Flashcards in 6. Anxiety, Depression, Mania PHARM Deck (99)
Big picture: drugs for depression target what kind of system?
how long do antidepressants take to exert their effects?
in what % of pts are antidepressants effective?
what is a monoamine?
close relative of ammonia (NH3), only one of the H ias been replaced by a different group
what are the 3 endogenous monoamines?
serotonin, norepi, dopamine
are depressed people actually deficient in monoamines?
it was originally thought that they were, but it turns out that they are not.
what is the current leading theory about why giving monoamines works for depression?
that they change brain structure and neural connectivity/neurogenesis.
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)
do we have more effective drugs now than we did in the 50s?
No more effective, possibly fewer side effects/less lethal w OD
why is there so much cross-reactivity with monoamines?
the receptors are all very similar. (histamine, muscarinic, adenosine, serotonin, dopamine....)
serotonin: should associate nerves that carry it with what anatomical structure?
serotonin is involved in what types of emotions?
fear, depression, anxiety, cognition, memory
pts on monoamines that target the serotonin system may have issues with what?
incr fear/anxiety, problems with memory
SSRI: prototypical drug?
what are the side effects of SSRIs
GI issues, sexual interest, sleep problems, night sweats, hyponatremia, mania
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.
weak 2D6, MAOI, TCA, NSAIDS, thioridazine
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.
citalopram: give to possibly bipolar pt?
no, can induce mania
which SSRIs cause QT prolongation? (2)
Excitalopram: what kind of drug?
fluoxetine: what kind of drug
paroxetine: what kind of drug?
fluvoxamine: what kind of drug?
chlomipramine: what kind of drug?
TCA, but works only on serotonin.
SNRI: what do they do?
same as SSRI but for norepi.
Norepinephrine-containing neurons are predominantly in what anatomical struct
compared to serotonin, how does NE affect the amygdala? hippocampus?
less affect on amygdala, less on hippocampus??
what is the prototypical SNRI