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IP3 > Depression/Anxiety > Flashcards

Depression/Anxiety Flashcards

1
Q

precursor to NE

A

tyrosine

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2
Q

NE synthesis steps (4)

A

tyrosine, L-DOPA, DA, NE

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3
Q

NE location in brain

A

locus ceruleus

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4
Q

5HT role

A

arousal, sleep-wake cycle, mood, motivaton

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5
Q

5HT location in brain

A

raphe nuclei

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6
Q

5HT precursor

A

tryptophan

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7
Q

which 5HT receptor is on the presynaptic terminal

A

1D

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8
Q

4 MAO-I

A

Phenelzine
tranylcypromine
isocarboxazid
selegiline

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9
Q

MOA of MAO-I

A

decrease MAO activity in neruons and liver
in neurons: inc. NE concentration
in liver: inc. tyramine from foods in circulation
increase NE and 5HT transmission in CNS

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10
Q

Antidepressants (6)

A 
MAO-I
TCA
SSRI
SNRI
Serotonin Modulators
Atypical antipsychotics
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11
Q

ADE for MAO-I (4)

A

Orthostatic hypotension
CNS stimulation
Weight gain
sexual dysfunction

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12
Q

TCA MOA

A

block uptake of amines by nerve terminals

inhibit NE and 5HT transporters

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13
Q

TCA drugs (5)

A 
Amitriptyline
Imipramine
clomipramine
protriptyline
doxepin
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14
Q

TCA ADE

A 
anti-ach
sedation
weight gain
orthostatic hypotension
lowered seizure threshold
qt prolongation
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15
Q

Combine TCA and MAO-I

A

NO, risk of hypertensive crisis

cause tons of NE in synapse

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16
Q

SSRI drugs (5)

A 
fluoxetine
sertraline
paroxetine
citalopram
escitalopram
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17
Q

SSRI MOA

A

selective inhibition of serotonin transporters

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18
Q

SSRI ADE

A

insomnia
dizziness
sexual dysfunction
GI: n/v/d

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19
Q

Serotonin Syndrome treatment

A

supportive
sedation: BDZ
cyproheptidine

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20
Q

Serotonin Syndrome symptoms

A 
ataxia
myoclonus
confusion
hypomania
agitation
restlessness
fever
chills
sweating
diarrhea
HTN
tachycardia
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21
Q

Withdrawal from SSRI symptoms

A 
flu-like
light-headedness
restlessness
sleep and sensory disturbances
headache
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22
Q

SNRI drugs (5)

A 
Duloxetine
venlafaxine
desvenlafaxine
levomilnacipran
milnacipran
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23
Q

serotonin modulators drugs (3)

A

trazodone
Vilazodone
Vortioxetine

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24
Q

Trazodone MOA

A

weak 5HT uptake inhibitor
5HT2A and 5HT2C antagonist
H1 antagonist: sedation

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25
Q

viibryd, Brintellex MOA

A

combined selective serotonin reuptake inhibitor and partial 5-HT1A receptor agonist

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26
Q

atypical antidepressants drugs (2)

A

Mirtazapine

Bupropion

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27
Q

Bupropion MOA

A

inhibits DA and Ne uptake

> for DA

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28
Q

bupropion Contraindication

A

history of head trauma

seizures

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29
Q

Mirtazapine

A

Antagonize alpha2 adrenergic autoreceptor
-inc. firing rate or noradrenergic neurons
-inc. NT release
antagonize 5HT2A,3 serotonin

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30
Q

2 theories of delayed effect of anti-depressants

A
  1. alternation in pre-synaptic auto-receptors or transports and NT synthesis
  2. activation of neuronal repair
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31
Q

stress effect on neurons

A

elevate glucocorticoids
increase glutamate levels
cause neuronal damage and dysfunction
reduction in BDNF (growth factor)

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32
Q

Antidepressants effect on CREB and BDNF

A

increase level of CREB (cAMP)

CREB increases BDNF

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33
Q

BDNF role

A

enhances dendritic sprouting, opposite effects of stress

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34
Q

Treatment of Anxiety Disorder (4)

A

Antidepressants
Buspirone
BZD
non-pharm

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35
Q

BZD MOA

A

selectively enhance the response to GABA to open the GABA-A receptor

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36
Q

what type of channel is GABA-A

A

chloride

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37
Q

GABA binding requires what 2 subunits

A

alpha

beta

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38
Q

2 subunits for BZD binding

A

alpha

gamma

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39
Q

BZD for anxiety (7)

A 
Alprazolam
Lorazepam
Clonazepam
Diazepam
Oxazepam
Chlordiazepoxide
Clorazepate
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40
Q

