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32 Cards in this Set
- Front
- Back
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What are the neurotransmitters involved in depression?
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5HT
NE DA |
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What is meant by the Monoamine hypothesis and the Receptor hypothesis of depression?
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Depletion of monoamines in synaptic cleft causes and unregulation of post synaptic receptors.
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What is the logic behind antidepressants?
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To normalize levels of monoamines in the synaptic cleft and subsequent normalization of receptors.
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Where is serotonin made?
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The raphe nucleus.
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What are the functions of the serotonergic projections to the following:
Frontal cortex Basal Ganglion Limbic System Hypothalamus |
Frontal cortex regulates mood.
Basal ganglion regulates movement (depletion leads to OCD). Limbic system prevents anxiety. Hypothalamus regulates appetite. |
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What happens when norepinephrine projections to the cerebellum is altered?
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Tremors.
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What are the indications for antidepressants?
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Depressive disorders
Anxiety OCD Eating disorders Pain syndromes |
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What are some advantages to using SSRIs?
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Minimal impact on muscarinic, histaminic, and adrenergic receptors.
Minimal cardiac effects. |
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Which SSRI can exhibit anticholinergic side effects?
Galactorrhea/EPS? |
Paxil (Paroxetine)
Prozac (Fluoxetine) |
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Which of the SSRIs is the least used due to drug interactions but is used for treatment resistant OCD?
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Fluvoxamine (Luvox)
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What are the three SNRIs?
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Venlafaxine *Effexor
Desvenlafaxine *Pristiq Duloxetine *Cymbalta |
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What are the norepi-dopamine reuptake inhibitors (NDRIs)?
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Buproprion *Wellbutrin,Zyban
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Which drug used as an alternative to SSRIs do not cause the sexual side effects present in SSRIs? What should we be aware of if givning this medicine?
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Buproprion
Seizure risk |
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Which antidepressant should not be given in patients with metabolic syndrome?
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Mirtazepine.
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Which MAOI is available as a patch?
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Selegiline
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What is the serotonin antagonist that is used in cases of serotonin syndrome?
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Cyproheptadine
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What is the clinical picture of serotonin syndrome?
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Hyperthermia
Autonomic Instability Rigidity Myoclonus |
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What is serotonin discontinuation syndrome?
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"The zaps"
Clinical picture: Nausea/Vomiting, insomnia, irritability, SHOCK-LIKE SENSATIONS, parasthesias. Note: This occurs more commonly with SSRIs/SNRIs with shorter half-lives. Therefore, treat with fluoxetine. |
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Fact: Typical antipsychotics block Dopamine receptors and additional receptors (H1, Muscarinic, and a2) that increase side effect profile.
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Fact: Typical antipsychotics block Dopamine receptors and additional receptors (H1, Muscarinic, and a2) that increase side effect profile.
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Fact: Atypical antipsychotics block 5HT in addition to Dopamine receptors which eliminates EPS/prolactin release.
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Fact: Atypical antipsychotics block 5HT in addtion to Dopamine receptors which eliminates EPS/prolactin release.
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Fact: Quetiapine and Clozapine do not exceed 60% occupancy. Quetiapine is rapidly displaced from D2 receptors.
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Fact: Quetiapine and Clozapine do not exceed 60% occupancy. Quetiapine is rapidly displaced from D2 receptors.
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What is caused by a sudden, considerable depletion of dopamine?
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NMS
Fever Encephalopathy Vital instability Elevated CPK Rigidity of muscles |
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What are the pharmacokinetics of Lithium?
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24hr half-life
Renally excreted Minimal protein binding |
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Which two drugs decrease risk of suicide?
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Lithium
Clozapine |
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True or False:
Lithium is a good drug to use for rapid cycling or cyclothymia. |
False.
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What is the half-life of valproate and what other pharmacodynamic characteristic is important to know?
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6-16 hours
90% protein bound |
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What is the black box warning for valproate?
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Hepatotoxicity
Teratogenicity Pancreatitis |
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Explain the interactions between carbamazepine and valproate.
Lamotrigine? |
CMZ decrease VPA levels and VPA increases levels of CMZ.
VPA also doubles lamotrigine level. |
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What is the maintenance concentration of carbamazepine?
Does it bind to protein? |
4-12 micrograms/milliliter
Yes, 76% pb. |
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Fact:
CMZ decreases oral contraceptive effectiveness. |
Fact:
CMZ decreases oral contraceptive effectiveness. |
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What are the first line drugs for all anxiety disorders?
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SSRIs or SNRIs
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What is common in paroxetine and fluoxentine?
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SSRIs that inhibit CYP2d6
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