What class: phenelzine?
MAOI
What class: Isocarboxazid?
MAOI
What class: Tranylcypromine?
MAOI
What class: Moclobemide
RIMA
What class: Amitryptiline
TCA (non-selective)
What class: Clomipramine
TCA
What class: Imipramine
TCA (non-selective)
What class: Noritryptiline
TCA (NA selective)
What class: Dosulepin
TCA
What class: Fluoxetine
SSRI
What class: (Es)citalopram
SSRI
What class: Sertraline
SSRI
What class: Fluvoxamine
SSRI
What class: venlaxafine
SNRI
What class: duloxetine
SNRI
What class: Reboxetine
NARI
What class: Mirtazapine
NaSSA
Anterior cingulate
Attention/conflict/response selection
Orbitofrontal cortex
Relative reward preference/rule learning
Class of drug which could be used to treat premature ejaculation
SSRI
Which SSRI’s inhibit CYP450?
Fluoxetine, paroxetine
Most common adverse effects of SSRIs
- sexual dysfunction
- GI (nausea, dyspepsia, constipation, diarrhoea)
- short term anxiety is fairly common
- in young people, there is probably an increased risk of self-harm (&suicide) in the first few weeks
TCA adverse effects
– Constipation – Dry mouth – Blurred vision – Effects on cardiac function – Postural hypotension (cholinergic and adrenergic blockade causing failure of peripheral orthostatic reflexes)
What does MAO A metabolise?
NA, 5-HT and tyramine
What does MAO B metabolise?
DA, tryamine and phenylethylamine
Name 3 irreversible MAOIs
Phenelzine
Isocarboxazid
Tranylcypromine
This type of drug is really good for atypical depression
MAOI
This type of drug results in increased NA and 5-HT storage and availability for release
MAOIS
Which foods could cause a tyramine crisis if you are on MAOIs?
Cheese, yoghurt, yeast extracts, meat, alcohol, broad beans, pickled herring
Symptoms of MAOI hypertensive crisis
Flushing headache, increased BP
-Rarely CVA
Treatment for MAOI hypertensive crisie
Alpha blockade –> PHENTOLAMINE / CHLORPROMAZINE !!! Learn !!!
Antipsychotic which may be antidepressant at low dose
Flupentixol
Types of mood stabiliser
Anti-convulsant drugs
“Atypical” antipsychotics
Others (lithium carbonate, NIMODOPINE)
-most mood stabilisers are anti-epileptic drugs (anti-convulsants)
How does lamotrigine work?
Blocks Na+ channels, although it doesn’t work directly via GABA, the overall effect is to reduce excitability and cell firing (potentially useful if you have over-excitable neurones)
-Lamotrigine may also inhibit 5-HT (plus NA and DA uptake as well)
One of the oldest mood stabilisers
-method of action unkown
Lithium
- method of action unknown
- but probably to do with inhibition of glycogen synthase kinase 3 (GSK-3)
True anti-psychotic activity is related to their affinity for which receptor?
The D2 receptor
-desired effect is DA blockade in the mesolimbic systems
Why can you get adverse effects such as movement disorders and hyperprlactinaemia with anti-psychotics?
Due to the DA blockade in the nigrostriatal and tubero-infundibular pathways)
If you block the nigrostriatal pathways what happens?
Movement disorders
If you block the tubero-infundibular pathways, what happens?
Hyperprolactinemia
Which 5-HT receptors increase anti-psychotic affinity
5-HT2c and 5-HT2a
Which 5-HT receptors decrease anti-psychotic efficiency
5-HT1a