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D&T2 Exam 1 > Mood Disorders - Egleton > Flashcards

Mood Disorders - Egleton Flashcards

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1
Q

what is the biogenic Amine hypothesis

A

mood disorders result from abnormalities monoaminergic neurotransmission

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2
Q

what happens to the neurotransmission for depression

A

reduced

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3
Q

what happens to the neurotransmission for mania

A

increased

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4
Q

what are some supportive evidence for the biogenic amine hypothesis

A

reserpine causes depression
antidepressants block repute of 5-HT/NE
MAO inhibitors increase monoamine neurotransmission

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5
Q

what are three problems with biogenic amine hypothesis

A

TCA’s don’t correlate with observed antidepressant effects

MAO and TCA have immediate effects, yet relief of depression takes weeks

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6
Q

How do TCA’s work

A

inhibition of presynaptic reuptake for both serotonergic and noradernergic neurons

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7
Q

How do SSRI works

A

specific serotonin reuptake inhibitors

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8
Q

how does SNRI work

A

combo reuptake inhibitors for both serotonergic and noradrenergic neurons

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9
Q

MAOI how does it wokr

A

monamine oxidase inhibitors in both serotonergic and noradrenergic neurons

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10
Q

what drug is used for first line drugs for depression and most anxiety disorders

A

SSRIs

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11
Q

what are some characteristics all SSRI’s share

A

WIDE THERAPEUTIC WINDOW

fewer autonomic side effects and less sedation then TCA’s

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12
Q

why might the reasons for SSRI have rapid inhibitoin effect but the effects of SSRI is not evident for 3-6 weeks after

A

gradual “ down regulation” or decrease in some postsynaptic serotonin receptor in response to large amounts of serotinin

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13
Q

name a SSRI durg

A

Fluoxetine (prozac)

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14
Q

what are 3 pharmacokinetics for SSRI

A
  • well absorbed in gut
  • hepatic cytochrome p450 metabolism
  • large protein binding
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15
Q

what is the most common adverse effect of SSRI

A

nausea
diarrhea
abdominal pain

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16
Q

what are other SSRI adverse side effects

A

Jitters

Sexual dysfunction

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17
Q

5-HT

A

serotonin

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18
Q

what is the black box warning for antidperessents

A

increase risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders

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19
Q

what is the black box warning for Fluoxetine

A

FDA approved for treatment of

  • OCD in children less than 7 years
  • MMD in children greater than equal to 8 years
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20
Q

SSRI’s should not be concurrently used with what other drug? if done what does this cause

A 
MAO - monoamine oxidase inhibitors
Serotonin syndrome ( severe hypertension)
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21
Q

what is another drug that can cause serotonin syndrome

A

Linezolid ( some MAO-I activity )

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22
Q

If you want to discontinue SSRI in a patient and want to start them on MAOI what should you do