BZD effect on sleep

A 
releive symptoms of insomnia
promotes onset
dec. SL
dec. stage 3,4, REM
increase stage 2
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41
Q

BZD for insomnia (5)

A 
Triazolam
Estazolam
Temazepam
Flurazepam
Quazepam
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42
Q

Z-hypnotics moa

A

bind to the bzd at alpha 1 site on the GABA-A receptor

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43
Q

Z-hypnotics (3)

A

Zaleplon
Zolpidem
Eszopiclone

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44
Q

alpha 1 subunit of GABA function

A

sedative effects of BZD

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45
Q

alpha 2 subunits of GABA function

A

anxiolytic effects of BZD

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46
Q

BZD antagonist

A

FLumazenil

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47
Q

Barbiturates MOA

A

bind to GABA-A receptor
-enhance GABA at low concentrations
-directly activate GABA at high concentration
prolong duration of channel opening

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48
Q

Suvorexant MOA

A

orexin receptor antagonist both OX1 and 2

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49
Q

Melatonin synthesis

A

in pineal gland from tryptophan

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50
Q

Melatonin receptor agonists (2)

A

Tasimelteon

Ramelteon

51
Q

Tasimelteon approved for

A

non-24 hour sleep wake rhythm disorder

52
Q

Ramelteon approved for

A

insomnia

53
Q

Antihistmaine sleep effects

A

feel sleepy but does not improve sleep suppress REM

54
Q

Histamine location

A

tuberomammillary nucleus of the posterior hypothalamus

55
Q

Antidepressants for insomnia

A

amitriptyline
doxepin
trazodone

56
Q

MAO-A deaminates?

A

serotonin

NE

57
Q

MAO-B deaminates?

A

DA
phenylethylamine
benzylamine

58
Q

Selegiline at low concentrations inhibits?

A

MAO-B irreversibly

59
Q

Selegiline at high concentrations inhibit?

A

MAO-A and B

60
Q

MAO-B functions for what disease

A

parkinson’s

61
Q

drugs that bind covalently to FAD in function of MAO

A

Phenelzine
Selegiline
Isocarboxazid

62
Q

Drug that binds to MAO itself

A

Tranylcypromine

63
Q

TCA which prefer to inhibit 5HT reuptake

A

Clomipramine
Imipramine
Trimipramine
Doxepin

64
Q

TCA which prefer to inhibit NE reuptake

A

Protriptyline
Desipramine
Nortriptyline
Amoxapine

65
Q

7 major diagnostic categories for depression

A 
Depressed patients sound anxious, so claim psychiatrics
depression
psychotic disorders
substance abuse
anxiety disorders
somatic disorder
cognitive disorder
personality disorder
66
Q

DSM-V Depression

A

depressed mood most of the day or markedly diminished interest or pleasure in almost all activities and 4 other signs

67
Q

untreated depression episode lasts?

A

> 6 months

68
Q

treated depression episode lasts?

A

4-5 months

69
Q

Major depressive episode symptoms

A 
SIGECAPS
4 of 8 w/ depressed mood for 2 weeks
sleep disorder
interest deficit
guilt
energy deficit
concentration deficit
appetite disorder
psychomotor retardation or agitation
suicidality
70
Q

Persistent depressive disorder symptoms

A 
ACHEWS
2/6 w/ depressed mood for 2 years
appetite disorder
concentration deficit
hopelessness
energy deficit
worthlessness
sleep disorder
71
Q

Manic episode symptoms

A 
DIGFAST
elevated mood w/ 3 of 7 
or
irritable mood w/ 4 of 7 for one week
distractibility
indescretion
grandiosity
flight of ideas
activity increase
sleep deficit
talkativeness
72
Q

Define response in depression

A

50% reduction in PHQ-9 score

73
Q

define remission in depression

A

PHQ-9 score <4

74
Q

define relapse in depression

A

return of symptoms meeting full criteria within 6-12 months following remission

75
Q

define recurrence in depression

A

occurrence of new episode following 6 to 12 months of full and sustained remission

76
Q

how long to recommend antidepressants after period of sustained remission

A

6-12 months

77
Q

1st line antidepressants

A 
SSRIs
SNRIs
vortioxetine
buproprion
mirtazapine
78
Q

2nd line antidepressants

A 
tca
nefazodone
trazodone
levomilnacipran
moclobemide
quetiapine
selegiline
vilazodone
79
Q

