Neuro 2 - Carrier - Affective Disorders

Front 1

Pathogenesis of depression?

Back 1

Depression associated with the loss of neurotrophic support

Effective anti-depressants inc. neurogenesis and synaptic connectivity in cortical regions

Front 2

T/F: Stress and Pain are associated with a drop in BDNF (Brain-derived neurotrophic Factor) levels

Back 2

T

Front 3

What does BDNF do to branching of brain neurons?

Back 3

Increases it (ie increases neurogenesis)

Anti-depressants inc. BDNF

Front 4

Whats the monoamine hypothesis?

Back 4

A deficiency in the amt. or function of cortical and limbic serotonin, NE, and Dopamine contributes to depression

Front 5

T/F: All anti-depressants effect the monoamine system

Back 5

TRUE

= enhance synaptic availability of serotonin, NE, Dopamine

Front 6

How does the HPA and steroid abnormalities affect BDNF?

Back 6

they suppress transcription of it

Front 7

Chronic elevation of monoamine receptors by anti-depressants does what?

Back 7

inc. BDNF

Front 8

Activation of monoamine receptors leads to what?

Back 8

Down-regulation of HPA Axis --> Normalizes HPA Function

Front 9

List the classes of Anti-depressants

Back 9

SSRI, SNRI, Tricyclic Antidepressants, Serotonin Antagonists, Monoamine Oxidase Inhibitors, Tetracyclic And Unicyclic Anti-depressants (others or unclassified)

Front 10

MOA SSRIs

Back 10

Inhibition of Serotonin Transporter (SERT)

Front 11

What do we use SSRIs for?

Back 11

Major depression, generalized anxiety disorder, PTSD, OCD, Panic disorder, PMDD, Bulimia

Front 12

List the SSRIs

Back 12

Fluoxetine, Sertraline, Citalopram, Paraoxetine, Fluvoxamine, Escitalopram

Front 13

SE's of SSRIs?

Back 13

Due to inhibition of SERT

In gut: N, V GI,
Spinal cord: dec. sexual function and interest
CNS: inc. H, Insomnia, Hypersomnia
Weight Gain: esp Paroxetine
Discontinuation syndrome = Dizzy+Paresthesia

Front 14

MOA SNRIs?

Back 14

Bind SERT and NE transporter

Front 15

Indications for SNRIs?

Back 15

Major depression, pain disorders, generalized anxiety, stress urinary incontinence, hot flashes in menopause

Front 16

Which have greater affinity for SERT, SNRIs or NETs?

Back 16

SNRIs

Front 17

List the SNRIs

Back 17

Duloxetine, Milnacipran, Venlafaxine

Front 18

SE's of SNRIs?

Back 18

SERT inhibition leads to SEs similar to SSRIs:

Inc. BP, HR, CNS activation (insomnia, anxiety, agitation)

Front 19

Clinical indication for Tricyclic Antidepressants (TCADs?)

Back 19

Depression that's unresponsive to SSRIs and SNRIs, apin conditions, enuresis, insomnia

Front 20

MOA Tricyclic Anti-depressants?

Back 20

Inhibition of 5-HT and NE uptake


Bind SERT and NET

Front 21

Use of the TCAD Imipramine?

Back 21

Enuresis

Front 22

Use of the TCAD Amitryptiline

Back 22

Pain

Front 23

List the TCADs

Back 23

Amitryptiline, Clomipramine, Imipramine

Front 24

SEs of TCADs?

Back 24

Anti-muscarinic effects

Dry Mouth, Constipation, (ANTI-DUMBBELSS
Anti-histamine effect = weight gain and sedation
Alpha-adrenergic blockade --> orthostatic hypotension, Arrhythmia, Sexual effects common

Front 25

List the 5-HT Antagonists

Back 25

Trazodone and Nefazodone

Front 26

Clinical Indications for Trazodone? Nafazodone?

Back 26

Trazodone = Major Depression, Hypnotic

Nafazodone = no longer commonly prescribed, formally major depression

Front 27

Half life of 5-HT Antagonists?

Back 27

not long - disadvantage b/c you'll have to take multiple throughout the day

Front 28

SE Nefazodone?

Back 28

Hepatotoxicity = what makes it BLACK BOXED

GI and Sedation

Dose-related Orthostatic Hypotension

Front 29

Use of Monoamine Oxidase Inhibitors

Back 29

Treatment of Depression unresponsive to other drugs

Front 30

MOA Monoamine Oxidase Inhibitors?

Back 30

Target MAO-A and MAO-B non-selectively

=CNS Stimulation is increased

Front 31

List the one MAOI we need to know

Back 31

Phenelzine

Front 32

SEs of the MAOIs?

Back 32

Orthostatic Hypotension and weight gain

Blocks metabolism of Tyramine

Sudden Discontinuation --> Psychosis, Excitement, Confusion

HIGH RATE OF SEXUAL EFFECTS (Anorgasmia)
Sedation, Confusion

Front 33

Why are foods with Tyramine (aged cheese, tap beer, soy products, dried sausage) contraindicated when taking an MAOI like Phenylzine?

Back 33

Tyramine broken down by MAO --> MAOI inhibitors inhibit this in GI --> High serum levels --> enhanced peripheral nonadrenergic effects ---> Inc BP (malignant hypertension) --> stroke, MI)

Front 34

If a pt is having massive sexual SEs with SSRI, whats a good alternative?

