5: Pharmacology of antidepressants and mood stabilisers Flashcards Preview

Psychiatry Week 1 2018/19 > 5: Pharmacology of antidepressants and mood stabilisers > Flashcards

Flashcards in 5: Pharmacology of antidepressants and mood stabilisers Deck (45)
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1

Are antidepressants only given for depression?

No

eating disorders, anxiety, chronic pain as well

2

What is dysthymia?

Persistent low-grade depression

3

What are some examples of monoamine neurotransmitters?

Noradrenaline (excitatory)

Dopamine (excitatory)

5-HT / Serotonin (inhibitory)

4

What is 5-HT?

Serotonin

5

NA, 5-HT and dopamine are examples of ____ neurotransmitters.

monoamine

6

Serotonin is widely distributed in the brain.

What are its functions

a) superiorly

b) at the nucleus raphe magnus?

a) Mood, sleep, appetite, perception

b) Analgesia

7

What effects does NA produce in the brain specifically?

Arousal

Emotional response

fight or flight in the brain

8

Which part of the brain releases NA in response to signals from the periaqueductal grey?

What general effect does this cause?

Locus caeruleus

Analgesia

9

Which enzyme metabolises monoamine neurotransmitters to clear them out of the pre-synaptic terminal?

Monoamine oxidase

10

What happens if you inhibit monoamine oxidase?

Neurotransmitter isn't cleared up

It sticks around in the synapse for longer

Increased excitation

11

What are two examples of monoamine oxidase inhibitors?

Phenelzine (irreversible)

Moclobemide (reversible)

12

Which monoamine oxidase inhibitor is

a) reversible

b) irreversible?

a) Moclobemide

b) Phenelzine

13

What is a major side effect, involving diet, of monoamine oxidase inhibitors?

If you eat products containing lots of tyramine e.g cheese, gravy you'll have a hypertensive crisis

14

Why aren't monoamine oxidase inhibitors e.g phenelzine, moclobemide widely used?

Side effects

15

What are some side effects of monoamine oxidase inhibitors?

Hypertensive crisis w/ high tyramine diet

Postural hypotension

Peripheral oedema

Insomnia

16

How do tricyclic antidepressants work?

Block re-uptake of monoamine neurotransmitter into pre-synaptic terminal

17

What are some examples of tricyclic antidepressants?

Imipramine

Dosulepin

Amitriptyline

Lofepramine

18

What are some side effects of TCAs?

Anticholinergic effects - reduce smooth muscle activity; blurred vision (can't accomodate), dry mouth, constipation, urinary retention

Cardiovascular problems - tachycardia, postural hypotension, (fatal) arrhythmia

Sedation

Weight gain

19

What are some anticholinergic effects of TCAs?

Dry mouth and eyes

Blurred vision (failure of accommodation)

Constipation

Urine retention

20

What are some cardiovascular side effects of TCAs?

Postural hypotension

Tachycardia

Arrhythmia (fatal in overdose)

bad for the heart in general

21

What can patients suffer if they overdose on TCAs?

Fatal arrhythmias

22

How do SSRIs work?

Same action as TCAs, prevent reuptake of monoamine neurotransmitter into pre-synaptic terminal

but act selectively on 5-HT

23

SSRIs act selectively on ___.

5-HT (serotonin)

24

What are some examples of selective serotonin reuptake inhibitors?

Fluoxetine

Citalopram

Sertraline

25

What are some side effects of SSRIs?

N&V (opposite: anti-emetics which INHIBIT a type of 5-HT)

Headache (opposite: triptans which INHIBIT a type of 5-HT)

Sweating

Sexual dysfunction

26

The nausea and headache typically caused by SSRIs is ___.

transient

meaning it goes away after a while

27

Which symptoms are

a) 5-HT1

b) 5-HT3

receptors responsible for?

a) Headache (antagonists are the -triptans, for migraine)

b) Nausea (antagonists are -setrons, or anti-emetics)

28

SSRIs may initially ___ the symptoms of anxiety or depression.

worsen

especially in young people

29

In young people, what do SSRIs increase the risk of?

Thoughts of self-harm / suicide

30

Why shouldn't SSRIs be given to patients under 25?

Increase in thoughts of self-harm / suicidal ideation