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Flashcards in 123 - Depression Deck (103):
1

What is cranial nerve V and it's branches and where does it leave to cranium?

Trigeminal branching into:

  • V1 - Opthalmic nerve - Superior orbital fissure
  • V2 - Maxillary nerve - Foramen rotundum
  • V3 - Mandibular nerve - Forman ovale

1

What are the 3 main ionotropic receptors for glutamate and what are they permeable to?

  1. AMPA - Sodium
  2. NMDA - Calcium and Sodium
  3. Kainate - Sodium and Calcium

1

What are the 4 main SSRIs?

  • Citalopram
  • Fluoxetine (Prozac)
  • Paroxetine
  • Sertraline

1

What are the symptoms of serotonin syndrome?

  • Agitation
  • Confusion
  • Tremor
  • Diarrhoea
  • Tachycardia
  • Hypertension
  • Hyperthermia

2

How would a patient feel with a depersonalisation disorder?

  • Feeling unreal
  • Feel like a robot or an actor

3

Name 2 drugs that block dopamine receptors.

  • Haloperidol
  • Quetiapine

3

How does Mirtazapine produce an antidepressant effect?

It blocks the α2-adrenoreceptor on the presynaptic terminal

It also blocks the 5HT2 and 5HT3 receptors

This leads to an increase in synaptic serotonin

4

What are some agonists of the serotonin receptors?

  • LSD
  • Sumatriptan - migraine treatment

4

What are the 3 main types of opioids found in the CNS?

  1. Endorphins
  2. Enkephalins
  3. Dynorphins

4

What are the side effects of Trazodone?

  • Sedation
  • N & V
  • Postural hypotension

5

What drugs do the TCAs interact with?

  • Other sedatives; opioids, alcohol, anxiolytics and sedative antihistamines
  • Drugs that prolong QT interval - Amiodarone
  • Catecholamines and other sympathomimetics
  • SSRIs - Increase plasma concentration of TCAs

6

What is cranial nerve II and where does it leave to cranium?

Optic nerve - Optic canal

7

Name 4 MAOI antidepressants.

  1. Phenelzine - irreversible
  2. Isocarboxazid - irreversible
  3. Tranylcypromine - irreversible
  4. Moclobemide

8

What is another use of the TCA amitripyline apart from depression?

The treatment of neuropathic pain.

9

What are the equivalent doses of Chlordiazepoxide, Lorazepam, Oxazepam, Nitrazepam and Temazepam to 5mg Diazepam?

  • Chlordiazepoxide - 15mg
  • Lorazepam - 500micrograms
  • Oxazepam - 5mg
  • Nitrazepam - 15mg
  • Temazepam - 10mg

10

What is cranial nerve III and where does it leave to cranium?

Oculomotor nerve - Superior orbital fissure

11

Where is the 'vomiting centre' found and what does it detect in the blood?

The area postrema at the base of the 4th ventricle

It detects levels of serotonin

12

What are the somatic presentations of depression?

  • Anhedonia
  • Early morning waking
  • Psychomotor retardation or agitation
  • Weight loss
  • Feel worse in the mornings
  • Loss of emotional reactivity

13

What drugs interact with Venlafaxine?

  • MAIOs
  • Alcohol
  • Warfarin
  • Clozapine

14

What functions does dopamine have in the CNS?

  • Movement
  • Motivation
  • Reward
  • Novelty

16

What is cranial nerve IV and where does it leave to cranium?

Trochlear nerve - Superior orbital fissure

16

What is cranial nerve X and where does it leave to cranium?

Vagus nerve - Jugular foramen

16

Which dopamine pathway feeds into the limbic system?

Mesolimbic pathway

 

17

What is cranial nerve VII and where does it leave to cranium?

Facial nerve - Internal acoustic meatus

18

What is tyrosine the precursor for?

  • Dopamine
  • Noradrenaline

19

What are the 2 subtypes of the monoamine oxidase enzyme and what do they do?

  • MAO-A; preferentially degrades serotonin
  • MAO-B; preferentially degrades phenylethamine and dopamine

20

What is the main inhibitory neurotransmitter of the CNS?

GABA - γ-Amino Butyric Acid

21

What is derealisation?

  • Patient describes as unreal
  • The surroundings lack colour or life
  • Often described as "as if I were watching a film"

21

What is cranial nerve I and where does it leave the cranium?

Olfactory nerve - Cribiform plate

21

Which cells take up GABA and degraded it to glutamine?

Glial cells

21

What are the effects of a MAOI overdose?

  • Hypomania
  • Coma
  • Hypotension - no dot use vasopressor drugs to fix - acute hypertensive crisis
  • Hypertension - use phentolamine to correct

23

What are the symptoms of a severe depressive episode with psychotic symptoms?

