Psychopharmacology of affective disorders

Question 1

classes of antidepressant

Answer 1

TCAs
SSRI
SNRI
MOAI
NARI (NA reuptake inhibitors)
SARI (serotonin antagonist)
NaSSA - Noradrenergic and specific serotonergic antidepressant

Question 2

TCA MOA

Answer 2

serotonin and NA reuptake inhibitors

different types affect NA and serotonin to different degrees

Question 3

side effects TCAs

Answer 3

1. anticholinergic
2. antihistaminic
3. a1 adrenergic blockade effects
4. ion channel blockade
5. anxiety
6. sexual dysfunction

Question 4

anticholinergic s/e?

Answer 4

dry mouth
blurred vision
constipation
urinary retention

Question 5

antihistaminic s/e

Answer 5

wt gain

sedation

Question 6

a1 adrenergic blockade

Answer 6

dizziness

hypotension

Question 7

ion channel blockade s/e?

Answer 7

cardiac arrhythmia - LQT

seizures

Question 8

examples of TCAs

Answer 8

2y amines - nortriptaline
3y amines - amitryptaline
2nd gen - lofepramine

Question 9

TCA hx

Answer 9

1st = imipramine 1950s and not originally antidepressants - anti-emetics derived from

Question 10

advantages of TCAs

Answer 10

1. well established in literature
2. better in severe depression
3. low cost

Question 11

disadvantages of TCAs

Answer 11

1. side effects
2. toxicity of OD
3. Narrow TI
4. CVS and CNS toxins in moderate dose

Question 12

SSRIs MOA

Answer 12

prevent reuptake of serotonin by neurons

more serotonin in synaptic cleft

agonist action at receptors

Question 13

SSRI types

Answer 13

fluoxetine - prozac
paroxetine - seroxat
sertraline - lustral
citalopram  - cipramil
excitalopram - lexapro

Question 14

features of fluoxetine

Answer 14

can use

Question 15

features of paroxetine

Answer 15

v short half life - no discontinuation symptoms

decreases in dose = rapid drop in levels as inhibits its own metabolism

Question 16

features of sertraline

Answer 16

can use in OCD

can use in breast feeding (still goes into milk though)

best CVS profile - used in those with CVS risk

Question 17

citalopram and escitalopram features

Answer 17

1. dose related QTC prolongation
2. max doses in >65s
3. escitalopram - least interaction cyt p450 - good augmenter

Question 18

s/e of SSRIs?

Answer 18

1. GI
2. headache
3. agitation
4. tremor
5. worsening anxiety - NB make sure not mania
6. insomnia
7. sexual dysfunction
8. increased risk of bleeding - rare
9. hyponatraemia - old ladies
10. suicidal ideation - rare, kids/young adults

Question 19

bleeding w/ SSRIs?

Answer 19

UGIB
NB risk factors for bleeding
due to effect on plt function

Question 20

GI probs SSRI

Answer 20

ND
constipation
anorexia

Question 21

advantages SSRI

Answer 21

better tolerated than TCAs
easy dosing
safer in OD

Question 22

disadvantages to SSRI

Answer 22

side effects - GI/sleep probs

can induce mania in patient with depression and underlying vulnerability eg fhx BPAD

serotonin syndrome

must be gradually reduced - discontinuation syndrome

Question 23

what are the sx of serotonin syndrome?

Answer 23

agitation
confusion
tachycardia
HTN
dilated pupils
muscle spasms
diaphoresis
diarrhoea
headache
severe: pyrexia, seizure, palpitations, LOC

Question 24

tx serotonin syndrome?

Answer 24

stop drug
benzos - diazepam or lorazepam for muscle stiffness

cyproheptadine - blocks serotonin production

O2, fluids

haemodynamically stabilise

ventilation, ICU if breathing probs

Question 25

MAOI MOA

Answer 25

irreversible inhibition of MAO-A (enzyme that metabolises serotonin/dopamine/NA/tyramine) - increased NTs at SC

Question 26

types of MAOI

Answer 26

tranylcyrpromine - parnate | phenelzine - nardil

Question 27

disadvantages to MAOI

Answer 27

tyramine reaction- no cheese, red wine, chocolate, game, yeast extract can cause HTV crisis

Question 28

use of MAOI

Answer 28

rare except in tx resistant depression poss atypical

Question 29

SNRIs MOA + examples

Answer 29

stops reuptake of serotonin and NA from SC types: venlafaxine - effexor duloxetine (also for neuropathic pain and urinary incontinence)

Question 30

advantages to SNRI

Answer 30

1. faster onset than ssri 2. similar OD profile to SSRI 3. can use with mirtazapine for refractory

Question 31

disadvantages of SNRI/ s/e

Answer 31

1. dose related HTN 2. GI 3. headache 4. tolerance issues 5. discontinuation syndrome can be nasty

Question 32

discontinuation syndrome?

Answer 32

``` dizzy nausea sweating stomach cramp dysaesthesias ```

Question 33

NaSSA MOA

Answer 33

a2 antagonist: more serotonin and NA release 5HT2 antagonist: more sedation/anxiolytic less sexual dysfunction antihistaminic moa - sedation, wt gain

Question 34

example of NaSSA

Answer 34

mirtazapine - zispin

Question 35

advantages to NaSSA?

Answer 35

can use with other antidepressants since different MOA can use where need wt gain and sedation

Question 36

side effects NaSSA?

Answer 36

drowsy wt gain jaundice/LFTprobs