A

allow 1-3 months of washout of SSRi

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23
Q

what are side effects of Fluoxetine

A

free anticholinergic effects
orthostatic hypotension
weight gain

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24
Q

what does Fluoxetine inhibit

A

cytochrome P450 isozymes

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25
what other disorders does Fluoxetine treat
Bulimia nervosa | anorexia nervosa
26
what is the mechanism of action for SNRI ( serotonin norepinephrine reuptake inhibitors )
NE and 5-HT reuptake inhibits ( SNRI)
27
what are three drugs for SNRI
Duloxetine Venlafaxine Desvenlafaxine
28
what are side effects of SNRI
nausea; constipation; abdominal pain ( especially Duloxetin) Anxiety; Akathisia, agitation- "Jitters" sexual side effects
29
what do TCA increase and decrease
increase: mood, appetite decrease: depression, anxiety
30
what is the mechanism of action for TCA's
inhibition of presynaptic neurotransmitter reuptake ( norepinephrine and serotonin)
31
what do secondary and tertiary amines do for TCA's
secondary: block NE reuptake tertiary: block 5-HT
32
When do you use TCA to treat depression
``` NOT first line treat enuresis (night time bed wetting for children) ```
33
what are side effects for TCA
``` orthostatic hypotension weight gain ( alpha 1 receptor antagonism) ```
34
TCA when combines with depressants and sedative worsen what
worsen sedation
35
TCA when combined with alpha-methyldopa and beta-adrenergic blockers worsen what
hypotension
36
TCA when combined with quinidine, thioridazine adds waht
additive cardiotoxicity
37
TCA when combined with antihistamines adds what
additive anticholinergic toxicity
38
TCA + MAO inhibitor cause what
rare severe CNS toxcity
39
what can acute poisonings of TCA cause? treatment options?
seizures no antidote do not use Phenytoin
40
with TCA tolerance to what effects occurs within a short time
anticholinergic effects
41
Does TCA have many drug drug interactions
yes
42
what does Amoxapine block
blocks NE
43
what drug has the highest seizure risk for all anti-depressents
Maprotiline
44
Mechanism of action for MAOI
inhibition of MAO resulting in increased stores of monoamines
45
are MAIO selective for type of MAO
NOT selective for MAO-A or MAO-B
46
why are MAOI used
highly resistant depression after TCA, SSRI falied
47
what are the three drugs for MAOI
Tranylcypromine Phenelzine Isocarboxazid
48
what should you not eat if you take MAOI
Tyramine: cheeses, chicken liver, beef, red wine
49
what are some side effects of MAOI
hypertension, cardiac arrhythmias,
50
MAOI lead to reduced breakdown of what
catecholamines and thus increased release : blurred vision, dryness of mouth
51
what are symptoms of acute poisoning of MAOI
hallucinations agitation convulsions
52
MAOI can treat what
hypertensive crisis
53
MAOI drug interaction with sympathomimetics
hypertensive crisis
54
MAOI drug interaction Meperidine (opiate analgesic)
fever, delirium, hypertension, hypotension
55
MAOI drug interaction oral hypoglycemics
further lowering of serum glucose
56
MAOI drug interaction L-Dopa
hypertensvie crisis
57
MAOI drug interaction TCA
fever, seizures, delirium
58
name other second generation drugs for anti-depressents
Buporpion ( wellbutrin, zyban)
59
what are side effects of Buporpion
``` sexual dysfunction agitation insomnia nausea weight loss seizures ```
60
what drug is used for smoking cessation
Bupriopion ( zyban)
61
what is the mechanism of action for Hypericum
inhibitor of MAO and 5-HT reuptake
62
Another name for hypericum
St. John Wort
63
What happens when Hypericum and SSRI are taken together
hypertensive crisis
64
Trazodone don't have what side effects
no anticholinergic side effects
65
Trazodone have what side effects
Priapism - can lead to permanent impotence | persistent clitoral erection in women
66
mechanism of action for Nefazodone
blocks NE and 5-HT
67
what are side effects of Nefazodone when it blocks alpha 1 receptor
sedation
68
MIrtazapine MOA
tetracyclic antidepressent | stimulates NE and 5-HT by blocking alpha2 and 5HT-1 receptors
69
what medication might you give to an anorexic nervosa patient and why
Mirtazapine | increases appetite and weight gain early in therapy
70
what medications should be avoided with high suicide risk patients
TCA | MAOI
71
what medications should be avoided with sensitivity to anticholinergic side effects
TCA
72
what medications should be avoided with eating disorder and depression
bupropion
73
what medications should be taken with depression and chronic pain
SSRI
74
what medications should be taken with weight gain on another anti-depressent
bupropion or SSRi | avoid mirtazapine
75
what medications should be taken with sexual dysfunction
bupropion | nefazodne
76
what drug is used to treat mania? a characteristic
Lithium | - low therapeutic index
77
What is monitored if a person is on Lithium
serum or urine levels daily during treatment of acute mania
78
what are side effects of lithium
weight gain polyuria, polydipsia ( by inhibiting ADH) hypothyroidism
79
Lithium is contraindicated with what
renal disease
80
MOA for carbamazepine
block NA channel
81
MOA for valproic acid
bock NA channels, increases GABA
82
MOA for Lamotrigine
block Na channels | inhibit glutamate release
83
Lamotrigine needs to be tritrated slowlydue to risk of what
Steven-Johnson syndrome
84
Fish oil Omega-3 fatty acids deceases what activity
MOA-B

D&T2 Exam 1 (22 decks)

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