B7.069 - Drugs for Mood Disorders

Question 1

primary use of antidepressants

Answer 1

treatment of depressive symptoms resulting in euthymia, should not elevate mood in non depressed people

Question 2

four major classes of antidepressants

Answer 2

MAOIs
TCAs
SSRIs
miscellaneous

Question 3

mechanism of most antidepressants

Answer 3

increased synaptic availability of NE and 5HT

Question 4

therapeutic effects of antidepressants takes how long to develop

Answer 4

several weeks

Question 5

ultimate effects of antidepressants may be due to

Answer 5

1. secondary changes in receptors
2. increased brain derived neurotrophic factors in hippocampus
3. cognitive changes, supported by the proven efficacy of cognitive therapy

Question 6

what are the MAOIs

Answer 6

Phenelzine

Tranylcypromine

Question 7

mechanism of MAOIs

Answer 7

increase synaptic availability of NE and 5HT by blocking their catabolism
IRREVERSIBLY inhibits MAOa (NE and 5HT) and MAOb (DA)

Question 8

receptors to MAOIs

Answer 8

Cholinergic
Histaminergic
alpha adrenergic

Question 9

use of MAOIs

Answer 9

Primarily in individuals not adequately treated by other antidepressants

Question 10

SE of MAOIs

Answer 10

Postural hypotension
weight gain
sexual dysfunction

Question 11

MAOIs overdose symptoms

Answer 11

unusual but can cause seizures, shock, delirium, hyperthermia, not typically fatal

Question 12

drug interactions of MAOIs

Answer 12

numerous!! Esp any drug that increases 5-HT or acts on its receptors
Can cause potentially fatal serotonin syndrome

Question 13

what is serotonin syndrome

Answer 13

Tremor
muscle rigidity
hyperthermia
hypertension
tachycardia
myoclonus

Question 14

food interactions with MAOIs

Answer 14

tyramine containing foods leading to hypertensive crisis, precautions must be observed for 2 weeks after cessation because of irreversible action

Question 15

what are the TCAs

Answer 15

Amitriptyline
Nortriptyline
Clomipramine

Question 16

TCA mechanism

Answer 16

inhibit the reuptake of NE and/or 5HT and also potent antagonists at various receptors including cholinergic, histaminergic, apha adrenergic

Question 17

AEs of TCAs

Answer 17

sleepiness
Sympathomimetic effects
Anticholinergic effects*
Orthostatic hypotension* 
Weight gain*
sexual dysfunction*

Question 18

TCA overdoses

Answer 18

Life threatening suicide risk
Coma
Arrhythmias
seizures
cardiac effects

Question 19

Interactions of TCAs

Answer 19

when combined with MAOIs

Question 20

what are the SSRIs

Answer 20

Fluoxetine
sertraline
paroxetine
citalopram
escitalopram

Question 21

SSRI mechanism

Answer 21

inhibit 5HT reuptake, can inhibit NE reuptake at higher doses

Question 22

SSRI SEs

Answer 22

anxiety
GI*
Decreased libido*
sexual dysfunction*

Question 23

discontinuation syndrome

Answer 23

can be seen with SSRIs, most associated with drugs with short half lives and anti muscarinin activity

Question 24

adverse drug interactions of SSRIs

Answer 24

MAOIs, can lead to serotonin syndrome

Question 25

Other dispositional interactions of SSRIs

Answer 25

CYP2D6 inhibitors - fluoxetine and paroxetine | CYP3A4 - fluvoxamine

Question 26

active metabolites of SSRIs

Answer 26

Fluoxetine metabolites inhibit CYP2D6, CYP3A4 --> long t1/2

Question 27

5-HT and NE uptake inhibitors

Answer 27

Duloxetine Venlafaxine Milnacipran

Question 28

NE uptake inhibitors

Answer 28

Maprotiline

Question 29

5-HT uptake inhibitors

Answer 29

Vilazodone | Vortioxetine

Question 30

Vilazodone uptake

Answer 30

5HT1A partial agonist | 5HT uptake inhibitor

Question 31

Vortioxetine

Answer 31

5-HT3 antagonists and 5HT1A agonist

Question 32

Mirtazepine

Answer 32

Increases 5-HT and NE release by blocking alpha 2 receptors on nerve terminals sedating

Question 33

Buproprion

Answer 33

Inhibits dopamine reuptake as well as having effects on NE and a lesser extent 5-HT Lower incidence of sexual dysfunction SE include CNS stimulation including anxiety, agitation or insomnia

Question 34

Trazadone MOA

Answer 34

sedating at sub-antidepressant doses 5-HT2A antagonist Weak inhibitor of NET and SERT V short t1/2

Question 35

first degree use of Trazadone and main SE

Answer 35

Hypnotic and pre anesthetic | can cause priapism

Question 36

amoxapine MOA

Answer 36

inhibits reuptake of 5-HT and NE (NET>SERT) | Dopamine antagonist - antipsychotic activity

Question 37

Amoxapine SE

Answer 37

EPS and tardive dyskinesia, also similar to TCAs

Question 38

ROA of antidepressants

Answer 38

Oral, some TCAs can be IM

Question 39

exceptions to rule that antidepressants have relatively long t1/2

Answer 39

Trazadone, venlafaxine, buproprion

Question 40

metabolism and excretion of antidepressants

Answer 40

mostly hepatic most eliminated in 7-10 days More rapid than children, slower in aged --> adjust dose

Question 41

black box warning of antidepressants

Answer 41

can increase risk of suicidal thinking and behavior

Question 42

Other uses of antidepressants

Answer 42

Panic disorder, OCD, enuresis, chronic pain, eating disorders, smoking cessation, sedative, migraine prophylaxis, ADHD

Question 43

drugs of bipolar

Answer 43

mood stabilizers antidepressants drugs for bipolar depression antipsychotics

Question 44

Mood stabilizers for bipolar

Answer 44

Lithium carbonate Valproic acid Carbamazepine Lamotrigine

Question 45

lithium mech

Answer 45

may affect ion transport, serotinin system, PI cascade or arachadonic acid signaling

Question 46

lithium pharmacokinetics

Answer 46

absorbed rapidly but accumulates slowly in brain Therapeutic levels reached in 6 to 10 days 95% excreted in urine

Question 47

Lithium side effects

Answer 47

``` low therapeutic index Tremor Acne polydipsia and polyuria teratogenic ```