  • Delusions of sin, guilt, poverty or imminent disaster
  • Hypochondriacal or nihilistic
  • Auditory hallucinations of defamatory or accusatory nature
  • Olfactory hallucinations of faeces or rotting flesh
  • Severe retardation or stupor

23

What is the antidepressant of choice following a MI or in cardiac disease?

Sertraline

24

Which TCA has the lowest risk of fatality if taken in an overdose?

Lofepramine

26

Which drugs target the serotonergic system?

  • SSRI - Fluoxetine
  • SNRI - Tramadol
  • Ondansetron - anti-emetic drug

27

What are the 2 main SNRIs used for depression?

  • Venlafexine
  • Duloxetine

28

What are the main side effects of the MAOIs?

  • Postural hypotension
  • Atropine-like effects; not as severe as TCAs
  • Weight gain
  • CNS stimulation; insomnia, restlessness and hallucinations

28

Apart from the "cheese reaction", what other drugs interact with MAOIs?

  • Opioids; particularly pethidine
  • Ephedrine containing products
  • Antidepressants

30

What is cranial nerve XII and where does it leave to cranium?

Hypoglossal nerve - Hypoglossal canal

31

What behaviours has serotonin been linked to?

  • Depression
  • Appetite
  • Nausea
  • Sleep

31

What are the contra-indications for the use of TCAs?

  • Prostatism
  • Narrow angle glaucoma
  • Recent MI
  • Heart block

31

What are the side effects of Mirtazapine?

  • Increased appetite and weight gain
  • Postural hypotension
  • Sedation and drowsiness
  • Sexual dysfunction in rare cases

33

Which drugs activate the GABAa receptor and what does this cause?

  • Benzodiazapiens such as Lorazepam
  • Alcohol

They cause sedation of the individual.

35

What enzyme is involved in the conversion of glutamine/glutamate into GABA?

L-glutamate decarboxylase

36

What are examples of hypnotic Benzodiazepines?

  • Temazepam
  • Nitrazepam
  • Zopiclone
  • Zolpidem
  • Zaleplon

37

What does the syndrome of inappropriate antiduiretic hormone secretion (SIADH) produce?(Side effect of SSRI)

Hyponatraemia

37

Which SSRI has an increased risk of insomnia and agitation?

Fluoxetine

37

Which SSRI is most likely to produce sedation and have discontinuation symptoms?

Paroxetine

38

What are other common symptoms of depression?

  • Reduced concentration and attention
  • Reduced self-esteem and self-confidence
  • Ideas of guilt and unworthiness
  • Bleak or pessimistic views of the future
  • Ideas of self harm/ suicide
  • Disturbed sleep
  • Diminished appetite
  • Irritability

39

What are the side effects of Benzodiazepines?

  • Drowsiness and falls
  • Impairments in judgement and dexterity
  • Forgetfulness, confusion, irritability, aggression and paradoxical dis-inhibition
  • Dependance can develop

40

Which receptors does Trazodone block?

  • 5HT2A
  • 5HT2C

41

What drugs target noradrenaline receptors in the CNS?

  • Adrenaline
  • Ritalin
  • TCAs
  • Cocaine
  • Amphetamines

41

What are the side effects of the SSRIs?

  • Nausea
  • Vomiting
  • GI distrubances
  • GI bleeding
  • Hyponatraemia
  • Sexual dysfunction
  • QT prolongation
  • Serotonin syndrome

42

What are the withdrawal symptoms of Benzodiazepines?

  • Insomnia
  • Anxiety
  • Loss of appetite and weight loss
  • Tremor
  • Perspiration.

43

Which hypnotic Benzodiazepine is associated with a "hangover effect", and why?

Nitrazepam - Longer acting benzodiazepine; still has affects in the morning after taking

45

What is the main difference between the 2 classes of GABA receptor (GABAa and GABAb)?

  • GABAa are ionotropic causing fast inhibition through Cl influx
  • GABAb are metabotropic and involved in presynaptic inhibition of neurotransmitter release from the presynaptic terminal

45

Which areas of the brain synthesise dopamine?

  • Ventral midbrain
  • Substaintia Nigra
  • Ventral tegmental area

45

How do TCAs exert their effect?

They inhibit the reuptake of noradrenaline and serotonin

The compete for pre-synaptic receptors

Also bind to acetylcholine and histamine receptors.

46

What side effects are seen with Duloxetine?

  • Nausea
  • Insomnia
  • Dizziness
  • Increase in HR and BP

47

Why are SSRIs contra-indicated in under 18 year olds?

There is an increased risk of suicide and self harm in this age group.

49

What are the core symptoms of depression?

  • Depressed mood
  • Loss of interest
  • Reduced energy
  • Tiredness after minimal effort
  • Usually at least 2 weeks in duration

51

Where is noradrenaline produced within the CNS?

  • Locus coeruleus
  • Nucleus of the Solitary Tract

52

What are some antagonists of the serotonin receptors?

