lecture 58 Flashcards
li - pathophysiology of dpression, pharmacology of antidepressants (24 cards)
what is the moa of Brexanolone (Zulresso)?
resensitizes GABA-a receptors
what are the types of depression/
reactive
major
bipolar affective
what are the features of depression?
physiological
psychological
cognitive
what are physiological features of depression?
decreased sleep
appetite changes
fatigue
psychomotor dysfunctions
what are the psychological features of depression?
dysphoric mood
worthlessness
excessive guilt
loss of interest/pleasure in all or most activities
what are the cognitive features of depression?
decreased concentration
suicidal ideation
what drugs can induce depression?
antihypertensive/CV
sedative-hypnotics
anti-inflammatory/analgesics
steroids
misc –> anti-parkinson, anti-neoplastic, neuroleptics
what are the 4 major hypotheses of depression?
biogenic amine
neuroendocrine
neurotrophic
integration
what is the basis of biogenic amine hypothesis of depression?
resperine causes depression by depleting NE and 5HT from vesicles with genetic polymorphisms in SERT promote and alterations in the 5HT1A/2C and a2 receptors
what is neuroendocrine hypothesis of depression?
changes in HPA axis leading to release of cortisol
what is the neurotrophic hypothesis of depression?
stress and pain decreases BDNF (brain-derived. neurotrophic factor)
what is the integration hypothesis of depression?
activation of cortisol during stress decreases BDNF
chronic signaling of MAO receptors to increase BDNF which prevents HPA axis from regulating it
what is the moa of MAOIs?
inhibit the degradation of NE and 5HT at the hands of MAO
what drugs are non selective MAOIs?
phenelzine
tranylcypromine
what drugs are selective MAOI?
MAO-B –> selegiline, safinamide
MAO-A –> moclobemide
what is the moa of TCAs?
inhibit both NE and 5HT reuptake via NET and SERT
also acts as receptor antagonist for histamine, muscarinic, and adrenergic receptors
what TCAs are tertiary?
imipramine
amitriptyline
clomipramine
doxepin
what TCAs are secondary?
desipramine
notriptyline
protriptyline
maprotiline
what is the moa of SSRIs?
block serotonin transporter pumps so more stays in the synapse/remains active longer
what drugs are SSRIs?
fluoxetine
fluvoxamine
paroxetine
sertraline
citalopram
escitalopram
what antidepressants drugs are partial agonists?
vilazodone
vortioxetine
what is the moa of SNRIs?
inhibit NET and SERT
what drugs are SNRIs?
venlafaxine
desvenlafaxine
duloxetine
milnacipran
levomilnacipran
what drugs are NSRIs?
reboxetine, atomoxetine
NE selective reuptake inhibitors
