Anti-Depressants :) Flashcards Preview

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Flashcards in Anti-Depressants :) Deck (40):
1

SHARK = concept groupings, similaries etc
~ = bold in notes and high yield
* = other stuff i think is high yeild maybe

hurrah.

2

concept: Pathophys of depression ie NT involved

DA
5Ht
NE
= happy making neuotransmitters
linked to a deficiency in ~signal transduction~

3

concept: Therefore, goal of antidepressants

increased SA, 5HT and NE to normal levels

4

concept: TCAs MOA

block monoamine reuptake - increases to normal levels

5

concept: MAO inhibitor MOA

prevent degradation of monoamines - increases to normal levels

6

concept: How long do a) pharmacological effects and b) clinical effects and c) beneficial effects of antidepressants take to kick in?

a) pharmaco - immediate
b) clinical - 2- 4 weeks
c) substantial benegit - 6-8 weeks
help patient through the transition

7

MAOi cause increase in which NT?

NE and 5HT

8

Name the MAOIs (SPIT + a/se dry mouth ;))

S: seregliptine
P: phenylzine
I: isocarboxazid
T: tryanylcypromine
seregliptine, phenylzine, isocarboxazid, tryanylcypromine

9

~*~Two reasons MAOis suck and arent really used anymore

SEROTONIN SYNDROME
the CHEESE REACTION

10

~*~Describe Serotonin syndrome

MAOi with anything that increases 5HT ie SSRI, SNRI, TCA, meperidine
* hyperthermia
* muscle rigidity
* myoclonus
apparently 5HT does those things

11

~*~Describe the Cheese reaction

Tyramine from food cant be broken down --> stimulates NE
* tachycardia
* hypertension
* arrhytmias
* seizure
* maybe stroke

12

List the TCAs please (NACID/naked)

N: nortryptiline
A: amytriptiline
C: clomipramine
I: imipramine
D: desipramine

13

List which ones are more 5HT-ergic and which ones are NE-ergic

triptylines and pramines

N: nortryptiline - more potent inhibitor of NET
A: amytriptiline - none
C: clomipramine - mroe potent inhibitor of SERT
I: imipramine - none
D: desipramine - more potentint inhibitor of NET

N-x-5-x-N @ NACID

14

What other receptors do TCAs affect and why do I care?

alpha adrenergic: orthostatic hypotension and reflex tachycardia

antimuscarinic: blurred vision, xerostomina, urinary retention, constipation and exacerbation of acute angle glaucoma

antihistamine: sedation and weight gain

15

~*~*~Whats your biggest concern fro someone on TCAs?

ARRHTYMIAS - largest cause of people passing away bc acts like class I antiarrhtymics by blocking FAST SODIUM CHANNELS

16

SHARK: how do you treat antiarrhtymias caused by TCA overdose

sodium bicarbonate

17

List the SSRI (SPEC-FF)

S - sertraline
P - paroxetine
E - es-citaloprone
C - citalopram
F - fluoxetine
F - fluvoxamine

18

~*~Why are SSRIs DOC for depression

no affects at histamine, muscarinic or alpha adrenoreceptors = way less side effects than TCAs

19

What else can MAOis be used for

PMDD, bulimia, depression, OCD, GAD, PD, PTSD, SAD

20

Which SSRIs inhibit what CYPs and who cares?

high potential for drug interactions
S - sertraline = low potential
P - paroxetine = HIGH potential via - of CYP2D6
E - es-citalopram = low potential
C - citalopram = low potential
F - fluoxetien = HIGH potential via - of CYP2D6
F - fluvosamine = HIGH potential via - of CYP1A2, CYP2C19, CYP3A4

21

Other a/se of SSRI espeically when taking with MAOis

Serotonin Syndrome - hyperthermia, muscle rigidity, and myclonus

22

List the SNRIs please

Venlafexine
Duloxetine

23

Whats the difference between teh two SNRIs

Venlafexine - inhibits 5Ht and then Ne at higher doses + weak DA
Duloxetine - inhibits 5HT and NE at all doses

24

**Why would you use a SNRI instead of an SSRI?

SNRIs inhibit P450 enzymes less
(SPEC FF: HIGH - paroxetine, fluoxetine, fluvoxamine and LOW - citalopram, es-citalopraim and sertraline

25

Name a drug that lacks the sexual dysfunction of SSRI and SNRI that treats depression

Buproprion - NE and DA uptake inhibitor, and icnreases NE and DA release

26

List the SARIs

NefaZODONE
traZODONE

27

~A/se of Nefazodone

hepatotoxicity - so not relaly used

28

MOA fo SARIs

strong inhibit 5HT2 receptors - no agitation and anxiery from stimulation in forebrain and no sexual dysfucntion from spc

weak inhibit SERT and NET

29

What is the main use of trazodone?

inhibits SERT, NET, alpha1 and H1 receptors and inhibits 5HT2 receptors --> extremely sedating and excellent hypnotic = MAIN USE IS AS HYPNOTIC

30

A/se of trazodone

priapism

31

when i say SARI you think?

hepatoxocity with nefazodone
hypnotic priapsim with trazodone

32

NASSA MOA

inhibit central alpha2
stimulate release of Ne and 5Ht
inhibit 5Ht2 and 5Ht3 -- no sexual dysfunction, no anxiety, no agitation
inhibit H1 -- sedation and weight loss

33

Name of the NASSA please

Mirtazadine

34

Atypical Antidepressants ?

quetiapine
aripiprazole
olanzapine - o-lanse-aux-epine

35

Mainstay treatment for bipolar

Lithium

36

MOA of Lithium

inhibits inositol poly/monophosphatase --> no inositol since cant cross BBB --> no IP3/DAG signalling --> prevention of manic episodes

also inhibits adrenergic, muscarinic and serotonergics

37

~*~*What neurons will be affected by Lithium and why :)

only active neurons will be affected by Lithium bc it acts in an ''uncompetitive'' manner......

38

Effects of Lithium on pregos?

cardiac problems in fetus
CATEGORY D!

39

Alternative treatment for bipolar?

valproate and carbamazepine - anti epileptics
atypical antipsychotics: o-lanse-aux-pines, aripiprazole, quitiapine, risperidone, ziprasidone
antiepileptic - lamotrigine

40

SHARK: list antidepressnats that dont cause sexual dysfunction

a) SARIs - nefazodone and trazodone - bc antag 5Ht liek NASSA
b) NDRI - buproprion; only affects Ne and DA
c) NASSA - mirtazadine bc antag 5HT2