Anti Depressants

Question 1

Types of Antidepressant drugs

Answer 1

TCAs
MAOI
SSRI
Lithium
Electroconvulsive

Question 2

What are the two classes of psychoses

Answer 2

Schizophrenia and affective disorders

Question 3

Whats are the two classes of affective disorder

Answer 3

Mania and Depression

Question 4

Symptoms of Depression

Answer 4

(emotional)
Misery/Pessimism
Low Self-esteem
Loss of Motivation
Anhedonia
(biological)
Slowing of thought & action
Loss of Libido
Loss of Appetite

Question 5

Describe Reactive Depression

Answer 5

Unipolar, relatively late onset, caused by stressful life events, non-familial

Question 6

Describe endogenous Depression

Answer 6

Unipolar, unrelated to external stress, shows familial pattern

Question 7

Describe bipolar depression

Answer 7

Oscillating depression, less common, early adult onset, strong hereditary tendency, drug treatment Lithium

Question 8

Monoamine Theory of Depression

Answer 8

Depression is a functional deficit of monoamines, mania is a functional excess

Question 9

How does reserpine act to reduce mania

Answer 9

inhibits NA and 5-HT (serotonin) storage

Question 10

How does ECT work

Answer 10

Increases CNS response to NA and 5-HT

Question 11

How is cocaine an exception to the Monoamine Theory

Answer 11

Cocaine reduces NA re-uptake in the synapse, but has no anti-depressive effects

Question 12

What is a biochemical inconsisteny with the monoamine theory?

Answer 12

reduction in monoamine metabolites in the urine in and delay of onset for treatment

Question 13

How do TCAs work eg Amitriptyline

Answer 13

Neuronal monoamine re-uptake inhibitors. Actions on NA and 5-HT is equal. Act on a2, histamine and mAChR receptors.Causes delayed down-regulation of b-adrenoceptors and 5-HT2 receptors

Question 14

How are TCAs taken

Answer 14

Orally, and highly PPB

Question 15

How are TCAs metabolised

Answer 15

Hepatic metabolism -> activated, and renal excretion

Question 16

What is the TCA H1/2

Answer 16

10-20 hrs

Question 17

What are the unwanted effects?

Answer 17

Atropine like effects, postural hypotension, sedation (H1 antagonism)

Question 18

Describe the Acute Toxicity of TCA

Answer 18

CNS: Excitement, delirium, seizures, coma, respiratory depression.
CVS: Cardiac dysrhythmias and ventricular fibrillation

Question 19

What are the drug interactions with TCAs

Answer 19

Other highly PPB drugs such as Aspirin
Hepatic microsomal enzymes eg. oral contraceptives
Potentiate other CNS depressants eg. alcohol
Antihypertensive drugs (monitor BP)

Question 20

How do MAOIs such as Phenelzine work

Answer 20

non-selective MAOI

Question 21

What do MAO-A an B correlate to?

Answer 21

A: NA and 5-HT
B: DA

Question 22

Why do MAOIs have long duration of action

Answer 22

Irreversible inhibitions

Question 23

What are the rapid effects of penelzine

Answer 23

increased cytoplasmic NA and 5-HT

Question 24

What are the delayed effects of Phenelzine

Answer 24

Down-regulation of 5-HT and b-adrenoceptors

Question 25

Describe the pharmacokinetics of pnelezine

Answer 25

Rapid oral absorption, short plasma t1/2, metabolised in liver, excreted in kidneys

Question 26

What are the unwanted effects of MAO

Answer 26

Atropine like effects, postural hypotension, sedation, weight gain, hepatotoxicity

Question 27

What are the drug interactions of MAOIs

Answer 27

Cheese reaction- tyramine containing foods + MAOI -> hypertensive crisis MAO + TCA = hypertensive crisis MAOI + pethidine -> hyperpyrexia, restlesness, coma and hypotenstion

Question 28

How do SSRIs like Fluoxetine work?

Answer 28

selective 5-HT reuptake inhibition less troublesome side effects Less effective vs severe depression

Question 29

What are the pharmacokinetics of SSRIs

Answer 29

Oral administration, 18-24hrs working, delayed onset of action (2-4 weeks), competes with TCA for hepatic enzymes therefore toxix

Question 30

Unwanted effects of SSRI

Answer 30

Nausea, diarrhoea, insomnia, loss of libido Interact with MAOI Prozac = Fluoxetine

Question 31

What are uses of Venlafaxine

Answer 31

Dose dependent reuptake inhibitor 5HT>NA>DA 2nd line treatment of depression

Question 32

What are the uses of Mirtazapine

Answer 32

a2 receptor antagonist increases NA and 5HT release Useful in SSRI intolerant patients