Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

*5. Neuro > Pharmacology: affective disorders > Flashcards

Pharmacology: affective disorders Flashcards

1
Q

3 examples of affective disorders?

A

Depression, mania, bipolar disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In affective disorders, there is disrupted interplay between various parts of the brain involved in controlling affect (mood). What are these?

A

Cortical areas (especially the prefrontal area and the anterior cingulate cortex)
Limbic system (hippocampus and amygdala)
Hypothalamus, pituitary, brainstem
Basal ganglia
Ventral tegmental area and nucleus accumbens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

BIOGENIC AMINE HYPOTHESIS
- Is also known as:
- Colloquially, is known as:
- What is the hypothesis? Impacts in depression vs mania?
- Biological mechanisms which may underpin the hypothesis?

A
  • Monoamine hypothesis
  • Chemical imbalance
  • Affective disorders are due to imbalances of biogenic amines (serotonin and NA) - deficient in depression, surplus in mania
  • Receptor abnormality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

BIOGENIC AMINE HYPOTHESIS
- Evidence against this hypothesis?

A
  • Not all patients respond to antidepressants
  • Drugs quickly affect NT levels, but effectson mood usually take a long time to occur (however, could be due to neuroplasticity taking time to occur).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DEPRESSION
Pathophysiology?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ANTI-DEPRESSANTS
4 synaptic sites of action of antidepressants?

A

Postsynaptic receptor (increased sensitivty)
Presynaptic receptor (less autoregulation)
Reduced presynaptic breakdown (eg. by MAO in mitochondria)
Reuptake pumps (inhibited)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ANTIDEPRESSANTS
General considerations:
- Up to how long can it take to see their full clinical effect? Why?
- Can adherence be a problem?
- Can suicidal intent be a problem? Why?
- Concerns for using on people under 25?

A
  • 8 weeks - as it can take this long or synaptic changes to occur
  • Yes
  • Yes: 8 week period; may now have the motivation to carry out plan
  • Can impact brain dev, as it’s still growing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

7 classes of antidepressants?

A
  • Selective serotonin reputake inhibitors (SSRI’s)
  • Selective noradrenaline reuptake inhibitors (NRI’s)
  • Serotonin noradrenaline reuptake inhibitors (SNRI’s)
  • Tricyclic antidepressants
  • Tetracyclic antidepressants
  • MAO inhibitors
  • Other drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ANTIDEPRESSANTS
Selective serotonin reuptake inhibitiors (SSRIs)
- MOA?
- Are they common?
- Are they first line treatment for depression in many cases?
- Can they take time to work, and initially worsen depression?
- Examples?

A
  • Block serotonin reuptake pumps –> more available in synapse
  • Yes
  • Yes
  • Yes
  • Sertraline, escitalopram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ANTIDEPRESSANTS
Selective serotonin reuptake inhibitors
- ADRs?

A
  • Insomnia (best taken in the morning)
  • Nausea
  • Dizziness
  • Initial worsening of anxiety and depression, increased suicide risk
  • Serotonin syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ANTIDEPRESSANTS
Serotonin syndrome
- What is it?
- What can cause it?

A
  • A syndrome (group of symptoms) associated with too high levels of serotonin
  • Some foods and medicines (eg. antidepressants, some opioids/migraine medications) –> high dose of a single drug, taking more than one serotonergic drug, inadequate washout period between drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ANTIDEPRESSANTS
Serotonin syndrome
- Is there sufficient evidence supporting the benefits of using 2 or more antidepressants?
- Does this outweigh the risks of serotonin syndrome?
- Why might people be prescribed 2 or more serotonergic drugs?

A
  • No; doesn’t outweigh risk
  • May take one for depression, another for another indication (eg. pain/migraine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ANTIDEPRESSANTS
Serotonin syndrome
- Symptoms? (Don’t memorise them all)

A
  • Hyperreflexia, clonus, tremor, incoordination
  • Shivering, sweating, fever
  • Diarrhoea
  • Mental state challenges - confusion, hypomania, agitation, nervousness
  • Severe: tachycardia, hyperthermia, delirium, convulsions, organ system failure, death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ANTIDEPRESSANTS
Selective noradrenaline reuptake inhibitors (NRI’s)
- MOA?
- Are they as common or effective as SSRIs/SNRIs?
- ADRs?
- Example?

A

Block NA reuptake
No
Dizziness, insomnia
Reboxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ANTIDEPRESSANTS
Serotonin noradrenaline reuptake inhibitors (SNRIs)
- MOA?
- Are they newer drugs (compared to SSRI’s and NRI’s?)
- Are they more selective for receptors than the others?

A
  • Block reuptake of both serotonin and noradrenaline
  • Yes
  • Yes
  • Yes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ANTIDEPRESSANTS
Serotonin noradrenaline reuptake receptors
- ADRs?
- Are there fewer ADRs compared to the other antidepressants?
- Examples?

