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Neuro final > Slattery Antidepressants > Flashcards

Slattery Antidepressants Flashcards

1
Q

What is the amine hypothesis of mood disorders?

A

Monoaminergic receptors insensitive/NT function deficient (this is depression)

Receptors too active in mania

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2
Q

Neurotrophic hypothesis of mood disorders?

A

No BDNF (brain derived neurotrophic factor)

BDNF important in resilience and neurogenesis

Chronic antidepressants can increase BDNF in cortex

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3
Q

What area of brain is depression linked to?

A

Limbic system

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4
Q

What are examples of a TCA

A

Desipramine and Imipramine

IPRAMINE!!!

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5
Q

MOA of TCA

A

Despramine - block reuptake of NE

Imipramine - block reuptake of NE/5HT

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6
Q

Why should you not give Despramine/Imipramine and fluoxetine at the same time/close in time to each other?

A
  • TCAs are metabolized by CYP2D6
  • Fluoxetine inhibits CYP2D6
  • This is a toxic level of TCA because the therapeutic index for them are already really low
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7
Q

Adverse effects of despramine/imipramine

A

SWATO
- S - sleepiness (these block H1 histamine receptors too)

  • W - weight gain (histamine blocker)
  • A - antimuscarinic effects (decreased parasympathetic response because we’re increasing sympathetic response)… dry mouth, blurred vision, constipation
  • T - tachycardia (block Na channels)
  • O - orthostatic hypertension/light headedness (block alpha1 receptors)
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8
Q

What’s up with the therapeutic index of TCAs? (desipramine and imipramine)

A

LOW! 5-10

Only give your patients a 1 week supply because if they want to kill themselves they’ll use this

Don’t treat with fluoxetine and this too… that’d be bad

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9
Q

What is a MAOI that we need to know?

A

Phenelzine

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10
Q

MOA of MAOI (Phenelzine)

A

Inhibits MAOA and MAOB

We care about MAOA because that metabolizes NE and 5HT

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11
Q

What’s up with therapeutic index of MAOI Phenelzine?

A

It’s <5!!! This is super toxic!!!

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12
Q

Why would you be an idiot if you gave Phenelzine too close to an SSRI?

A

Serotonin syndrome

We are going to have way too much 5HT…. We’re blocking the reuptake AND inhibiting the metabolism (MAOA)

Your patient will have hyperthermia, muscle rigidity, tremors, confusion, agitation, DEATH

DO NOT GIVE SSRI WITH MAOI UNLESS YOU WANT TO KILL YOUR PATIENT

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13
Q

How long should you wait between Phenelzine and Fluoxetine (SSRI)

A

5 damn weeks. Don’t give them serotonin syndrome.

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14
Q

What foods/drugs can’t you eat if you’re on Phenelzine (MAOI)?

A

AGED CHEESE
RED WINE
BEER
EPHEDRINE COLD MEDS

All of these have TYRAMINE in them (sympathomimetic amine that will raise your blood pressure)

If you’re taking an MAOI you’re inhibiting the MAO in the liver too and so your liver can’t metabolize the tyramine that’s in your bad for your foods.

Tyramine is going to enter your circulation, RAISE YOUR BLOOD PRESSURE TO A DANGEROUS LEVEL AND KILL YOU

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15
Q

What are the SSRIs that we should know

A

Fluoxetine (Prozac)
Sertraline (Zoloft)
Escitalopram (Lexapro)

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16
Q

What is the mechanism of action of Fluoxetine, Sertraline, Escitalopram?

A

Inhibit reuptake of 5HT by inhibiting 5HT2a receptor

17
Q

Why shouldn’t you give an SSRI alone in bipolar disorder?

A

Because then your patient will just become manic and that’s not great either

18
Q

Why should you keep a close eye on your patient on an SSRI?

A

You might have given them a drug that will give them enough energy for them to kill themselves. That’d make you feel quite bad.

19
Q

So… SSRIs and TCAs pretty much have the same mechanism (for sure imipramine)… what makes an SSRI better?

A

Less adverse effects

TCAs have SWATO and with SSRIs we’ve just got GI distress and sexual dysfunction

20
Q

What is an atypical antidepressant that starts with a V?

A

Venlafaxine

21
Q

What does Venlafaxine do?

A

SNRI! (Serotonin norepinephrine reuptake inhibitor)
Inhibits reuptake of 5HT at low doses
Inhibits reuptake of norepinephrine at medium doses
Inhibits reuptake of dopamine in high doses!

22
Q

Why is an SNRI good?

A

Remember SNRI is Venlafaxine

It DOESNT ∆ adrenergic, histaminergic, cholinergic receptors! Don’t get orthostatic hypertension, weight gain, etc…

23
Q

Why would an SNRI be bad?

A

SEROTONIN-norepinephrine reuptake inhibitors…..

SEROTONIN SYNDROME DUH
Don’t give fluoxetine with it/too soon after

24
Q

What’s an atypical antidepressant that starts with an M?

A

Mitrazapine (Remeron)

25
Q

What’s the MOA of Mertazapine?

A

Block PRESYNAPTIC alpha receptors to increase NE/5HT!

These alpha receptors are serotonergic (heteroreceptors) or adrenergic (auto receptors)

26
Q

What happens NORMALLY with a serotonergic (heteroreceptor)? And why am I inhibiting this with Mirtazapine?

A

5HT released from presynaptic cell
5HT triggers autoreceptors to INHIBIT more 5HT release (from same neuron)
AND AND AND!
NE from neighboring neurons can act on the CLOSE BY ALPHA RECEPTOR to inhibit release of 5HT!!!

This is why it’s called a heteroreceptor

So… then this serotonergic heteroreceptor removes 5HT from the synapse…. THIS IS WHY WE INHIBIT IT WITH MIRTAZAPINE!

27
Q

What happens NORMALLY with an adrenergic (auto receptor)? What drug am I inhibiting this with?

A

MIRTAZAPINE!

NE released from the cell and….
Presynaptic alpha receptors take it back up

INHIBIT this with mirtazapine so you don’t have reuptake

28
Q

What’s an atypical antidepressant that starts with a B?

A

Buproprion!!

29
Q

Whats the MOA of Bupropion?

A

Inhibit reuptake of NE/DA

30
Q

What’s another thing that bupropion can be used in?

A

Smoking cessation

31
Q

What is the MOA of Ketamine?

A

NMDA glutamate receptor antagonist

32
Q

What’s good and bad about Ketamine?

A
  • Good - works in hours and can last a week…. sometimes used as anesthetic for children in the ER
  • Bad - gonna give you some nightmares and hallucinations
33
Q

What am I going to use Lithium for?

A

Who knows what the mechanism is

I’ll use it to treat bipolar disorder by increasing euthymia

34
Q

What’s bad about Lithium?

A

TOXIC!!!

Low therapeutic index

  • Normal levels - fatigue, muscle weakness, slurred speech,, nephrogenic diabetes insipidus
  • Toxic levels - ∆ LOC, muscle rigidity, coma

DON’T GIVE A DIURETIC WITH LITHIUM!

35
Q

Why shouldn’t I give a diuretic with Lithium?

A

More will be reabsorbed by the kidneys and because there’s already a low TI it’ll be toxic to you if you do

36
Q

Whats the MOA of Valproic acid??

A

Anticonvulsant but it can also treat bipolar disorder in the same way as lithium….

Combine VA and Lithium in patients who don’t respond to either

37
Q

What’s the MOA of Carbamazepine

A

ANTICONVULSANT! But also used to treat bipolar

Neuro final (6 decks)

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