depression pharmacological treatment

Question 1

what 2 receptors do the most effective anti-depressants work on?

Answer 1

5-HT (serotonin) and NA (noradrenaline)

Question 2

Where are 5HT cell bodies contained in the brain?

Answer 2

in the dorsal and median raphe nuclei

Question 3

Where are NA cell bodies contained in the brain?

Answer 3

in the Locus coerulus

Question 4

what determines the synthesis rate of NA and 5HT?

Answer 4

1. TPH for 5HT (tryptophan hydroxylase)

2. TH for NA (tyrosine hydroxylase)

Question 5

what determines the breakdown of 5HT and NA?

Answer 5

MAO (monoamine oxidase)

Question 6

what determines the release rate of 5HT and NA?

Answer 6

the firing activity of the impulse

Question 7

what determines the reuptake rate of 5HT and NA?

Answer 7

the transporter activity

Question 8

what part of 5HT, NA and DOPA does MAO act on?

Answer 8

the NH2 at the end of the chain

Question 9

where do MAO act?

Answer 9

they break down the monoamine in the cytosol and regulate the vesicle content

Question 10

How do the monoamine reuptake transporters work?

Answer 10

they transport the monoamines from the synaptic cleft to the presynaptic terminal

Question 11

how can we increase 5HT and NA neurotransmission?

Answer 11

1. reduce their breakdown in the synaptic cleft hence increase their release per impulse
2. block their reuptake hence increase their duration and concentration in the synaptic cleft.
3. increase the post-synaptic receptor activation.

Question 12

what are the two main classes of antidepressant drugs?

Answer 12

1. inhibitors of monoamine metabolism (so they inhibit monoamine oxidase)
2. inhibitors of monoamine reuptake e.g. (SSRIs, SNRIs and TCAs)

Question 13

what group of MAO are blocked by monoamine oxidase inhibitors (MAOi)?

Answer 13

1. Monoamine Oxidase A (MAOAa)
   or drugs that block
2. Monoamine oxidase A and B (MAOA and MAOb)

Question 14

what are drugs that target just MAOb used for?

Answer 14

used for treating Parkinson’s disease.

Question 15

give an example of only an MAOb inhibitor?

Answer 15

Selegiline

Question 16

Give an example of an MAOa and MAOb inhibitor?

Answer 16

Iproniazid

Question 17

Give an example of a MAOa inhibitor?

Answer 17

Clorgyline

Question 18

Give an example of a TCA?

Answer 18

amitriptyline

Question 19

Give an example of a SSRI?

Answer 19

citalopram

Question 20

give an example of SNRI

Answer 20

duloxetine and venlafaxine

Question 21

which of these are selective: SSRI, SNRI or TCA

Answer 21

SSRIs

Question 22

what are the side effects of reuptake inhibitors

Answer 22

GI disturbance 
sexual dysfunction 
dry mouth 
sedation 
hypotension 
weight gain 
skin lashes 
anaphylaxiss

Question 23

how do MAOIs bind: reversibly or irreversibly

Answer 23

ireeversibily

Question 24

what effect do MAOIs have on blood pressure

Answer 24

they lower blood pressure by causing vasoconstriction, hence provoking hyperetensive crisis

Question 25

what is the downside of taking other antidepressants alongside the depressant your already on

Answer 25

causes serotonin syndrome

Question 26

what happens in serotonin syndrome

Answer 26

- blocks reuptake transporter and inhbiting MAO would increase 5HT release and there'll be a build up of serotonin in the synaptic cleft

Question 27

symptoms of serotonin syndrome

Answer 27

``` high temp agitation in creased reflexes tremor sweating dilated pupils diarrhoea delirium comvulsions death ```

Question 28

what is the first lien antidepressant treatment

Answer 28

SSRIs

Question 29

last line antidepressant treatment

Answer 29

MAOI

Question 30

How long should you continue to treat after patient has recovered

Answer 30

6 month - 2 years after recovery

Question 31

what symptoms are experienced in antidepressant discontinuation syndrome

Answer 31

dizziness, headache, nausea and lethargy

Question 32

what is used to treat bipolar disorder

Answer 32

lithium valproate atypical antipschotics fluoxetine

Question 33

what causes bipolar disorder

Answer 33

dpomaine hyperactivity - antagonists of the dpomaine receptor reduce mania - reducing dopamine synthesis reduces mania

Question 34

where are dopamine cell bodies contained

Answer 34

in the ventral tegmental area in the midbrain

Question 35

how is dopamine released

Answer 35

by tonic and phasic release

Question 36

how does lithium work

Answer 36

decreases DA release decreases DA ( and 5HT) receptor signalling inhbits seconf mess

Question 37

what is the main use of lithium in Bipolar Disorder

Answer 37

acute mainia and prophylaxsis

Question 38

what is the recommended plasma lithium levels

Answer 38

0.4-1mmol / L

Question 39

side effects of lithium

Answer 39

``` dry mouth or metallic taste in mouth mild shaking or fine tremor of the hand (s) thirst passing mroe urine dizziness mild dizziness weight gain oedema ```

Question 40

what does it mean by lithium being teratogenic

Answer 40

interferes with fetal development and causes birth defects

Question 41

how does sodium valproate work

Answer 41

increases GABA transmission

Question 42

when do we use valproate

Answer 42

when lithium isn't tolerated

Question 43

side effects of valproate

Answer 43

``` nausea vomiting sedation tremor hair loss weight gain pancreatitis ```

Question 44

is valproate teratogenic

Answer 44

yes, causes fetal valproate syndrome, neural tube defects and intellectual impairment