A
  • Hypertension, hypercholesterolemia; nausea, dizziness
  • Yes, fewer ADRs
  • Venlafaxine, duloxetine (treats neuropathic pain)
17
Q

ANTIDEPRESSANTS
Tricyclic antidepressants
- Are they a relatively older type of drug?
- MOA?
- Example?

A

Yes
Inhibits NA and serotonin reuptake
Amitriptyline

18
Q

ANTIDEPRESSANTS
Tricyclic antidepressants
- ADRs?
- Because of their ADRs, are other antidepressants generally preferred?

A

Anticholinergic
Cardiac dysrhythmias (lethal in overdose)
Yes

19
Q

ANTIDEPRESSANTS
Tetracyclic antidepressants
- Are they a relatively older type of drug?
- MOA?
- Example?

A
  • Yes
  • Blocks presynaptic alpha 2 adrenoreceptors –> reduced autoregulation of NA release –> increased NA
  • Indirectly increases serotonin release
  • Mirtazapine
20
Q

ANTIDEPRESSANTS
Tetracyclic antidepressants
- ADRs?
- Given this, specific indications for these antidepressants?

A
  • Sedation (due to antihistamine properties) and increased appetite
  • May be indicated for depression with insomnia/unintentional weight loss
21
Q

ANTIDEPRESSANTS
MAO inhibitors
- MOA?
- Can MAO inhibitors be both reversible and irreversible?
- Are there both MAO A and B subtypes?
- Why is selective MAO inhibitors preferred to non selective (ie both A and B?)

A
  • Inhibits MAO (monoamine oxidase) –> less monoamine (serotonin and NA) breakdown
  • May be reversible or irreversible
  • Yes
  • When non selective, both MAO A and B breaks down tyramine (found in some foods) in the liver - acts as indirectly acting sympathomimetic –> lots of NA released –> sympathetic crisis; THUS dietary restrictions are required.
22
Q

ANTIDEPRESSANTS
MAO inhibitors
- ADRs?
- Examples?

A
  • Sleep disturbances, dizziness, nausea
  • Phenelzine (irreversible), moclobemide (reversible)
23
Q

ANTIDEPRESSANTS
3 other drugs?

A
  • Vortioxetine
  • Melatonin
  • St John’s Wort
24
Q

ANTIDEPRESSANTS
Vortioxetine
- Is it relatively new?
- MOA?
- ADRs?

A
  • Yes
  • Inhibits serotonin reuptake
  • Increases serotonin receptor activity
  • Headache, nausea
25
Q

ANTIDEPRESSANTS
Melatonin
- Is it relatively new?
- MOA?
- ADRs?

A
  • Yes
  • Melatonin receptor agonist
  • Fatigue/drowsiness
26
Q

ANTIDEPRESSANTS
St John’s Wort
- Evidence base?
- ADRs?
- Impact on other drugs?

A
  • Some evidence showing it is beneficial in mild-moderate depression
  • Dry mouth, headache, photosensitivity, palpitations
  • Induces liver CYP enzymes –> drug interactions
27
Q

ANTIDEPRESSANTS
- Is it important that guidelines are followed when switching between antidepressants?
- Is it important to taper antidepressant reduction to prevent withdrawal?

A
  • Yes
  • Yes
28
Q

BIPOLAR DISORDER DRUGS
- First line drugs?
- Second line drug?

A
  • Antipsychotics and antiepileptics
    Lithium carbonate
29
Q

BIPOLAR DISORDER DRUGS
Antipsychotics and antiepileptics
- Why is it first line, and not lithlium carbonate?
- Antiepileptic MOA?
- Antipsychotic MOA?

A
  • Safer and acts faster
  • Antiepileptics: via anticonvulsant activity
  • Antipsychotics: via antagonism of dopamine and serotonin
30
Q

BIPOLAR DISORDER DRUGS
Antipsychotics and antiepileptics
- 2 examples of antipsychotics?
- 2 examples of antiepileptics?

A

Antipsychotics: quetiapine, olanzapine
Antiepileptics: valproate, carbamazepine

31
Q

BIPOLAR DISORDER DRUGS
Lithlium carbonate
- MOA?
- How long does it take to become effecitve?

A
  • Substitutes itself for sodium ions, altering APs and neuronal signalling to reduce transmitter release
  • ~2 weeks
32
Q

BIPOLAR DISORDER DRUGS
Lithlium carbonate
- Indications?

A
  • Stabilise mood
  • Prophylaxis in difficult to control illness
33
Q

BIPOLAR DISORDER DRUGS
Lithlium carbonate
- ADRs?

A
  • Cardiac dsrhythmia, convulsions, hypothyroidism, diarrhoea
  • Narrow margin of safety (very toxic)

*5. Neuro (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions