Mood Disorders

Question 1

Hypothesis for the source of depression

Answer 1

1. Monoamine Hypothesis

2. Loss of neurotrophic support

Question 2

What does reserpine do?

Answer 2

Depletes monoamines

Question 3

What transmitter is associated with explanaiton of the neurotrophic hypothesis

Answer 3

BDNF

Question 4

Five types of anti-depressants

Answer 4

1. SSRIs
2. SNRIs (pure or TCA)
3. 5HT2 Antagonist
4. Tetra/Unicyclic Antidepressants
5. MAOIs

Question 5

Important SSRIs to remember

Answer 5

Fluoxetine, Paroxetine, Fluvoxamine (Inhibit 450s)

Sertraline, Citalopram, Escitalopram

Question 6

There are toxicity concerns when SSRIs are distributed with…

Answer 6

TCAs

Question 7

Indications or SSRIs?

Answer 7

MDD
Anxiety Disorders (GAD, Panic, Social, OCD, PTSD)
Premenopausal Dysphoric disturbance
Eating disorder (Bulimia only)

Question 8

Adverse Effects of SSRIs (6)

Answer 8

Sexual Dysfunction
Weight Gain
Serotonin Syndrome
Adolescent suicide
Withdrawl syndrome
Newborn Effects

Question 9

Symptoms of Serotonin Syndrome

Answer 9

Cog – Delirium, Coma
Autonomic – HTN, Tachy
Somatic – Myoclonus, hyperreflexia, tremor

Question 10

Effects of SSRIs on newborns?

Answer 10

Persistant Pulmonary HTN
Neonatal abstinence syndrome
COngenital malformations (no strong evidence)

Question 11

Three important SNRIs

Answer 11

Duloxetine
Venlafaxine
Des-venlafaxine

Question 12

Name the five SNRI Tricyclic Antidepressants

Answer 12

Imipramine (anticholinergic)
Amitryptyline (hits many receptors, sedating)
Nortryptyline
Clomipramine
Desipramine

Question 13

Which TCAs effect 5HT more than NE?

Answer 13

Imipramine, Amitryptyline

Question 14

Which TCAs effect NE more than 5HT?

Answer 14

Desipramine, Nortriptyline

Question 15

TCAs are used to treat…

Answer 15

MDD not responsive to SSRIs
Anxiety disorders
Pain (diabetic neuropathy, fibromyalgia)
Enuresis
Insomnia

Question 16

Adverse effects of SNRIs

Answer 16

Cardiotoxicity (TCAs can block Na channels)
Sexual Dysfxn
Weight Loss
Serotonin Syndrome (esp. when TCA+MAOI)
Suicidal Thoughts
Withdrawl
Sedation

Question 17

5HT2 Antagonists are also called… the important one is…

Answer 17

SARI (Serotonin antagonist and reuptake inhibitor)

Trazodone

Question 18

Active metabolite of Trazodone

Answer 18

mCPP

Question 19

People takin Trazodone can’t drink…

Answer 19

grapefruit juice

it blocks CYP3A4

Question 20

Trazodone adverse effects

Answer 20

Hypotension from adrenergic receptor blockade

Question 21

Trazodone uses…

Answer 21

depression (mostly replaces by SSRIs)
hypnotic
anxiety

Question 22

Name the unicyclic antidepressant and its mode of action

Answer 22

Buproprion
DA and NE reuptake inhibitor
Also a nAChR antagonist

Question 23

Adverse effects of Buproprion

Answer 23

Few Sexual Side Effects
Insomnia
Anorexia
Seizures

Question 24

Uses for Buproprion

Answer 24

AD, supplement to SSRI, smoking cessation

Question 25

Name the tetracyclc antidepressant and its MOA

Answer 25

Mirtazapine Stimulates NE, 5HT release. Blocks 5HT receptor affects many other receptors

Question 26

Use ot mirtazapine

Answer 26

Refractory MDD

Question 27

Three important MAOIs

Answer 27

Selegiline (MAO-B irreversible) Tranylcypromine (non selective, irrev.) Phenelzine (non-selective, irrev)

Question 28

uses for MAOIs?

Answer 28

refractory MDD, anxiety, PARKINSONS

Question 29

MAOI adverse effects at therapeutic concentrations

Answer 29

``` Orthostatic HTN Weight Gain Sexual Dysfxn CNS activation Sedation ```

Question 30

Sx and Tx of TCA overdose

Answer 30

Sx -- arrythmia, symp. activation, anticholinergic, seizures | Tx - cardiac monitoring, HCO3

Question 31

Sx and Tx of MAOI overdose

Answer 31

Sx -- hyperadrenergic, psychosis, confusion/fever/delirium, seizures Tx - Cardiac monitoring, HCO3

Question 32

What happens when a person on an MAOI gets a bunch of tyramine

Answer 32

Malignant HTN, Stroke, MI

Question 33

Drug classes for bipolar disorder

Answer 33

Lithium Carbonate Atypical Antipsychotics Antiepileptics Benzodiazepines

Question 34

Two proposed mechanisms by which Lithium may work?

Answer 34

Inositol Depletion | GSK-3 inhibition

Question 35

Plasma lithium levels must be continuously monitored. While monitoring, you should consider...

Answer 35

Diuretic Use (can reduce clearance) Na in Diet Exercise (dehydration can increase levels)

Question 36

Side effects of Lithium

Answer 36

Tremor (treat with beta blockers) Low Thyroid Fxn Edema (Na interactions) Arrythmias (Lithium depresses the sinus node)

Question 37

What happens to people who overdose on lithium

Answer 37

Coma N,V,Diarrhea Ataxia, Nystagmus, Slurred Speech, Spasms

Question 38

How to treat an acute manic episode

Answer 38

Valproate 2nd place -- carbamazepine SEVERE -- antipsychotic/benzodiazepine

Question 39

How to do maintenence therapy for BD

Answer 39

Lithium (+Benzo in severe) Lamotrigine Risperidone

Question 40

Atypical antipsychotics that may be used in bipolar disorder

Answer 40

Aripiprazole, olanzapine, papliperidone | Quetiapine, Risperidone, Ziprasidone

Question 41

Two antiepeleptics used in treatment of bipolar disorder

Answer 41

Carbamazepine, Valproate