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Pharmacology Exam 2 > The antidepressants and Lithium > Flashcards

The antidepressants and Lithium Flashcards

1
Q

Define depression and its incidence

A

disorder of mood

most frequent of mental illnesses

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2
Q

Name the two types of depression

A

reactive depression: 60%

endogenous depressions: 40%

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3
Q

What is reactive depression?

A

normal response to loss

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4
Q

what is endogenous depression?

A

no clear correlation with life events

  • unipolar: 25%
  • bipolar: 15%
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5
Q

Symptoms of depression (mostly endogenous)

A
  • depressed mood - most of day - everyday
  • decreased interest in life in general
  • sleep disturbances
  • appetite changes
  • loss of energy - slowed movements
  • feelings of worthlessness: denial of past accomplishments
  • guilt

extreme cases:

  • intense psychological pain
  • recurrent thoughts of death
  • loss of cognitive function
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6
Q

Name two factors that cause endogenous depression.

A

hereditary and environmental factors

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7
Q

What is the biochemical basis of depression?

A
  • depletion of NT in CNS (NE, 5HT)

- any agent that increases NT, may elevate mood

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8
Q

Name the two treatments for depression.

A

ECT and pharmaco

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9
Q

What does ECT do?

A

induce seizure

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10
Q

Name 5 clinical uses of antidepressants

A
  • ADD
  • bulimia
  • depression
  • panic attacks
  • OCD
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11
Q

What are the two general MOAs for the antidepressants?

A
  • prevent NT reuptake (NE, 5HT)

- prevent NT breakdown

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12
Q

Which class of drug serves as the DOC for antidepressants?

A

The reuptake inhibitors

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13
Q

Name the first generation reuptake inhibitors

MOA?

A

amitriptyline
imipramine

these are tricyclic antidepressants

They inhibit NE reuptake - very effective

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14
Q

Name the 7 (bolded) second gen reuptake inhibitors

MOA?

A
  • citalopram
  • escitalopram
  • fluoxetine
  • fluvoxamine
  • paroxetine
  • sertraline
  • vilazodone

MOA: SSRIs - these do inhibit NE, but have a stronger affect of serotonin

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15
Q

Name the 4 third gen reuptake inhibitors

MOA?

A
  • desvenlafaxine
  • duloxetine
  • milnacipram
  • venlafaxine

MOA: SNRI - inhibit reuptake of both serotonin and norepinephrine

Difference among the generations is based on pharmacokinetics

They have the same efficacies

These are not euphoriants - not abused.

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16
Q

Name three additional antidepressants

A
  • buproprion
  • mirtazapine
  • nefazodone

***there were no notes on these, but were bolded

17
Q

SE of first gen reuptake inhibitors.

A

First gen are more likely to cause side effects
-act on multiple receptors

  • sedation
  • weight gain
  • anticholinergic: dry eyes, dry mouth, blurred vision, constipation
  • cardiovascular: arrhythmias, decreased BP, alpha1 blockade (hypotension)
18
Q

Name the SE of second gen reuptake inhibitors.

A
  • GI upset
  • nausea
  • insomnia
  • headache
  • decreased libido
19
Q

Name SE of third gen reuptake inhibitors

A

similar to second.

-cardio stimulation: increased HR and force of contraction

20
Q

Describe toxicities of reuptake inhibitors used as antidepressants

TI of 1st gen?

TI of 2nd gen?

A

With massive overdose:

  • seizures
  • resp depression
  • cardio arrhythmia
  • renal failure

1st gen TI: 5-6

2nd gen TI > 1st gen

21
Q

describe pharmacokinetics and pharmodynamics of antidepressant reuptake inhibitors

A
  • effect may take weeks to develop
  • long T1/2 and long Vd
  • generally metabolized by P450
  • effects are synergistic with alcohol
22
Q

Name the 3 Monoamine Oxidase (MAO) inhibitors

MOA?

A
  • phenezeline
  • isocarboxacid
  • tranylcypromine

MOA: irreversibly inhibit metabolism of NE and 5HT - slow onset

23
Q

What are the toxicities of the MAO inhibitors?

A

CNS: insomnia, agitation, hallucinations, seizures

  • liver toxicity
  • weight gain
  • hypotension
24
Q

How do the MAO inhibitors interact with indirect-acting amines?

A

interaction with indirect acting amines (amphetamine):
-release of NE —> hypertensive crisis

some foods (aged cheese, wines) contain indirect acting amines (tyramine) ——> hypertensive crisis

25
Q

what should be taken into consideration when prescribing antidepressants to children?

A

a severe increase in likelihood of suicide

26
Q

Describe the manic phase of bipolar depression

A
  • euphoric
  • irritable
  • Increased motor activity / sexual activity
  • flight of ideas
  • delusions of grandeur
  • decreased sleep
  • poor judgement
  • social intrusiveness
  • spending sprees

25-50% attempt suicide - often associated with drug abuse

27
Q

What are the three Txs for bipolar depression?

A
  1. ECT
  2. antipsychotic drugs: phenothiazines, haloperidol
  3. Lithium (Li+)
28
Q

Describe Lithium’s use, MOA

A

success in nearly 70% px
used prophylactically
little effect on normal individuals

MOA: alter glutamate metabolism, decrease NE release

  • given orally (5 - 7 days to work)
  • low TI <2
29
Q

What are the short term, long term and toxicities of Lithium?

A

Short Term:

  • termors
  • thirst
  • increased urine production (block ADH)
  • edema
  • weight gain
  • nystagmus

Long Term:

  • renal damage
  • hypothyroidism

Toxicities:

  • nausea
  • delirium
  • coma
30
Q

OTHER tx of bipolar disorder

A

Anti-seizure:

  • carbamazepine
  • lamotripene
  • valproic acid

Diuretic:
-acetazolamide

Partial dopamine agonist of 2nd gen antipsychotics:
-aripriprazole aka abilify

Pharmacology Exam 2 (10 decks)

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