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Pharmacology > DRUGS FOR MOOD DISORDERS > Flashcards

DRUGS FOR MOOD DISORDERS Flashcards

1
Q

neurotransmitters are divided into what 3 major classes?

A
  • small molecule neurotransmitters (eg. dopamine)
  • neuropeptides (eg. substance P)
  • neurotransmitter gases (eg. nitric oxide)
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2
Q

what are the small molecule neurotransmitters?

A
  • acetylcholine
  • monamines
  • amino acids
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3
Q

what diseases does acetylcholine improve?

A

cognition for Alzheimers disease

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4
Q

what diseases does dopamine improve?

A

schizophrenia, Parkinson’s disease

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5
Q

what diseases does norepinephrine, epinephrine an serotonin improve?

A

depression, bipolar disorder

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6
Q

what are the 4 monoamines?

A
  • dopamine
  • norepinephrine
  • epinephrine
  • serotonin (5-HT)
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7
Q

amino acid - glutamate

A

excitatory - increase in activity

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8
Q

amino acid - GABA

A

inhibitory - stimulate benzodiazepines

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9
Q

noradrenergic system (norepinephrine)

A
  • neurons originate from the locus cerulean project to limbic system and cerebral cortex
  • metabolized by enzyme monoamine oxidase (MAO)
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10
Q

a lot of drugs we prescribe for conditions OUTLOOK of cns, can have direct effects on functioning cns

TRUE OR FALSE

A

true

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11
Q

how do you increase the tone of noradrenergic system?

A

you can do so by inhibiting metabolism

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12
Q

serotonergic system

A
  • neurons originate in raphe nuclei project to the limbic system and cerebral cortex (co localized with NE system)
  • many receptor classes: 5-HT1 to 5-HT7 with subtypes for each
  • decreased serotonergic tone associated with depression
  • metabolized by the enzyme monoamine oxidase (MAO)
    -98% of serotonergic receptors are located outside the CNS
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13
Q

what is a mood disorder?

A

persistent disturbance in mood that impairs a persons ability to effectively engage in normal activities of daily living that are not attributable to the physiological effects of a substance/drug or to another medical condition

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14
Q

major depressive disorder DSM-5TR symptoms

A
  1. depressed most of day
  2. diminished interest or pleasure in all activities
  3. significant changes in weight or appetite
  4. insomnia or hypersonic
  5. psychomotor agitation or retardation
  6. fatigue or loss of energy
  7. feelings of worthlessness or excessive or inappropriate guilt
  8. diminished ability to think or concentrate, or indecisiveness
  9. recurrent thoughts of death and suicidal ideation

5 or more of these symptoms during the same 2 week period - at least one symptoms is either depressed mood or loss of interest/pleasure

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15
Q

how to antidepressant drugs treat depression?

A
  • by enhancing, elevating or stabilizing mood and are used to treat all symptoms of major depressive disorder as well as the depressive phases of bipolar disorder
  • effective in managing anxiety and OCD related disorders
  • effective in treating psychological/physical signs of pain
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16
Q

why should those under 25 be closely monitored for warning signs of suicide, especially at the start of treatment?

A

because the brain is constantly changing/evolving

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17
Q

what are the drug classes for antidepressants?

A
  • selective serotonin reuptake inhibitors (SSRIs)
  • atypical antidepressants (Including SNRIs)
  • tricyclic antidepressants (TCAs)
  • monoamine oxidase inhibitors (MAOIs)

most have an effect on serotonin

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18
Q

selective serotonin reuptake inhibitors (SSRIs)

A

FIRST LINE THERAPY
- inhibit serotonin reuptake into the presynaptic neuron; presynaptic 5HT receptors become less sensitive, post synaptic receptors become more sensitive
- improved side effect profile compared to other antidepressant drugs; no affinity for histamine, alpha adrenergic or muscinaric receptors
- preferred drug class

19
Q

what are side effects of SSRIs?

A

sexual dysfunction, nausea, headache, weight gain, anxiety/nervousness, akathisias an sleep disturbances

20
Q

withdrawal symptoms of SSRIs

A

nausea, dizziness, lethargy, anxiety tremor, palpitations, irritability

DISCONTINUATION OF DRUG SHOULD BE GRADUAL

21
Q

how long can it take for SSRIs to work?

A

4-6 weeks

22
Q

what is serotonin syndrome?

A

-associated with extreme increases in serotonin levels
-results in mental status changes (confusion, anxiety, restlessness), hypertension, tremors, sweating, hyperpyrexia and ataxia
-in extreme cases, mechanical ventilation and muscle relaxants may be necessary

23
Q

what co administration of drugs can cause an extreme increase in serotonin levels?