Back 34

Bupropion, Mirtazapine

Use = depression not responsive to other agents

Front 35

List the Unclassified drugs and what the main receptor they work on is

Back 35

Amoxapine (5-HT), Bupropion (NET), Maprotiline (H1 and NET), Mirtazapine (H1)

Front 36

TEST***: Which Unclassified drug stays in the system for a long time and has a biphasic elimination

Back 36

Bupropion = had Biphasic Elimination. 1st phase lasts 1 hr, second phase lasts 14 hrs

Half life = 11-14 hrs

Front 37

SE Amoxipine?

Back 37

Parkinson Syndrome (Blocks D2 activity)

Front 38

SE Bupropion

Back 38

Agitation, Insomnia, Anorexia (can lead to seizures in over dose)

Front 39

SE Mirtazapine?

Back 39

Highly Sedating

Front 40

T/F: Sedative effects of Mirtazapine can be additive when given with Benzos or Alcohols

Back 40

TRUE

Front 41

Most commonly prescribed drug class for Major Depressive Disorder, Anxiety Disorder

Back 41

SSRI

Front 42

After SSRIs, Bupropion and Mirtazapine, what are the second line drugs for Major depressive Disorder?

Back 42

TCADs and MAOIs (mostly used in pts un-responsive to other drugs)

Front 43

DOC for pain conditions?

Back 43

TCADs and SNRIs

Front 44

Treatment of OCD?

Back 44

SSRIs and Clomipramine

Front 45

What can we use for Smoking Cessation?

Back 45

Bupropion and Nortryptyline

Front 46

Explain how we start a pt on SSRIs

Back 46

Starting dose is within normal range. If no change after 4 weeks dose can be increased and titrated to max dose if needed

SSRIs, SNRIs and newer agents may not respond to inc. dose

Front 47

Which drugs require titration to appropriate dose over several weeks?

Back 47

TCADs and MAOIs

Front 48

SE Anti-depressants?

Back 48

Inc risk suicide in pts UNDER AGE 25

= assoc. with inc. risk suicidal ideation

Front 49

What pregnancy category are most Anti-depressants?

Back 49

C = weigh risks/benefits to mother

Front 50

What are Anti-depressants used for?

Back 50

primary = Major depressive Disorder
secondary = Panic attacks, generalized anxiety disorder, PTSD, OCD
ALSO: Pain disorders, premenstrual dysphoric disorder, Hot flashes, stress urinary incontinence

Front 51

T/F: Anti-depressants can be used for acute and chronic depression

Back 51

TRUE

Affects seen 1-2 months

Front 52

Once remission of depression occurs, how long can drug effects be seen?

Back 52

6 months to 1 year

Front 53

Pt has PTSD, OCD, Social Anxiety disorder, GAD and Panic disorder. What do we give them?

Back 53

SSRI or SNRI

Front 54

Pt has chronic pain due to car accident 5 years ago. Tx?

Back 54

TCADs and SNRIs (ex = Amitriptyline, Duloxetine, Milnacipran)

Front 55

Define Premenstrual Dysphoric Disorder

Back 55

During late luteal phase of every cycle = anxiety, depressed mood, irritability, insomnia, fatigue, physical symptoms

Tx = Fluoxetine and Sertraline

Front 56

Pt has a Bulimia eating disorder. Tx?

Back 56

Fluoxetine can reduce binge-purge cycle

Bupropion can tx Obesity

Front 57

Pt prematurely ejaculates and wants a drug to help him satisfy the ladies. What do you give him?

Back 57

SSRI

Front 58

St. John's Wort is effective for what?

Back 58

Mild to Moderate Depression, Anxiety, nervous tension, insomnia, seasonal affective disorder

Front 59

What do we use to treat Bipolar Disorder Manic phase?

Back 59

Lithium

OR

Ariprazole, Chlorpromazine, Olanzepine, Quetiapine, Risperidone, Ziprasidone

Front 60

What do we use to treat Bipolar Disorder Acute mania and prevention of recurrence?

Back 60

Carbamazepine and Valproic Acid

Front 61

What do we use to treat Bipolar Disorder to prevent recurrence?

Back 61

Lamotrigine

Front 62

What do we use to treat the Bipolar Depression of Bipolar Disorder?

Back 62

Olanzapine and Fluoxetine

OR Quetiapine

Front 63

MOA Lithium?

Back 63

Closely related to Na+

Substitute for Na+-Na+ exchange across a membrane

Can induce Li+-Na+ exchange

Front 64

T/F: At therapeutic concetrations of Lithium there is no effect on the Na/Ca2+ exchanger on Na+/K+ ATPase

Back 64

TRUE

Front 65

Lithium decreases inositol leading to mood stabilization

Back 65

TRUE

Front 66

Bipolar pt is treated with Lithium. onset, monitor?

Back 66

Onset = slow

Monitor serum levels because it has a narrow therapeutic level

Front 67

SE Lithium?

Back 67

Tremor
Choreoathetosis (excessive movements/wringing of hands/extremities)
Psychiatric

Dec. thyroid function

Renal = NEPHROGENIC DIABETES INSIPIDUS

Edema
CV (brady-tachy syndrome)
Acne

Front 68

T/F: Renal clearance of Lithium increases during pregnancy, its transferred through breast milk, and Lithium can cause toxicity in new borns

Back 68

TRUE

Front 69

Besides Lithium, what else can we use to tx Bipolar Disorder?

Back 69

Valproic Acid, Carbamazepine, Lamotrigine