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Neuropharmacology > Anti-depressant > Flashcards

Anti-depressant Flashcards

1
Q

Name MAO-A Inhibitor

A
  • moclobemide
  • clorgyline
    -> selective and reversible
    (unlike irreversible MAO-B I selegiline)
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2
Q

Interaction of MAO-A inhibitor

A
  • cheese reaction
  • react with many food and drugs which contain large quantities of tyramine
  • (beer, yeast, cheese, pickled meat)
  • tyramine acts as catecholamine in MAO inhibited patient
    -> vasoconstriction and hypertension

*-> less likely to produce cheese reaction in selective and reversible

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3
Q

Advantage of moclobemide

A
  • lacks adverse effects of TCAs
    -> alternative option in elderly patients and those with heart disease
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4
Q

Adverse effects of moclobemide

A
  • nausea/ dizziness/ headache/ insomnia
  • caution while co-prescribing pethidine, SSRIs and TCAs
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5
Q

Name tricyclic antidepressants

A
    • Amitriptyline (-> Nortriptyline)
  • Imipramine (-> Desipramine)
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6
Q

TCA antidepressant MOA

A
  • inhibit NET (norepinephrine transporter) and serotonin transporter (SERT) at neuronal and platelet membrane
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7
Q

Name side effects of TCAs

A
  1. anti cholinergic: dry mouth, constipation, urinary retention
  2. sedation
  3. increased appetite and wg
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8
Q

TCAs interaction

A
  1. potentiate sympathomimetics amines -> avoid adrenaline containing amine
  2. potentiate CNS depressants
  3. concurrent MAOI -> hypertensive crisis
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9
Q

Name SSRIs (selective serotonin reuptake inhibitor)

A
  • fluoxetine
  • citalopram
  • paroxetine
  • sertraline
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10
Q

SSRIs general interaction

A
  • serotonin syndrome
    -> when concurrent use with serotonergic drugs: MAOI, tramadol, pethidine
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11
Q

Fluoxetine

A
  • longest acting SSRIs
  • approved for use in children 7 y/o or older for depression/ OCD
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12
Q

Setraline

A

juvenile depression efficacy

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13
Q

Name SNRIs (serotonin and noradrenaline reuptake inhibitor) and prominent side effects

A
  • venlafaxine
  • nausea/ sweating/ anxiety/ withdrawal syndrome
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14
Q

Name four atypical antidepressants

A
  1. trazodone
  2. mianserin
  3. mirtazapine
  4. bupropion
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15
Q

Trazodone

A
  • major drug target: 5HT2A receptor (acts as antagonists) -> directly involve in mood control
  • less effective 5HT reuptake blocker, prominent adrenergic bloker -> hypotension
  • metabolite strong 5HT2 blocker
  • less prone to arrhythmia
  • prolonged and painful penile erection
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16
Q

Mianserin

A
  • block presynaptic a2 receptors -> increase release and turnover of NA -> antidepressant effect
  • not inhibit uptake of 5HT/ NA
  • overdose seizure
  • blood dyscrasias
17
Q

Mirtazapine

A
  1. block a2 receptors -> enhance NA and 5 HT release
  2. NA further increase serotonergic raphe neurons firing via a1 receptors
  3. selective enhancement of antidepressive 5HT1 receptor -achieved by concurrent blockade of 5HT2 and 3 receptors
18
Q

Bupropion

A
  1. inhibit DA and NA uptake -> excitant effect
  2. metabolize into amphetamine-like compound -> presynaptic release of DA and NA
    - contraindicated in eating disorder and bipolar
    - infrequently use - except with atypical features
19
Q

Treatment for severely depressed

A

Electroconvulsive therapy

20
Q

Bipolar disorder drug treatment x3

A
  1. anti epileptic drug
  2. lithium
  3. atypical antipsychotics (olanzapine, aripriprazole)
    => mood stabilizer
21
Q

Lithium effect

A
  • calming effect/ mood stabilizer -> treat acute mania
  • prophylaxis of recurrent manic and depressive episodes
  • anti suicidal effect
22
Q

Lithium MOA

A
  1. dopamine pathway - decrease dopamine transmission
  2. glutamate pathway
  • downregulate NMDA receptor
  • modulate associated myoinositol second messenger system -> long term change in neurotransmission and gene transcription
  1. GABA pathway
    - increase level of GABA
    - directly activate GABA receptor
  2. Second messenger systems
    - cAMP: increase AC, cAMP and CREB (cAMP response element binding protein)
    - PI signalling
    - suppress GSK-3 (glycogen synthase kinase -3)
    -> transcriptional regulation
    -> gene expression
    -> mood stabilizer
23
Q

Lithium interactions

A
  • diuretics: cause plasma Li+ level to rise
  • NSAID, tetracycline, ACEI: lithium retention
  • neurotoxicity with haloperidol, carbamazepine, chlorpromazine
24
Q

Lithium overdose

A
  • muscle twitching
  • coma
  • drowsiness

Neuropharmacology (6 decks)

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