Mood Disordered Flashcards
(47 cards)
Describe the mechanism of action of Mirtazipine
Noradrenaline and serotonin specific antidepressant
Mianserin another example
Doesnt effect serotonin reuptake
Give example of SNRI
Venlafaxine
Duloxetine
Describe the mechanism of action of Reboxetine
NaRI
Describe the mechanism of action of Rivastigmine
reversible inhibition of cholinesterase
Describe the mechanism of action of Carbamezipine and Phenytoin
Stabilises Na channels
Describe the mechanism of action of Olanzapine
Dopamine and 5HT2 antagonism
Describe the mechanism of action of Aripiprazole
Partial agonist at 5HT1A and D2, and 5HT2A antagonist
Describe the mechanism of action of Methylphenidate
Inhibiting DA and NA reuptake
Describe the mechanism of action of Lamotrigine
NMDA receptor modulation, stabilises Na channels and blocks calcium channels, some GABA modulation
What are EPSEs and what is their MoA?
SE antipsychotics drug but they can also occur when antipsychotics are discontinued (withdrawal dystonia)
antagonism of dopaminergic D2 receptors in the basal ganglia
basal ganglia are referred to as extra pyramidal as they are separate from the axons of the pyramidal cells that connect the cortex to the spinal cord hence ‘extrapyramidal side effects’
What symptoms do EPSEs include and descibe four main types?
Dystonias - prolonged and unintentional muscular contractions of voluntary or involuntary muscles
Parkinsonism - characterized by the triad of tremor, rigidity (lead pipe or cogwheel), and bradykinesia
Akathisia - a subjective sense of restlessness, along with such objective evidence of restlessness as pacing or rocking
Tardive dyskinesia
What are the five main types of dystonias?
Torticollis - cervical muscles spasms, resulting in a twisted posturing of the neck.
Trismus (lock jaw) - contraction of the jaw musculature.
Opisthotonus - arched posturing of the head, trunk, and extremities.
Laryngeal dystonia - difficulty in breathing
Oculogyric crises - involuntary contraction of one or more of the extraocular muscles, which may result in a fixed gaze with diplopia
Which antidepressant lower incidence of sexual dysfunction
Mirtazipine
Blood samples for lithium should be taken XXXXX post dose
12 hours
Blood samples for lithium should be taken XXXXX post dose
12 hours
Lithium contraindications
Addison’s disease
Brugada syndrome
Cardiac disease associated with rhythm disorders
Clinically significant renal impairment
Untreated or untreatable hypothyroidism
Low sodium levels, including people that are dehydrated and those on low-sodium diets
Describe lithium tremor
Generally symmetric and indistinguishable from essential or physiologic tremor
Primarily occurs in the hands
Most apparent with intentional posture, such as writing or holding a coffee cup
Typically presents early in treatment but may emerge at any time
More common with older age (presumably due to the additive effects of age-related essential tremor)
Higher lithium levels correlate with greater risk of tremor
Beta-blockers may help (often propranolol)
second generation tricyclics (secondary amines) mechanism of side effects
side effects are primarily related to their noradrenergic activity and may include:
Dry mouth
Constipation
Urinary retention
Tachycardia
Mild sedation
second generation tricyclics (secondary amines) mechanism
These primarily inhibit the reuptake of noradrenaline, which increases the levels of this neurotransmitter in the synaptic cleft and enhances noradrenergic neurotransmission. This mechanism is associated with improved mood and analgesic effects, particularly useful in treating neuropathic pain.
first generation tricyclics (tertiary amines) mechanism
These inhibit the reuptake of both serotonin and noradrenaline, which increases the levels of these neurotransmitters in the synaptic cleft and enhances serotonergic and noradrenergic neurotransmission. This dual action makes them effective in treating depression but also contributes to a broader side effect profile.
first generation tricyclics (tertiary amines) side effects?
Sedation (due to antihistaminic activity)
Orthostatic hypotension (due to alpha-adrenergic blockade)
Anticholinergic effects such as dry mouth, blurred vision, constipation, and urinary retention
Weight gain (due to antihistaminic and anticholinergic effects)
Cardiotoxicity, particularly in overdose
Common early adverse effects of MAOIs include
orthostatic hypotension, daytime drowsiness, insomnia, and nausea; later prevalent effects encompass weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.
Pharmacodynamic interactions with MAOIs can lead to two main issues:
Serotonin syndrome (primarily due to SSRIs)
Raised blood pressure (induced by indirectly acting sympathomimetic amine releasers, such as pseudoephedrine and phenylephrine)
What is MAOI Cheese Reaction
Monoamine oxidase, located in the gastrointestinal tract, neutralises tyramine. If drugs inhibit the breakdown of ingested tyramine, it gets absorbed, displacing norepinephrine from sympathetic nerve endings and epinephrine from the adrenal glands
When large amounts of pressor amines are released, symptoms such as severe occipital or temporal headaches, sweating, pupil dilation, neck stiffness, palpitations, and elevated blood pressure might arise
Thus need specific dietary restrictions Inc cheese, fermented sausage, draught beer