  • Ondansetron
  • Clozapine - atypical antipsychotic

53

What are the 4 main classes of antidepressants?

  1. TCAs
  2. MAOIs
  3. SSRI
  4. "Others"

54

What is cranial nerve VIII and where does it leave to cranium?

Vestibulocochlear nerve - Internal acoustic meatus

55

Where is the majority of serotonin found in the body?

The GIT - The enterochromaffin cells

57

Where are opioids projected to in the CNS?

  • Periaqueductal Grey
  • Brainstem

59

What type of receptor does Noradrenaline bind to in the CNS?

Metabotropic receptors.

60

Which SSRI has a long half-life, so can be stopped abruptly if needs be?

Fluoxetine

61

Above what doses does Venlafaxine produces its greatest efficacy?

Above 150mg/day

63

What functions is acetylcholine linked to?

  • Acetylcholine from basal forebrain; memory and cognition
  • From the tegmentum; arousal and sleep.

64

When are MAOIs likely to be given?

They are given if other first line drugs do not work.

66

Where in the CNS is acetylcholine produced?

  • Basal forebrain
  • Tegmentum
  • All motor neurones

67

What are the adverse effects of TCAs and how long do they usually last?

  • Sedation
  • Confusion
  • Motor in-coordination
  • Weight gain
  • Usually last 1-2 weeks and stop as the antidepressant effect starts

68

What are the side effects of Venlafaxine?

  • Nausea
  • Sexual dysfunction
  • Nervousness
  • Weight changes
  • Increased BP in higher doses

70

What is the main excitatory neurotransmitter of the CNS?

Glutamate

72

What is the other main inhibitory neurotransmitter apart from GABA, and where is mainly localised?

  • Glycine

Mainly found in the brainstem and spinal cord

74

What happens to glutamate receptors when alcohol or ketamine is ingested?

They are blocked leading to sedation of the individual

75

What is cranial nerve VI and where does it leave to cranium?

Abducent nerve - Superior orbital fissure

76

What is quorum sensing?

It is the use of chemicals, such as serotonin, by bacteria to detect the number of similar pathogens in the area

Used by Entamoeba histolytica

77

What is cranial nerve XI and where does it leave to cranium?

Accessory nerve - Jugular foramen

78

Where is histamine produced in the CNS?

Hypothalamus

80

Which dopamine pathway activates the striatum?

The mesostriatal pathway

81

What are the different severities of depression?

  • Mild - 2 Core symptoms plus 2 others
  • Moderate - 2 core symptoms plus 3/4 others
  • Severe - Core symptoms plus 4 others that are intense

82

Which drug classes are more cardiotoxic, TCAs or Mirtazapine?

TCAs

83

What is the "wash-out" period?

  • It is the period needed for MAOI to leave the body
  • It is usually 2 weeks and no new antidepressants should be given

84

Name some TCAs that are more selective for the prevention of noradrenaline reuptake?

  • Maproteline
  • Desipramine
  • Reboxetine
  • Protriptyline
  • Nortriptyline

85

What the is "cheese reaction"?

It is the interaction of MAOIs with tyroamine rich food such as mature cheese, beer, yeast extract and pickled herring

It is characterised by severe hypertension

86

What should be avoided if taking Trazodone?

  • Sedatives
  • Alcohol
  • MAOIs
  • Other antidepressants

87

What are opioids involved with in the CNS?

  • Analgesia
  • Reward

89

What is cranial nerve IX and where does it leave to cranium?

Glossopharyngeal nerve - Jugular foramen

90

What is noradrenaline involved with in the CNS?

  • Attention
  • Arousal

91

What are the 2 main receptors for dopamine and what is their action?

  • D1 - excitatory
  • D2 - inhibitory

92

What side effects of TCAs are related to the blocking of α1-adrenoreceptors?

  • Postural hypotension
  • Tachycardia; ventricular dysrhythmias and QT prolongation

93

What are the 2 main non-specific TCAs?

  • Amitriptyline
  • Imipramine

94

Which SSRIs increase the plasma concentrations of antipsychotics and TCAs?

  • Fluoxetine
  • Paroxetine
  • Sertraline

96

What is the street name of Flunitrazepam?

Rohypnol or roofies

97

What drugs do the SSRIs interact with?

  • MAOIs
  • Alcohol
  • NSAIDs
  • Anticoagulants

98

Which antidepressant is associated with the greatest risk of death from an overdose?

Venlafaxine

99

What Parkinson's treatment increases the level of dopamine available?

Ropinirole

100

What are the anti-muscarinic side effects of TCAs?

  • Blurred vision
  • Dry mouth
  • Constipation
  • Urinary retention
  • Also termed Atropine-like side effects.

102

Where is serotonin produced within the CNS?

The raphe nuclei in the brainstem.

103

Name some examples of anxiolytic Benzodiazepines.

DiazepamChlordiazepoxide LorazepamOxazepam