Term
| What classes of drugs are available to treat depression? |
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Definition
Antidepressants
1) Older (TCI's/ MAOI's)
3) New (SSRI's) |
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Term
| What classes of drugs are available to treat Mania? |
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Definition
1) Mood stabilizers (Lithium: Anticonvulsants-Valproate, CBZ, Lamotrigine)
2) Antipsychotics
- Old "Typicals"
- New "Atypicals" |
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Term
| What are the 5 major Anxiety disorders and the drug classes that treat them? |
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Definition
Treat with Anti-depressents (Old or New) for Prevention
Treat with Anxiolytics (Benzos) for Acute symptoms
1) OCD
2) PTSD
3) Generalized AD
4) Specific and Social Phobias
5) Panic Disorder |
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Term
| How does the "Monoamine Hypothesis" relate to anti-depressent drug mechanisms? |
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Definition
Depression/anxiety results from inadequate monoamine (5-HT, NE, DA) transmission, so BOOST IT!
Problem is they are non-specific!
1) MAOI's block breakdown of NTs
2) TCA's, SSRIs block NE and/or 5-HT uptake |
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Term
| What are the major serotonin receptor subtypes and their proposed effect of stimulation? |
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Definition
1A is the one you want to hit, but all are in the CNS!
1) 5HT1A found in CNS
- Anti-depressent, Anti-anxiety, Improved cognition
2) 5HT1B found in CNS
- Agitation, anxiety, akathisia, panic
- Insomnia, myoclonic jerks, sexual dysfunction
3) 5HT3 (CNS)
- Nausea, diarrhea, GI upset, Headache |
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Term
| What is the difference between alpha-1 NE and alpha-2 NE receptors in terms of effects of stimulation/inhibition? |
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Definition
Opposite actions in PNS (1 increases BP and 2 decreases BP!)
1) When stimulated, Alpha-1 increased BP
- When inhibited, leads to dizziness, orthostatic hypotension and tachycardia (reflex)
2) When stimulated, alpha-2 decreases BP |
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Term
| What clinical effect would a Beta-NE receptor antagonist have? |
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Definition
Beta-NE exert antidepressant effects in CNS (other NE act in PNS), but can cause panic.
If you inhibit, you could get depressed! |
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Term
| What clinical effect would a DA receptor antagonist have? |
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Definition
| Decrease Agitation, but possibly cause sexual dysfunction. |
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Term
| What clinical effect would a Histamine (H1) receptor antagonist have? |
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Definition
| CNS action causing sedation and weight gain |
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Term
| What clinical effect would a mACH-receptor antagonist have? |
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Definition
-Blurred vision
- Dry mouth
- Sinus tachycardia
- Constipation
- Urinary retention
- Memory/Cognitive impairment |
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Term
| What are the 6 major SSRIs and how do you distinguish between them? |
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Definition
1) Fluoxetine
-long half-life: active metabolite with > interactions
2) Paroxetine
- Most anti-ACh of SSRI's with > interactions
3) Sertraline
- Well tolerated < interactions
4) Fluvoxamine
- >>> Interactions
5) Citalopram
- Well tolerated < interactions but concerns about QT prolongation
6) Escitalopram
- "S" enantiomer of Citalopram with fewer SE. |
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Term
| Which SSRIs have relatively greater drug/drug interactions? |
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Definition
1) Fluvoxamine is the WORSE (don't give to old people)
2) Fluoxetine/Paroxetine have relatively more |
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Term
| Which 2 SSRIs are enantiomers of each other? |
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Definition
1) Citalopram
2) Escitalopram (S enantiomer)- PREFERRED |
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Term
| Which SSRIs are relatively well tolerated with few drug/drug interactions? |
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Definition
1) Sertraline
2) Citalopram (QT prolongation concern)
3) Escitalopram (enantiomer of 2) |
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Term
| What is the only available NE and DA re-uptake inhibitor used to treat Depression? |
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Definition
Bupropion is NDRI with little 5-HT activity
- newer generation often used to supplement patients that only partially response to SSRIs (also marketed for smoking cessation)
- DON'T GIVE IF HX of PSYCHOSIS |
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Term
| What are the 3 available SNRIs used to treat depression and their important effects? |
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Definition
1) Venlafaxine (causes HTN in some)
2) Desvenlafaxine (active metabolite of 1)
3) Duloxetine (also used for neuropathic pain from diabetes) |
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Term
| Which anti-depressent is a "NASA" acting on NE and 5-HT and what are its associated side effects? |
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Definition
Mirtazapine
- Sedating and stimulates appetite (antihistamine effects as well) |
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Term
| What are the 5 major TCAs used to treat depression? |
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Definition
Older drugs with similar mechanisms to SSRIs, blocking re-uptake at synapse.
