Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
63 Cards in this Set
- Front
- Back
|
Which 2 of the following NT system is diffusely projecting systems?
- NE - DA - 5HT |
NE and 5HT
|
|
|
What is the primary mode of NT release from central 5HT and NE systems?
|
varicosities (bulgies in the axons), NT released from vesicles to extracellular space
|
|
|
The following are characteristics of which 2 NT systems?
- project broadly throughout te cerebral cortex - autoregulate their own release |
NE and 5HT
|
|
|
What is the rate limiting enzyme for the following NTs?
- NE - DA - 5HT |
NE: tyrosine hydroxylase
DA: tyrosine hydroxylase 5HT: tryptophan hydroxylase |
|
|
What is the name of the NT transporter on synaptic vesicles?
What are some NT reuptake transporters? |
transporters on synaptic vesicles:
- VMAT: proton-monoamine antiporter transporters on cell membrane: - NET - 5HTT - DAT |
|
|
Which subtype of 5HT receptor is G protein coupled?
Which subtype of 5HT receptor is most important for clinical depression? |
5HT3: G protein coupled
5HT1: most important in depression |
|
|
Which of the following is expressed on serotonergic cell bodies in the raphe nuclei and in hippocampus?
- 5HT1A - 5HT1D - 5HT2A - 5HT2C |
5HT1A
|
|
|
Which of the following mediates the autoinhibitory mechanism of NT?
- 5HT1A - 5HT1D - 5HT2A - 5HT2C |
5HT1D
|
|
|
T/F: Depression is simply caused by deficiency of neurotransmitters.
|
F.
It is the changes in the receptor sensitivity that mediates the clinical effects of antidepressant drugs. |
|
|
What is the molecular mechanism of MAOI?
|
block the deamination of monoamines by binding to and inhibiting the functional flavin moiety of MAO.
|
|
|
The antidepressant effect of MAOI is primarily due to the inhibition of ____. (MAO-A or MAO-B)
|
MAO-A
|
|
|
Phenelzine is a type of ___.
|
MAOI
|
|
|
What are some side effects of phenelzine?
|
MAOI
- hypertensive crisis if take tyramine containing food. - orthostatic hypotension (lightheadedness, sedation) - weight gain |
|
|
What kind of food should be avoided in patients taking MAOI?
|
Tyramine containing food:
- aged cheese - fermented soy/ soy sauce - pickled food - aged yeast extract - broad-pod beans - chianti/vermouth wine |
|
|
What drugs should be avoided when taking MAOI?
|
- stimulants
- sympathetomimetics - other antidepressants - L-DOPA - opioids |
|
|
TCA with 2nd amines preferentially affect ___ system whereas TCA with tertiary amines preferentially affect ___ system.
|
NE
5HT |
|
|
TCA does not work on ___ system.
A. NE B. DA C. 5HT |
B.
|
|
|
Which drug class do the following belong to?
- imipramine - desipramine - amitriptyline - nortriptyline |
TCA
|
|
|
Which of 2 of the following have the fewest side-effects?
- imipramine - desipramine - amitriptyline - nortriptyline |
- desipramine
- nortriptyline |
|
|
Which of the following has the most side-effects?
- imipramine - desipramine - amitriptyline - nortriptyline |
- amitriptyline
|
|
|
What is the most dangerous side effects of TCA?
|
Cardiovascular:
- conduction delays - bundle branch blocks - 1st degree atrioventricular blocks Effects are due to Na channels. |
|
|
What types of receptors does TCA bind to and block? (5)
|
- serotonin reuptake
- NE reuptake - alpha 1 adrenergic receptor - histamine receptor - M1 |
|
|
High affinity to histamine receptor would cause what side effects?
|
sedation
- weight gain - impaired coordination - orthostatic hypotention - cognitive impairment |
|
|
High affinity to muscarinic receptor would cause what side effects of TCA?
|
- dry mouth
- constipation - urinary hesitancy - - visual acuity - aggrevate glaucoma - tachycardia - cognitive impairment - sexual: impotence |
|
|
High affinity to alpha adrenergic receptor would cause what side effects of TCA?
|
- orthostatic hypotention
- reflex tachycardia - sex: ejaculation - tachycardia - cognitive impairment |
|
|
What are some side effects of serotonin?
|
- anxiety
- anorexia - nausea/vomit - insomnia - diarrhea - sedation - weight gain - sex: desire, arousal, orgasm HT2A: anxiety, akathisia, orgasm, ejaculation 2C:anxiety, panic attacks 3: nausea, vomit, diarrhea 4: cramps, diarrhea |
|
|
What are some side effects of NE?
|
- anxiety
- tremor - tachycardia |
|
|
What symptoms can SSRI treat?
|
- depression
- OCD - panic disorder - PTSD - social phobia |
|
|
T/F: Low dose SSRI is nonselective, high dose is selective.
|
F.
Low dose SSRI is selective, high dose is nonselective. |
|
|
What drug class do the following belong to?
