential side effect of lamotrigine?

A

Very small risk of Stevens-Johnson syndrome

38
Q

What are some antipsychotics used as mood stabilisers?

A

Quetiapine, aripiprazole, olanzapine, lurasidone

39
Q

What is the action of antipsychotics?

A

Dopamine and 5-HT antagonsim

40
Q

What are the side effects of antipsychotics?

A

Sedation, weight gain, metabolic syndrome, extrapyramidal side effects (aripiprazole)

Psychiatry (36 decks)

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