6. Anxiety, Depression, Mania PHARM Flashcards Preview

M2 Psychiatry > 6. Anxiety, Depression, Mania PHARM > Flashcards

Flashcards in 6. Anxiety, Depression, Mania PHARM Deck (99)
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1

Big picture: drugs for depression target what kind of system?

monoamine neurotransmission

2

how long do antidepressants take to exert their effects?

6-8 weeks

3

in what % of pts are antidepressants effective?

only 60-70%

4

what is a monoamine?

close relative of ammonia (NH3), only one of the H ias been replaced by a different group

5

what are the 3 endogenous monoamines?

serotonin, norepi, dopamine

6

are depressed people actually deficient in monoamines?

it was originally thought that they were, but it turns out that they are not.

7

what is the current leading theory about why giving monoamines works for depression?

that they change brain structure and neural connectivity/neurogenesis.

8

what are some ways to structure the antidepressant meds?

-by age (old/new depending on whether before or after prozac/Fluoxetine - 1986)
-by structure (mono/secondary/tertiary amines)
-by function (reuptake inhibitor, MAOI)

9

do we have more effective drugs now than we did in the 50s?

No more effective, possibly fewer side effects/less lethal w OD

10

why is there so much cross-reactivity with monoamines?

the receptors are all very similar. (histamine, muscarinic, adenosine, serotonin, dopamine....)

11

serotonin: should associate nerves that carry it with what anatomical structure?

raphe nucleus

12

serotonin is involved in what types of emotions?

fear, depression, anxiety, cognition, memory

13

pts on monoamines that target the serotonin system may have issues with what?

incr fear/anxiety, problems with memory

14

SSRI: prototypical drug?

citalopram

15

what are the side effects of SSRIs

GI issues, sexual interest, sleep problems, night sweats, hyponatremia, mania

16

SSRIs: black box warning is what?

can incr suicidal ideation in teens to 25 yrs. but doesn't increase actual suicide completion. better to give SSRI than to let depr go unchecked.

17

Citalopram: interactions?

weak 2D6, MAOI, TCA, NSAIDS, thioridazine

18

Citalopram: heart effects?

QT prolongation. may not be enough to be a problem, but if pt is borderline anyway may be problem. can cause Torsades arrythmia.

19

citalopram: give to possibly bipolar pt?

no, can induce mania

20

which SSRIs cause QT prolongation? (2)

citalopram, escitalopram.

21

Excitalopram: what kind of drug?

SSRI

22

fluoxetine: what kind of drug

SSRI

23

paroxetine: what kind of drug?

SSRI

24

fluvoxamine: what kind of drug?

SSRI

25

chlomipramine: what kind of drug?

TCA, but works only on serotonin.

26

SNRI: what do they do?

same as SSRI but for norepi.

27

Norepinephrine-containing neurons are predominantly in what anatomical struct

locus coeruleus

28

compared to serotonin, how does NE affect the amygdala? hippocampus?

less affect on amygdala, less on hippocampus??

29

what is the prototypical SNRI

venlafaxine

30

venlafaxine: side effects?

GI, sexual, sleep, sweating, hyponatremia, mania