- fluoxetine - paroxetine - sertraline - citalopram |
SSRI
|
|
|
Where is SSRI metabolized?
|
Liver: it inhibits cytochrome P450 isoenzymes.
|
|
|
What receptors do SSRIs have affinity for?
|
Lots!
- SRI, NRI, DRI, 5HT2C - mACh - sigma actions - inhibit NOS - CYP450 - 2D6 - 3A4 - 1A2 |
|
|
What are these symptoms called?
- mental disturbance: agitation, confusion, insomnia - autonomic disturbance: diaphoresis, hyperpyrexia, tachycardia, hypertension - motor hyperactivity: rigidity, tremor |
serotonin syndrome
|
|
|
What drug withdrawal is this?
- flu-like symptoms - restless - confusion - irritability - sleep/wake cycle disturbance |
abrupt withdraw of SSRI
|
|
|
Which class of drug is venlafaxine and duloxetine?
|
mixed 5HT and NE: 5HT > NE
can elevate blood pressure, so need to monitor BP while taking them. |
|
|
Mechanism and side effects.
mirtazapine |
mechanism:
- alpha2 antagonist, enhances NE - increase serotonine transmission - 5HT2A 5HT3 blocker side effects: - sedation - weight gain - low sexual dysfunction |
|
|
Mechanism and side effects.
Bupropion |
mechanism:
- augment NE release - block DA reuptake side effects: - seizures |
|
|
Mechanism and side effects.
trazadone |
mechanism:
- 5HT2A antagonist - weak serotonin reuptake block side effects: - extreme sedation - priapism |
|
|
Trazadone is primarily prescribed for ____ at low doses.
|
insomnia
|
|
|
What is bupropion good for?
Who is it contraindicated for? |
good for:
- depression - smoking cessation contraindicated for: people at risk for seizures or bulemia nervosa |
|
|
Mechanism of lithium.
|
- enter via Na channel
- block PIP2 regeneration, thus inhibit central adrenergic, muscarinic, and serotoninergic NT. enhances 5HT decreases DA, NE transmission |
|
|
Which is the only drug that decrease the risk of suicide in people with bipolar disorder?
|
lithium
|
|
|
What is the first line treatment in bipolar disorder?
|
lithium
|
|
|
How would a decrease in salt(sodium) intake alter lithium's effect?
|
- sodium is preferentially absorbed in renal proximal tubule.
- decrease in Na intake would increase lithium absorption and potential drug toxicity. |
|
|
What are some side effects of lithium?
|
- weight gain
- polyuria/polydipsia - hypothyroidism - sedation - fine tremor |
|
|
What is the therapeutic index of lithium?
|
Very narrow: 0.6-1.2 mEq/l
|
|
|
What happens when serum lithium level is greater than 1.5 mEq/l?
|
- tremor
- blurred vision - vertigo - confusion, delirium - GI |
|
|
What happens when serum lithium level is greater than 2.5 mEq/l?
|
- seizures
- obtundation, coma - arrhythmia - permanent neurotoxicity - cardiopulmonary arrest, death |
|
|
What drugs increase lithium levels?
|
- ACE inhibitor
- NSAIDS - some antibiotics - diuretics |
|
|
What drugs decrease lithium levels?
|
- caffeine
- carbonic anhydrase inhibitor diuretics - laxatives - osmotic diuretics - theophylline |
|
|
What drugs will cause additive side effects of lithium?
|
- antipsychotics: increase EPS, seizure
- antidepressant: seizure |
|
|
What happens if a pregnant woman take lithium?
|
may cause cardiac anomalies in the newborn: eg. Ebsteins anomaly.
|
|
|
A newborn baby has Ebsteins anomaly. What did the mother take when she was pregnant?
|
lithium
|
|
|
Valproate is approved for uses in ____.
|
bipolar disorder, manic phase.
|
|
|
Side effects of valproate.
|
- neural tube defect in pregnancy
- dyspepsia/weight gain - dysphoria, fatigue, dizziness, drowziness - sedation - tremors - bipolar disorder |
|
|
Carbamazepine can be used in ___.
|
bipolar disorder, manic phase.
|
|
|
Side effects of carbamazepine.
|
- neural tube defect in pregnancy
- agranulocytosis, aplastic anemia - drowsiness - slurred speech, ataxia, impaired coordination |
|
|
Mechanism of valproate.
|
increases GABA in CNS
- inhibit enzymes that catabolize GABA - block reuptake of GABA |
|
|
Mechanism of lamotrigine.
|
- block voltage sensitive Na channels
- decrease presynaptic release of glutamate and aspartate. |
|
|
Side effects of lamotrigine.
|
- headache, dizziness, insomnia
- stevens-johnson syndrome |
|
|
Hypericum(St. John's wart) may be used to treat ___.
|
depression: MAOI and inhibition of MAO uptake
|
|
|
What should you do if your patient with depression is also anemic (low RBC)?
|
Add folate to the treatment.
|
|
|
How does TMS work?
|
Utilizes Eddy currents.
|
