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PT2 Psych 7-12 > antidepressants pharmacology > Flashcards

antidepressants pharmacology Flashcards

1
Q

diagnosis of major depressive disorder

A

at least 5 of the following lasting over 2 weeks

  • depressed, sad mood
  • loss of pleasure or interest
  • significant changes in weight/appetite
  • significant sleep alterations
  • psychomotor agitation, restlessness, irritability
  • fatigue
  • sense of worthlessness, helplessness, or guilt
  • decreased concentration
  • recurrent morbid thoughts or suicidal ideation
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2
Q

persistent depressive disorder

A 
low sad mood on most days for at least 2 years with two of the following symptoms:
-hopelessness
-hypo/hypersomnia
-fatigue
-low self esteem
poor appetite
-poor concentration
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3
Q

disruptive mood dysregulation disorder

A

childhood disorder with extreme irritability, anger, and frequent intense temper outbursts

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4
Q

subtypes of depression

A
  • melancholic (vegetative)
  • reactive
  • psychotic (associated w/ hallucinations)
  • atypical (overeating, weight gain)
  • seasonal pattern (2 episodes in same season in subsequent years)
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5
Q

what percentage of the risk for depression based on genetic factors

A

40%

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6
Q

depression vulnerability is linked to

A
  • neurotrophins, ie. BDNF

- CLOCK genes

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7
Q

role of CLOCK genes

A

regulate circadian rhythms and sleep

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8
Q

neurotransmitters associated with depression

A

serotonin

norepinephrine/dopamine

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9
Q

serotonin synthesis pathway

A

tryptophan >tryptophan hydroxylase> 5-hydroxytryptophan >L-amino acid decarboxylase> serotonin

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10
Q

rate limiting step in serotonin production

A

tryptophan hydroxylase

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11
Q

serotonin cell bodies location

A

raphe nuclei

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12
Q

norepinephrine cell bodies location

A

locus coeruleus

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13
Q

Brain-derived neurotrophic factor (BDNF) role

A
  • cell growth and function of nervous system
  • apoptosis
  • learning and memory
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14
Q

what regulates synthesis and release of BDNF

A

monoamines

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15
Q

risk factors for depression

A
  • female
  • minorities
  • low education levels
  • unable to work/unemployed
  • no health insurance
  • relatives w/ depression, anxiety or alcohol use
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16
Q

non-genetic causes of depression

A
  • chronic inescapable stress

- viral infections, urbanicity, early trauma in early life

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17
Q

neurotransmitter sequence in HPA axis

A
  • CRH from hypothalamus to anterior pituitary
  • ACTH from pituitary to adrenal gland
  • cortisol from adrenal gland
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18
Q

cortisols effect on hypothalamus and anterior pituitary

A

inhibitory (negative feedback)

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19
Q

cortisols effect on body

A

metabolic - causes elevation of blood glucose

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20
Q

cortisols effect in CNS

A
  • acute: increases release of glutamate

- chronic: reduces serotonin, NE, and BDNF (synaptic changes and dentrite remodeling)

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21
Q

disorder of synaptic plasticity

A

depression

-result of maladaptive emotional learning

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22
Q

negative affective bias

A
  • tendency to interpret reality in a pessimistic way
  • seen in subject w/ chronic stress that modifies the shape and connectivity of neurons
  • a genetic predisposition for depression
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23
Q

HPA axis is activated in response to (and cortisol released)

A

chronic stress

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24
Q

the ultimate cause of depression

A

increase in cortisol and changes in serotonin and NE causes changes in BDNF which alters synaptic plasticity causing depression

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25
Q

changes in serotonin and NE lead to changes in

A

dendritic arbor

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26
Q

why is there lag in antidepressants

A

it takes time for serotonin and NE to remodel the dendritic arbor

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27
Q

neuroendocrinology of depression

A
  • HPA axis is upregulated and loses its negative feedback controls
  • hypercortisolemia is associated with reduced synaptic formation
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28
Q

BDNF levels in hippocampus and nucleus accumbens in depression

A
  • hippocampus decreased due to chronic stress

- nucleus accumbens increased

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29
Q

activity level of structures in the brain in depression

A
  • hypoactive prefrontal cortex
  • hyperactivity of amygdala and other limbic regions
  • hypoactivity of hippocampus
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30
Q

why is psychotherapy needed in treatment of depression

A

depression is a maladaptive learning pattern that takes a negative view; through treatment pts can reshape how they interpret the world into a positive way

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31
Q

ketamine use in depression

A

NMDA antagonist that helps shape new synapses, effectively stopping maladaptive learning from taking place

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32
Q

nonpharm treatment for seasonal affective disorder

A

photic therapy (helps increase serotonin levels)

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33
Q

nonpharm for treatment-refractory depression with risk of suicide

A
  • electroconvulsant therapy

- deep brain stimulation

34
Q

serotonin transporter (SERT) characteristics

A
  • 12 transmembrane loops
  • presynaptic
  • also in cell bodies and dendrites
  • transport is regulated by Na (cotransporter)
35
Q

serotonin is degraded by what in the presynaptic neuron

A

MAO-A

36
Q

SSRI

A 
citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
37
Q

initial adverse effects of SSRIs

A
  • insomnia
  • anxiety
  • irritability
  • suicidal thought
  • N/V
38
Q

adverse effects of SSRIs that persist after 4th week

A
  • anhedonia and apathy
  • drowsiness
  • decreased libido
  • fatigue
  • bruxism
39
Q

