Pharm Test 2- Antidepressants

Front 1

What's the amine hypothesis? Therefore, what two transmitters do we want to increase the action of? What is this theory missing?

Back 1

that a decrease in amine mediated neurotransmission in the brain causes depression; serotonin and norepinephrine; the fact that dysregulation of monoamine transmission is causing depression in these people

Front 2

TCAs, SSRIs, and NRIs all have what primary mechanism of action (broad)?

Back 2

block reuptake of either serotonin and/or norepinephrine into the presynaptic nerve terminal

Front 3

Desensitization/down-regulation of what two receptors most likely underlies the clinical efficacy of reuptake inhibitors? Where are they: pre-synaptic or post-synaptic?

Back 3

Beta1 (adrenergic receptor) and 5-HT (serotonergic receptor); post-synaptic

Front 4

TQ: The mechanism of action of SSRIs/NRIs (respectively): ___/___ is activated AND THEN DOWN REGULATED in the pre-synaptic neuron while ____/____ is desensitized in the post-synaptic neuron (INCREASING the responsiveness of other receptors in the same post-synaptic cell).

Back 4

5-HT pre-synaptic autoreceptor/alpha2 pre-synaptic autoreceptor; 5-HT post-synaptic receptor/beta1 post-synaptic receptor

Front 5

T or F: antidepressants actually increase the risk of suicides for children and adolescents

Back 5

T (black box warning required by FDA)

Front 6

_________ can cause dangerous levels of catecholamines (hypertensive crisis) if given with indirect-acting sympathomimetics like _______, ephedrine or phenylpropanolamine.

Back 6

MAO inhibitors; tyramine

Front 7

What two drug classes combine to cause Serotonin syndrome?

Back 7

SSRIs and MAO inhibitors

Front 8

What class of drugs has made TCAs become second line drugs? Why?

Back 8

SSRIs (fewer side effects with equal efficacy)

Front 9

Out of the TCAs, which inhibit reuptake of serotonin, norepinephrine or both?
1. Imipramine
2. Clomipramine
3. Amitriptyline
4. Desipramine

Back 9

1. N and S
2. S
3. N and S
4. N

Front 10

Which TCA has an unknown mechanism of action (no effect on amine neurotransmitter reuptake?)

Back 10

Trimipramine (Surmontil)

Front 11

TCAs have ____, ____ and ___ side effects (which receptors?)

Back 11

adrenergic, histaminic, and muscarinic (can't see, pee(poop), bend the knee) (TCAs antagonize all of these in some way)

Front 12

T or F: TCAs given within 2 weeks of MAOI therapy causes death. Also, the seizure thereshold is decreased with TCA use.

Back 12

T

Front 13

What antidepression drug is a second line agent for depression as well as used for neuropathic pain?

Back 13

Amytriptyline (Generic)

Front 14

What TCA is most selective for inhibition of serotonin reuptake?

Back 14

Clomipramine (Anafranil)

Front 15

What TCA may actually act as a stimulant and causes less sedation than other agents in the class?

Back 15

Protriptyline (Vivactil)

Front 16

What's the active metabolite of Amitriptyline?

Back 16

Nortriptyline

Front 17

What TCA is the most selective and potent inhibitor or NE reuptake?

Back 17

Desipramine (Norpramin)

Front 18

Atomoxetine is which kind of reuptake inhibitor?

Back 18

NE

Front 19

Serotonin reuptake inhibitors can cause unwanted _____ and _____ side effects secondary to 5-HT3 receptor activation.

Back 19

GI, sexual

Front 20

What are the 1st line agents for depression?

Back 20

SSRIs

Front 21

What drug (the prototypical agent) is a SSRI used to Tx PMDD?

Back 21

Fluoxetine (Prozac, Sarafem=PMDD)

Front 22

What heterocyclic (atypical antidepressant) has a contraindication of seizure disorders?

Back 22

Bupropion (Zyban)

Front 23

____ irreversible inhibits MAO A and B while _____ reversibly inhibits MAO A and B.

Back 23

Phenelzine (Nardil); Tranylcypromine (Parnate)

Front 24

What does RIMA stand for?

Back 24

Reversible inhibitor of MAO A

Front 25

MAOIs can cause a hypertensive crisis when mixed with ___________.

Back 25

sympathomimetics (amphetamine, cocaine, tyramine)

Front 26

How do you treat hypertensive crisis (mixing MAOI with sympathomimetic)?

Back 26

giving 5mgs of phentolamine (Regitine alpha-adrenergic blocker) IV

Front 27

Drugs that increase _____ can exacerbate mania. Drugs that reduce ____ or ____ tx mania.

Back 27

catecholamines (ex: anti-depressants); dopamine or norepinephrine

Front 28

What's the 1st line tx for manic episodes? Does it tx right away or take some time?

Back 28

Lithium (Eskalith); onset takes 7-10 days (so NOT FOR ACUTE MANIA; primarily for the prevention of recurrenced of manis episodes)

Front 29

T or F: a person on a high sodium diet will get too much Lithium (if normal amount Rx'ed).

Back 29

F! low sodium diet

Front 30

The clinical efficacy of lithium is likely due to its ability to reduce ____ trasmission thru a combo of mechanisms.

Back 30

catecholaminergic

Front 31

T or F: antipsychotics, anti-epileptics or BDZs can be used to tx Mania as well.

Back 31

T (Valproate becoming more common as a 1st line agent in those intolerant to lithium)

Front 32

What will reduced renal function, diarrhea, sodium depletics diuretics (Thiazides) and excessive sweating do to Lithium levels?

Back 32

increase them

Front 33

What's the most effective tx for lithium overdose?

Back 33

dialysis (can also use diuretics, gastric lavage, etc...)

Front 34

T or F: at therapeutic levels of Lithium, tremor can occur.

Back 34

T