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Psychopharmacology of affective disorders Flashcards

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1
Q

classes of antidepressant

A 
TCAs
SSRI
SNRI
MOAI
NARI (NA reuptake inhibitors)
SARI (serotonin antagonist)
NaSSA - Noradrenergic and specific serotonergic antidepressant
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2
Q

TCA MOA

A

serotonin and NA reuptake inhibitors

different types affect NA and serotonin to different degrees

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3
Q

side effects TCAs

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

anticholinergic s/e?

A

dry mouth
blurred vision
constipation
urinary retention

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5
Q

antihistaminic s/e

A

wt gain

sedation

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6
Q

a1 adrenergic blockade

A

dizziness

hypotension

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7
Q

ion channel blockade s/e?

A

cardiac arrhythmia - LQT

seizures

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8
Q

examples of TCAs

A

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

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9
Q

TCA hx

A

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

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10
Q

advantages of TCAs

A
  1. well established in literature
  2. better in severe depression
  3. low cost
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11
Q

disadvantages of TCAs

A
  1. side effects
  2. toxicity of OD
  3. Narrow TI
  4. CVS and CNS toxins in moderate dose
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12
Q

SSRIs MOA

A

prevent reuptake of serotonin by neurons

more serotonin in synaptic cleft

agonist action at receptors

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13
Q

SSRI types

A 
fluoxetine - prozac
paroxetine - seroxat
sertraline - lustral
citalopram  - cipramil
excitalopram - lexapro
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14
Q

features of fluoxetine

A

can use

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15
Q

features of paroxetine

A

v short half life - no discontinuation symptoms

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

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16
Q

features of sertraline

A

can use in OCD

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

best CVS profile - used in those with CVS risk

17
Q

citalopram and escitalopram features

A
  1. dose related QTC prolongation
  2. max doses in >65s
  3. escitalopram - least interaction cyt p450 - good augmenter
18
Q

s/e of SSRIs?

A
  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
19
Q

bleeding w/ SSRIs?

A

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

20
Q

GI probs SSRI

A

ND
constipation
anorexia

21
Q

advantages SSRI

A

better tolerated than TCAs
easy dosing
safer in OD

22
Q

disadvantages to SSRI

A

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

23
Q

what are the sx of serotonin syndrome?

A 
agitation
confusion
tachycardia
HTN
dilated pupils
muscle spasms
diaphoresis
diarrhoea
headache
severe: pyrexia, seizure, palpitations, LOC
24
Q

tx serotonin syndrome?

A

stop drug
benzos - diazepam or lorazepam for muscle stiffness

cyproheptadine - blocks serotonin production

O2, fluids

haemodynamically stabilise

ventilation, ICU if breathing probs

25
Q

MAOI MOA

A

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

26
Q

types of MAOI

A

tranylcyrpromine - parnate

phenelzine - nardil

27
Q

disadvantages to MAOI

A

tyramine reaction- no cheese, red wine, chocolate, game, yeast extract

can cause HTV crisis

28
Q

use of MAOI

A

rare except in tx resistant depression

poss atypical

29
Q

SNRIs MOA + examples

A

stops reuptake of serotonin and NA from SC

types:
venlafaxine - effexor
duloxetine (also for neuropathic pain and urinary incontinence)

30
Q

advantages to SNRI

A
  1. faster onset than ssri
  2. similar OD profile to SSRI
  3. can use with mirtazapine for refractory
31
Q

disadvantages of SNRI/ s/e

A
  1. dose related HTN
  2. GI
  3. headache
  4. tolerance issues
  5. discontinuation syndrome can be nasty
32
Q

discontinuation syndrome?

A 
dizzy
nausea
sweating
stomach cramp
dysaesthesias
33
Q

NaSSA MOA

A

a2 antagonist: more serotonin and NA release

5HT2 antagonist: more sedation/anxiolytic

less sexual dysfunction

antihistaminic moa - sedation, wt gain

34
Q

example of NaSSA

A

mirtazapine - zispin

35
Q

advantages to NaSSA?

A

can use with other antidepressants since different MOA

can use where need wt gain and sedation

36
Q

side effects NaSSA?

A

drowsy
wt gain
jaundice/LFTprobs

Psych (23 decks)

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