SSRI withdrawal syndrome symptoms

A 
dizziness
headache
nervousness
nausea
insomnia
40
Q

unique paroxetine adverse effect

A

risk of congenital cardiac malformation

41
Q

unique citalopram adverse effect

A

QT prolongation

42
Q

SSRI discontinuation syndrome

A
  • “brain zaps” (electric shock-like sensations)
  • sweating
  • nausea
  • insomnia
  • tremor
  • confusion
43
Q

vortioxetine MoA

A
  • inhibition of SERT
  • 5-HT7 antagnoist
  • %-HT3 antagonist (no nausea)
44
Q

vortioxetine place in therapy

A

useful in pts with lots of N/V, but not as efficacious as SSRIs

45
Q

vortioxetine side effects

A

same as SSRIs but less sexual side effects

46
Q

vilazodone MoA

A
  • inhibition of SERT

- partial 5-HT1A agnoist

47
Q

vilazodone side effects

A
  • diarrhea
  • nausea
  • headache
  • lower sexual side effects
48
Q

trazodone MoA

A

-5-HT2A receptor antagonist

49
Q

trazodone side effects

A
  • dry mouth
  • blurred vision
  • dizziness
  • fatigue
  • N/V
  • increased libido and priapism
50
Q

Nefazodone has same side effects as trazodone except

A

priapism

51
Q

SNRI drugs

A

venlafaxine
desvenlafaxine
duloxetine
milnacipran

52
Q

SNRI general MoA

A

block SERT and NET

53
Q

SNRI that can also affect dopamine levels

A

venlafaxine

54
Q

adverse effects of SNRI

A
  • SSRI effects

- increased energy and suicide risk

55
Q

venlafaxine unique side effect

A

cardiotoxicity

56
Q

duloxetine unique side effect

A

hepatic failure

57
Q

bupropion MoA

A
  • potent dopamine transporter inhibitor

- nicotinic antagonist

58
Q

bupropion adverse effects

A
  • low seizure threshold
  • high risk of suicide
  • headache, dizziness
  • no weight gain or sexual dysfunction
59
Q

TCA general MoA

A

inhibit serotonin and norepinephrine transporters

60
Q

essential amino in TCAs and SSRIs interacts with what

A

asp-98 in SERT

61
Q

TCA drugs

A 
amitriptyline
desipramine
doxepin
imipramine
nortriptyline
protriptyline
trimipramine
62
Q

TCA contraindications

A

bipolar disorder

manic depression

63
Q

drugs associated with LDH leakage and tissue damage of heart

A

TCAs

64
Q

TCA side effects

A
  • reduced seizure threshold
  • arrhythmia
  • cardiotoxicity
  • anticholinergic effects
  • sedation
  • orthostatic hypotension
  • weight gain
65
Q

mirtazapine MoA

A
  • stimulates NE release through alpha2 antagoist effects
  • blocks SERT
  • blocks 5-HT2c and histamine
66
Q

mirtazapine side effects

A
  • somnolence
  • increased appetite
  • weight gain
  • xerostomia
  • constipation
67
Q

MAO A metabolizes what

A

serotonin, NE, and dopamine

68
Q

MAO B metabolizes what

A

dopamine and phenylethylamine

69
Q

reversible MAO A inhibitor

A

moclobemide

70
Q

Cheese effect is due to

A

-irreversible MAO A inhibition

71
Q

cheese effect

A

high blood pressure and severe CV crises resulting from tyramine containing food

72
Q

foods with tyramine

A

fermented foods such as cheese and wine; also bananas and avocados

73
Q

tyramine function

A

causes increased NE release when not metabolized by MAO A

74
Q

drugs that are irreversible MAO A and B inhibitors

A

isocarboxazid
phenelzine
tranylcypromine

75
Q

drugs that are irreversible MAO B inhibitors

A

selegiline

rasagiline

76
Q

MAO A inhibitors are used for

A 
depression
dysthymia
panic disorder
PTSD 
OCD
77
Q

MAO B inhibitors are used for

A

parkinsons

neurodegenerative diseases

78
Q

MAOI adverse effects

A
  • drowsiness/fatigue
  • low blood pressure
  • decreased libido
  • weight gain
  • tons of other stuff
79
Q

serotonin syndrome risk associated with

A

use of MAOIs and SSRI/SNRI/TCA

80
Q

MAO that don’t have serotonin syndrome risk

A

MAO A selective drugs

81
Q

serotonin syndrome signs

A
  • cognitive abnormalities (agitation, euphoria, confusion)
  • autonomic abnormalities (hypertherpia, tachycardia, diaphoresis)
  • neuromuscular abnormalities (muscle rigidity, tremors, ataxia)

PT2 Psych 7-12 (5 decks)

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