Pharmacology of Antidepressants

Question 1

which drugs have the most effect in moderate depression

Answer 1

most of the drugs have a similar effect

Question 2

which drugs are most effective in severe depression

Answer 2

TCAs

Question 3

what are teh 3 cardinal symptoms of depression

Answer 3

anergia, low mood and anhedonia

Question 4

outline the criteria for mild, moderate and severe depression

Answer 4

Question 5

do AD work immediately?

Answer 5

no, take around 2-6 weeks

Question 6

how long do depressive symptoms need to be present for for crtieria?

Answer 6

most of teh day for the past 2 weeks

Question 7

are dosing adjustments amde for older patients?

Answer 7

yes, they dont need as large as an adult dose

usually start on half the adult dose

Question 8

what happens if you start a patient on an AD and see no change?

Answer 8

assess after 4-6 weeks

increase dose and review in 2 weeks

if after 6 weeks at max/max tolerated dose there is still non/inadequate response - switch drug

Question 9

if eg fluxoetine doesnt work cn you switch to citalopram?

Answer 9

no, must swittch AD class

Question 10

how long after resolutionof symptoms must AD be continued for, and after recurrence

Answer 10

6-12 months

12-24 if recurrence

Question 11

what happens if you stop AD too soon?

Answer 11

50% relapse

Question 12

in which circumstances would AD be continued indefinitely?

Answer 12

3rd relapse, or very severe

Question 13

what is the monoamine hypothesis

Answer 13

suggests that depression results from functionally deficient monoaminergic transmission in the CNS. although this is too simple to fully explain depression, pharmacological theory is based on increasing the monoaminergic transmission

Question 14

endocrinology and depression

Answer 14

dexamethasone suppression test is abnormal in 1/3 patients - abnormally weak response of plasma cortisol to exogenous steroid

this may reflect monomaine transmission in the hypothalamus

Question 15

what is the first derivative of serotonin

Answer 15

tyrptophan

Question 16

what is noradrenaline made from

Answer 16

Question 17

what is the role of monoamine oxidase enzyme

Answer 17

removes the neurotransmitters norpinehrine, serotonin and dopamine from the brain by reabsorbing them from teh synpatic clefr and breaking them down

Question 18

mechanism of action of SSRIs

Answer 18

selectively inhibit the reuptake of serotonin from the synaptic cleft

Question 19

which drug is used first line in depression

Answer 19

usually SSRI, individuals respond differently to different drugs

Question 20

when are SSRIs taken

Answer 20

morning, reduce insomnia

Question 21

use of SSRIs in teh elderly

Answer 21

avoid! they cause hyponatraemia and falls

Question 22

SSRIs and sexual function

Answer 22

can cause sexual dysfunction and failure of orgasm

Question 23

what effect do SSRIs have on weight

Answer 23

can cause anorexia

Question 24

drug for patient with depression and obesity?

Answer 24

fluoxetine causes weight loss

Question 25

drug interactions with SSRIs

Answer 25

there is an increased risk of GI bleeding if taken with NSAIDs

Question 26

which 2 SSRIs are best for patients who are worried about drug interactions

Answer 26

citalopram and sertralie have the lowest risk of interactions

Question 27

are there discontinuation symptoms with SSRIs?

Answer 27

yes, similar to AE myoclonus too

Question 28

which SSRi is the safest in cardiac problems?

Answer 28

sertraline

Question 29

what is there an increased risk of with SSRIs, especially in teens

Answer 29

transient increase in self harm or suicidal ideation, more likely in younger person

Question 30

depression in the elderly

Answer 30

avoid SSRIs half dose of TCA

Question 31

mechanism of action of TCAs

Answer 31

block the reuptake of monoamines into presynaptic terminals (mainly noradrenaline and serotonin)

Question 32

in which class of depresion are TCAs good

Answer 32

severe, and elderly

Question 33

what are the main AE of TCAs

Answer 33

they have anticholinergic effects as block M2 and M3 receptors in smooth muscle: bladder (urinary retention), vascular and airways, blurred vision, dry mouth, constipation

Question 34

do TCAs have an effect on weight?

Answer 34

cause weight gain

Question 35

when are TCAs taken

Answer 35

at night - they cause sedation

Question 36

what problems can teh sedation from TCA cause

Answer 36

daytime performance affected by drowsiness and difficulty concentrating

Question 37

what are the CVS side effects of TCAs

Answer 37

cause postural hypotension, tachycardia and in more severe cases arrhythmias

Question 38

what type of event would deem patients as having an increased arrhythmias risk, and so should avoid TCAs

Answer 38

eg post MI

Question 39

overdose of TCAs

Answer 39

are cardiotoxic initially, excitement and delirium and convulsions cardiac dysrhythmias (heart block)

Question 40

how does sudden death usually occur in TCA overdose

Answer 40

usually due to atrial fibrillation

Question 41

why should TCAs be avoided in those with suicidal intent

Answer 41

due to cardiotoxicity

Question 42

how do dual reuptake inhibitors work

Answer 42

block the reuptake of monoamines noradrenaline and 5HT into presynaptic terminals

Question 43

when are dual reuptake inhibitors taken

Answer 43

in the morning - insomnia

Question 44

what other use does duloxetine have

Answer 44

neuropathic pain and bladder instability (stres incontinence)

Question 45

when are dual reuptake inhibitors usually used

Answer 45

if SSRI hasnt worked excellent in combination with mirtazapine

Question 46

in which cases may mirtazapine be considered first line

Answer 46

if patient has insomnia and or poor appetite

Question 47

does mirtazapine have a faster or slower onset than others

Answer 47

faster

Question 48

what substance should mirtazapine not be combined with

Answer 48

alcohol - can cause GI upset

Question 49

trazodone

Answer 49

monoamine receptor antagonist

Question 50

which drug can cause priapism

Answer 50

trazodone, MARA