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A-CNS Pharma > Antidepressants > Flashcards

Antidepressants Flashcards

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1
Q

بسم الله الرحمن الرحيم
_______________________
Depression is classieef into

A

Unipolar common =major depressive disorder
Bipolar
Depression + Mania
هلوسات مش عارف ينام المود خربان بتيكلم كثير

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2
Q

Major depressie dioedere prevelance = ?
Woemn or men ?
Age?
Comrobidites?

A

17%
WOMEN
MID TWENTIES
anxiety + abuse

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3
Q

Symptoms of derpession ?

A

Emotinal physcial and cognitive
EMotional = Anhedonia saddness , sucidie , loss of interes gulit
Physcial : Sleep + appetite + psychomotor distrubances
Cognitice: concentration + memory disturbed
+
Severe= Deulisons + Hallucinations

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4
Q

Core symptoms of depression ?

A

Depressed mood
Anhedonia

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5
Q

Atypical depression =

A

Significant appetitie + hypersmonia
Resistant treatment
so Used MAOI!

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6
Q

Meahcnism of antidepressants

A

Increaisng Monamine dopamine serotonin and NE
dOWN Regulation of B and 5HT receptors delayed!
Neurotropich factors increased BDNF essentila for neuroplasticity

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7
Q

Mention mechanism of class of antidepressants

A

Prevention of reuptake of monoamines = TCA SSRI SNRI NDRI
______________________________
Prevention of Catabolism by MAO =MAO I

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8
Q

Describe response to antidepressants

A

First week = Imprve sleep and appetie but may be agitated and in anxiety
__________________________-
1-3 weeks Concentraion and memory improved but there is Hyperactivity and sex drive
____________________________
2-4 weeks:
Begins to Feel Pleasure ^_^
Relief of depressive mood

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9
Q

Mention TCAs

A

Imipramine
clomipramine
Antitriptline
Nortiptlyine
Desipramine
________________
I CAN DO !

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10
Q

Describe Mehanism of TCAs?

A

Prevent reuptake of NE and serotonin
but
Blocking autonimunc
Histaminc Muscarininc
and alpha adrenergic rcepetors

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11
Q

TCAs
block alpha adrengerfic receptors casugin ?
Blcok histaminc receptors causing ?
Blcok Muscarcinic receptors causing ?

A

Alpha= Hypoteension + arrythima
Histamine = sedation
Muscarinic = Atropin like action
constipation - urine retention and Dry mouth
_____________________
Caridotoxix
sexual dynsfunctiono
BPH
Narro TI
_____________________
Sucidie risk + Swithc to mania so cautiosuly in bipolar

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12
Q

TCA has caridotoxic effect causing ?

A

Arrythmia nad AV Block ! @

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13
Q

TCA shoud be taken cautiosuly in ?

A

Cardiacs and eplipticus

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14
Q

TCA is taken cautiously in Sucical or bipolar patients

A

Sucidie risk + Swithc to mania so cautiosuly in bipolar

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15
Q

Never give TCA with Alcohola and ansthetics
and hypotensive?

A

ALochol and anstheric increasing seation
Hypotensive!!@

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16
Q

Never give TCA with Sympatthomimietics and MAOI ?

A

MAOI increasing serotinin bay cause serotonin syndrome

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17
Q

Never give SSRI iwth TCAwhy?

A

Fluoxetine and Paroxetine inhibit TCA metabolism by inhibitng CYP2D6 Increasing TCA level that of Narrow therpautic index causing Toxicity

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18
Q

Patient with deprssion and Neuropathic pain is given ?

A

TCA + SNRI !

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19
Q

Mention indications of TCA

A

NMD = 1-Depression + ansxiety
2-Noctuernal enuresis
3-Migarane +CHRONIC PAIN neurophatic ( amitryptline )

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20
Q

Describe TCAs toxicity and Mangement

A

AC2
Atropine toxicity
Convulsions
Cardia: arryhmia hypotension and Block
___________________________
NaHCO3 for hypotension and arrythmia

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21
Q

Indications SSRI
Mention indication of fluoxetine

Study These Flashcards
A

FAnE 1-First line DERPRESSION
2-ANXIETY ( GAD-OCD -PANIC ATTAKK)
3-Eating disorderes as bulemia nervosa and anxiety nervosa

22
Q

Advanatge os SSRI

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A

TOCA
Less autonomic blocake
Less cardiotoxic
Less ObESITY
Wider TI

23
Q

Citalopram dose

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A

never exceeds 40mg/day for risk of Increased QT interval

24
Q

Adverese effects of SSRI (FLUXOETINE PAROXETINT)

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A

Nause -vomiting
Drowindwss =insmonia
Sexual dysfunction
Drug interaction
Risk of suicide in teenage
s2d2

25
Paroxetin has ,,, effect on sleep but fluoxetinte ?
Paroxetine sedating Fluoxeitne activating
26
Fluoxeitnie and paroxetine interactions
Inhibintg CYP 2D6 increasing TCA toxicity also Antipsychotics antidepressants and B Blockers
27
Never to give TCA AND CITOALOPRAM SSRI ?
QT interval prolongation
28
Mangemetn of sexual dysfunction
Rduce the dose Vigra repace with Mirtazapine and buporion
29
Nevere give SSRI with MAOI to avoid,,,,,describe
Serotnin syndrome =Mental abnormalities =Autonimic abnormalitis : tachycardia - diaphoreiss-mudriasis - shivering =Neuromuclar abnormalitis : Clonus hyperreflexia -tremoes and seizures
30
SNRI AS ,,,,WORKING BY?
Vend and hend Venlafaxine + Duloxetine _____________________ Preventing reuptake of NE and Serotonin
31
Mention pros and cons of Venlafaxeine
Pros no autoniminc blockade on H1 M a rceptors _________________ Cons :- Hypertension in Tachycardia in high dose>150 mg Nause vomiting Sexual dysfunvtion
32
Used in stress Urinary incontinice?
Duloxetine ______________ Incrasing NE and serotonin in the scaral semgents increasing tone of shpincters !
33
No sexual dysfunction in ?
atypical antidepressants
34
Aypicla antidepressaants mention
Bupriopin increaisng NE and DA Mirtazapine blocking Alpha 2 and 5HT2
35
Imp notes on Bupropion
1-No sexual dysfunction 2-Smoking cessation Increasing DA in nucleus accumbens 3-Contraindicated in Epileptic patients + Alcohol withdrawal
36
Mirtazapine is CC by?
Blocking a2 inhibiotry effect increasing 5HT3 and NE _______________CC BY? Anti emetics effect blocking 5TH3 receptor in CTZ and GIT -No sexual dysfunction instead of SSRI -SEDATION AND WEIGHT GAIN WORKING IN H1 BLOCKING
37
MAOI : NON SELEVTIC MAO A ,B I AND ,,,,,,AND,,,,,,,, SLECTIVE MAOAI: .......... _____________________ MAO is safety valve targeted for ? cuasing .....inactivation of MAO ?
Tranylcyprmoine & phenelzine Moclobemide _____________________:- Preventing damage causing Reuptake of NE 5HT and dopamine increasing their propotions in synaptic clefts ____________________ Irreversible
38
MAOI is condisered last line treamtnet in depression whyyy?
Due to cheses reaction HTN CRISIS If food containg tyraimine
39
Tyramine is indirect,,,,,,,,,, When taking ,,,,,,,,,, drugs there is increased abosoprton of tyramine causign ?
Sympathomimetic MAOI Cheese Reaction of HTN crisis
40
MAOI And Cold remedies
Cold remedis may be sympathomumetic increasing NE with its increase by MAOI causing HTN Crisis
41
MAOI and TCAS
TCAS increasing NE and MAOI increasit it also causing Hypertension hyperthermina and convulsions
42
MAOI AND SSRI Pethidine Tramadol
SSRI increase Serotonin as MAOI ALSO Pehtidine to norpethdine increasing Seortinin as MAOI Also Tramadol Decreasing reuptake of Serotonin increasing it aas MAOI Causing Serotinin syndrome with conusloion and hyperthermia
43
pRECUATIONS OF MAOIs Avoid drug interactions Avoid in elderly why ? Avoid RCAs or SSRI except after 2 weeks from stopping MAOI called ",,,,,,":
Elderly :- alpha 1blockade causing postural hypotension Muscarinic blckade: causing atropine like actions ____________________ Washout period
44
Selevtive revresible inhibiotor of MAO-A
Moclobemide
45
Has the advantage over risk of cheese reaction ? why?
Moclobemide due to its selectivity to mao a so there is MAO B working on tyramine and also its is short acting reversible easily displaced and replaced by tyramine allowing tyramine to be metabolized by MAO-A
46
Agomeltaine works on ?
Melatinionin recpros M1&M2 Agonist 5HT2C antagonist incresing NE And Dopamine not hypnotic as ramelton due to increasd NE ________________________
47
Indications of Agomelatinin ?
Major depressive disorder: Ciradiacn Rythm correction
48
Mention theraputic indications of antidepressants
UNSe DAP 1-Depressive disorderes 2-Anxiety - OCD ( SSRI + Clompreamine) 3-Post-traumatic-stress -disorder and Impulse control disorder 4-Eating disorders bulemia and anxiety nervosa 5-smoking cessation Bupropion 6-Neurophatic pain : TSD TCAS SNRI and DULOXETINE 7-Urinary incotinece dulxetine Nocutrnal enrurisis Impiramine
49
5Rs of tratment are?
Respione 50 % Remission normal 3 months Recovery nor relapse > 6 months Relaspe after respone or remission Reurrence: Epidoe after recovery
50
Algorithim :- Age comrobitis symptoms -SSRI Fisrt line -SNRI If chronic pain -Isnomina weight loss = mirtazapine -smoking cessation = bupirpion -OCD Clomiparmine ____________________________ Maximize dose or Class change! or Member change! Combination enhancement! Augmentation therapy! Li Lamotigine thyroid hormone 2nd generation antipsychotics : quitapine + Olanzopine ____________________________________ ECT:جلسات ظبط ايقاغ المخ _____________________________ remission ?
Remisson with maintaind 6 moth tratement if recovery ! MAINTAINCE OR NO ?! A question of Risk factors __________________________ Sudden discontuniaion !!!!!!! Discontuinaton syndome Depressed mood Disqeulibrium Muscle aches GIT symptoms Trmors Isomina nad Night mares parasthesia ___________________________ gradual discontiunation
51
رب إني لما أنزلت إلي من خير فقير ^_^

A-CNS Pharma (11 decks)

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