A

-SSRIs + MAOIs
-SSRIs + TCAs
-SSRIs + lithium
-SSRIs +st Jones wart
-MDMA (ecstasy)
-SSRIs + fentanyl
-SSRIs + meperidine

24
Q

what are the atypical antidepressants?

A

-SNRIs
-NDRIs

25
Q

SNRIs

A

-inhibit reuptake of serotonin and norepinephrine to elevate mood; symptoms may improve earlier than other drugs

26
Q

what is duloxetine (Cymbalta)?

A

effective in management of neuropathic pain characteristic of fibromyalgia and diabetic neuropathy; may increase risk of post partum hemorrhage

27
Q

NDRIs

A

(these dont touch serotonin - worsen epilepsy)
- antidepressant: Wellbutrin, smoking cessation: zyban
- less likely to induce sexual dysfunction, weight gain or insomnia vs SSRIs
- good side effect profile; contradicted in those with seizure disorders

28
Q

TCAs

A
  • inhibit NE, 5-HT and DA reuptake into the presynaptic neuron, increasing NE, 5-HT and DA levels in the synapse
  • affinity for histaminergic, muscinaric and alpha1 adrenergic receptors
  • 90% of TCAs are bound to serum albumin
  • used to treat depression in refractory cases
  • also used in management of neuropathic pain an childhood enuresis
29
Q

what are side effects of TCAs

A

sedation, blurred vision, dry mouth, urinary retention, constipation, tachycardia, orthostatic hypotension
- effects minimized if dose is slowly increased over 2-3 weeks
- weight gain and sexual dysfunction are also potential adverse effects

30
Q

MAOIs

A

(used if TCAs, SSRIs or SNRIs are not an option)
- inhibition of MAO enzyme increases monoamine levels
- hypertensive crisis associated with SES and elevated levels of tyramine
- potentiate the hypoglycaemic effects of insulin and anti diabetic drugs

31
Q

bipolar I disorder DSM5-TR

A

characterized by at least 1 lifetime manic episode, most clients also experience major depressive episodes over the course of their lives

32
Q

what is a manic episode

A

distinct period of abnormally and persistently elevated expansive, increased or irritable mood and activity or energy, lasting at least 1 week and present most of the day, nearly every day
- the episode is not attributable to the physiological effects of a substance (drug of abuse, a medication, other treatment) or other medical condition

33
Q

what are the symptoms of bipolar I disorder DSM-5TR?

A
  • inflated self esteem or grandiosity
  • decreased need for sleep
  • more talkative than usual or pressure to keep talking
  • flight of ideas of subjective experience that thoughts are racing
  • distractibility
  • increased goal directed activity or psychomotor agitation
  • excessive involvement that have high potential for painful consequences

3 or more of these symptoms are present to a significant degree and represent a noticeable change from usual behaviour

34
Q

lithium

A
  • used for the treatment of mania and reducing the frequency and magnitude of mood changes
    -inhibits excitatory neurotransmitters (dopamine and glutamate) and promotes GABA-mediated neurotransmission (GABA is an inhibitory neurotransmitter)
    -drug interactions (narrow therapeutic index)
35
Q

which drug can decrease renal clearance and increase lithium levels?

A

indomethacin

36
Q

what are the monitoring requirements for lithium?

A
  • serum levels must be monitored 5 days post any change in regimen
    -12 hour serum level every 3 months
  • creatinine, urinalysis every 3-6 months
  • clients encouraged to drink 2-3 litres fluid per day
  • take at bedtime: protective of kidneys (nephrogenic diabetes insipidus)
37
Q

what are symptoms of lithium toxicity?

A

muscle weakness, lack of coordination, vomiting, diarrhea tremor, twitching, lethargy, mental confusion, polyuria

38
Q

what anticonvulsant drugs can be used to manage manic episodes?

A

carbamazepine, divalproex (valproic acid)

39
Q

what are adverse effects of divalproex (valproic acid)?

A

dizziness, drowsiness, headache, nausea, blurred vision, sedation

40
Q

what are adverse effects of carbamazepine?

A

dizziness, drowsiness, blurred vision, confusion, muscle tremor, nausea, vomiting, mild cramps, increased sensitivity to sun, skin sensitivity an rashes and poor coordination

41
Q

what are some atypical antipsychotic drugs?

A

aripiprazole an brexpiprazole, olanzapine, risperidone
- can manage mania, major depressive disorder, schizophrenia
- adverse effects vary with each drug within this class

42
Q

What are the two receptor classes of the noradrenergic system?

A

Alpha an beta

43
Q

What does the noradrenergic system maintain?

A

maintains emotional tone (mood, arousal, alertness/wakefulness)

44
Q

What does the serotonergic system maintain?

A

maintains sleep wake cycle, emotional tone and sensory perceptions

Pharmacology (20 decks)

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