- DUAL-agents (NE and 5-HT) with potentially fatal side effects such as Arrhythmia ("torsades de pointes" with increased QT interval)
1) Desipramine
2) Nortryptyline
3) Amitriptyline
4) Imipramine
5) Clomipramine |
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Term
| What are the 3 major MAOIs used to treat depression and how do they work/what side effects do they cause? |
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Definition
Inhibit enzyme that breaks down NE/5-HT/DA, but can cause Hypertensive crisis from ingesting tyramine ("cheese crisis")
- DON'T MIX with SSRIs
1) Phenelzine
2) Tranylcypromine
3) Selegiline |
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Term
| Why not mix MAOIs with SSRIs? |
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Definition
| Combination of re-uptake inhibition with MAO inhibition can cause dangerously high 5-HT levels and lead to 'Serotonin Syndrome' (Elevated pulse and BP, confusion, muscle stiffness and fever) |
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Term
| What is the "Dopamine Hypothesis" of Schizophrenia? |
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Definition
ALL anti-psychotics act on D2
1) Excessive DA transmission is responsible for (+) symptoms
2) Deficit in DA transmission in motivation/attention/cognition pathways causing (-) symptoms |
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Term
What are the 4 key DA pathways in the brain and how do they function in the context of Schizophrenia?
What happens to this activity when you give anti-psychotic medications? |
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Definition
1) Mesolimbic (+ symptoms)- Elevated
- D2 antagonist deceases hallucinations/delusions
2) Mesocortical (- symptoms)- Reduced
- D2 antagonist worsens negative symptoms
3) Nigrostriatal- Normal
- D2 antagonist induces Parkinsonism
4) Tuberoinfundibular (prolactin)
- D2 antagonist cause cause hyperprolactinemia |
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Term
What are 2 examples of potent 1st-generation anti-psychotics?
Why might you give Decanoate instead? |
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Definition
1) Haloperidol (IM/PO/IV) and Fluphenazine
2) Decanoate are injected deep into muscle within sesame oil, allowing gradual release |
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Term
| What are the 7 major Atypical anti-psychotics and their side-effects? |
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Definition
1) Risperidone (Hyperprolactinemia, Extrampyramidal)
2) Olanzapine (Most weight gain)
3) Clozapine (Most weight gain, rare Agranulocytosis)
4) Quetiapine (Sedation, Weight gain)
5) Ziprasidone (Weight "neutral", QTc prolongation)
6) Aripiprazole (Partial DA-R agonist)
7) Paliperidone (Active metabolite of Respiridone) |
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Term
Which atypical antipsychotic medications cause weight gain?
What is the "weight neutral" option? |
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Definition
1) Olanzapine and Clozapine are the MOST
- Quetiapine can cause weight gain as well
2) Ziprasidone is weight-neutral, but look out for QTc prolongation. |
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Term
| Why give Atypical anti-psychotics instead of Typical Psychotics such as Haloperidol or Flephenazine? |
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Definition
1 )Extrapyramidal symptoms
- Parkinsonism
- Temporary and managed by anti-ACh (benadryl)
2) Neuroleptic Malignant Syndrome (NMS)
-RARE all-over muscle rigidity caused by D2 blockage (gradual)
- high levels of CMK are seen in blood
- STOP and flush with IV fluids
3)Tardive Dyskinesia
- Writhing movements (can be permanent) that can look like Chorea
- Switch them to atypical
4) Acute Dystonic reactions
- sudden-onset contraction of single group of muscles that can be painful/frightening
- IM injection of anti-ACh such as benadryl/congentin will work instanstly |
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Term
| Why check fasting glucose, lipids and body weight prior to providing Atypical Anti-psychotics? |
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Definition
Metabolic Syndrome is possible (Diabetes risk)
1) Elevated serum glucose
2) Triglycerides
3) Body weight |
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Term
According to the "Dopamine Hypothesis," the negative symptoms in Schizophrenia (affecting flattening, amotivation, alogia) result from a deficit in DA transmission in which brain pathway?
a. Nigrostriatal
b. Tuberoinfundibular
c. Mesolimbic
d. Mesocortical |
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Definition
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Term
Which of the following antidepressants ins the most dangerous if taken in overdose?
a. Sertraline
b. Imipramine
c. Paroxetine
d. Escitalopram
e. Fluvoxamine |
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Definition
B (Imipramine is a TCA....Torsades de pointes!)
- Sertraline, Fluvoxamine, Paroxetine and Escitalopram are all SSRIs |
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Term
As a class, the newer 'atypical' antipsychotics have a lower incidence of certain adverse reactions and side effects than the older 'typical' antipsychotics. Which side effect or adverse reaction actually more common with atypicals?
a. Neuroleptic Malignant Syndrome
b. Acute Dystonia
c. Tardive Dyskinesia
d. Weight Gain |
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Definition
| D (park of Metabolic syndrome that can cause Diabetes) |
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Term
According to the "Monoamine Hypothesis," Depression can result from insufficient neurotransmission of specific monoamines in brain pathways that regulate mood. Which of the following is not one of the monamines implicated in the treatment of depression?
a. ACh
b. DA
c. 5-HT
d. NE |
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Definition
| A (anti-ACh agents are sometimes given with other antipsychotic agents, though). |
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Term
Adults in late life are very susceptible to the cognitive side effects of anti-ACh medications. Which antidepressant might be best to avoid in this population, for this reason?
a. Bupropion
b. Citalopram
c. Paroxetine
d. Sertraline |
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Definition
C- Paroxetine is an SSRI with anti-ACh properties
- Sertraline (well-tolerated) and Citalopram (QT prolongation) are SSRIs without anti-ACh
- Buproprion affects NE and DA (little 5-HT), and is a concern for Hx of Psychosis. |
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