3rd line antidepressants

A

phenelzine
tranylcypromine
reboxetine

80
Q

sertraline dose range

A

50mg qd-200/day

81
Q

citalopram dose range

A

20mg qd-40mg/day
max dose if <60 40mg
max dose if >60 20mg

82
Q

fluoxetine dose range

A

20mg qd-80mg/day

83
Q

paroxetine dose range

A

20mg qd-50mg/day

84
Q

venlafaxine dose range

A

75mg qd-375/day

85
Q

duloxetine dose range

A

20-30bid-60/day

86
Q

bupropion dose range

A

100mg bid-450/day

87
Q

mirtazapine dose range

A

15mg-45mg

88
Q

Manage sexual side effects (4) for depression

A

watchful waiting
dosage reduction
drug holiday
switch antidepressants

89
Q

antidepressants with least sexual sE

A

mirtazapine
nefazodone
bupropion
vilazodone

90
Q

Add on therapy for sexual dysfunction for depression

A 
DA modulation
-amantadine
-bupropoin
-ropinirole
serotonin modulation
-buspirone
-cyprheptadine
-mirtazapine
-nefazodone
NE modulation
-yohimbine
91
Q

Serotonin Syndrome Signs (12)

A 
HTN
tachycardia
tachypnea
hyperthermia
mydriasis
sialorrhea
diaphoresis
hyperactive bowel sounds
incrased neuromuscular tone
hyperrelexia
agitation
coma
92
Q

Common drugs that can add to serotonin syndrome (6)

A 
dextromethorophan
fentanyl
linezolid
lithium
tramadol
sumatripans
93
Q

D/c syndrome symptoms

A 
FINISH
flu-like
insomnia
nausea
imbalance
sensory disturbances
hyperarousal
94
Q

bupropion contraindicated

A

current seizures
alcohol withdrawal
benzo withdrawal
bulemia

95
Q

Secondary vs tertiary amines

A

tertiary NE>5HT reuptake inhibition

Secondary selective NE reuptake inhibiton

96
Q

Depression no response at 4 weeks?

A

incresase in dose and reevaluate in another 2-4 weeks

97
Q

Define panic attack

A

abrupt surge of intense fear or discomfort

have 4 symptoms

98
Q

Define Panic disorder

A

recurrent unexpect panic attack
1 month of: persistent worry/concern or
significant maladaptive changes in behavior

99
Q

TCA not effective in?

A

SAD

100
Q

Buspirone does not improve

A

mood/depression

101
Q

BZD relief what anxiety symptoms

A

somatic and autonomic

not cognitive symptoms

102
Q

which BZD ok for liver disease and elderly?

A

LOT
lorazepam
Oxazepam
temazepam

103
Q

1st line for anxiety

A

SSRI

SNRI

104
Q

2nd line for anxiety

A

TCA

buspirone

105
Q

3rd line for anxiety

A

MAO-I

106
Q

when can BZD be used as monotherapy

A

Panic disorder w/ no underlying mood disorder

107
Q

drugs not effective for SAD

A

ciralopram and fluoxetine 2nd line
TCA
busirone monotherapy
daily beta blocker

108
Q

drugs not effective for panic disorder

A 
citalopram 2nd line
buspirone
antihistamines
antipsychotics
trazodone
109
Q

PTSD augmentation

A

alpha-1 antagonist: prazosin
-nightmares and insomnia
atypical antipsychotics: risperidone, quetiapine
-decrease hypervigilance and re-experiencing
anticonvulsants/mood stabilizers
-divalproex, carbamazepine, topiramate, lamotrigine
-decrease re-experiencing and agression

110
Q

drugs not effective for PTSD

A

Buspirone
Bupropion
Desimpramine

111
Q

drugs not effective for OCD

A

SNRI
Amitriptyline
imipramine

112
Q 
time to response
GAD
panic
SAD
PTSD
OCD
A 
2-4 initial, 4-6 full
6-12
4 weeks 
8-12 weeks
10-12 weeks
113
Q

pregnancy DOC for anxiety

A

citalopram, fluoxetine, sertraline

114
Q

drugs to avoid in pregnancy for anxiety

A

paroxetine: cv malformation

BZD in 2st trimester: cleft lip

115
Q

stage 1 sleep

A

sleep initiation

intact voluntary muscle tone

116
Q

stage 2 sleep

A

50% sleep time

muscles relax

117
Q

stages 3,4

A

delta or slow wave sleep

118
Q

REM

A

20% sleep time
dreaming
paralysis
active brain function

119
Q

DSM-V Insomnia

A

poor sleep
poor daytime functioning
>3 nights/wk
>3 months

120
Q

alcohol effects on sleep

A

dec. SL
inc. TST
fragments sleep

121
Q

OTC meds effect on sleep

A

inc. SM
inc. TST
no effect on SL

122
Q

melatonin effect on sleep

A

dec. SL

123
Q

RLSL DSM-V

A

urge to move the legs
>3 times/wk
>3 months
poor daytime funcitoning

IP3 (7 decks)

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