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30 Cards in this Set
- Front
- Back
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What is the main theory of the pathomechanism of depression? |
The monoamine theory. It theorizes that depression is caused by decreased transmission of monoamines like norepinephrine and serotonin in the CNS. |
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What is common for the mechanism of all antidepressants? |
They all increase noradrenergic and/or serotonergic transmission in the CNS. |
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Which types of drugs are first-line in treating depression? |
SSRIs and SNRIs |
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Name some selective serotonin reuptake inhibitors (SSRIs) |
Fluoxetine, paroxetine, sertraline, escitalopram |
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What are the indications for SSRIs? |
Depression, anxiety disorders, bulimia |
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What is the mechanism of action of SSRIs? |
SSRIs inhbit the serotonin transporter (SERT), which reuptakes serotonin in the synaptic cleft. |
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What are the side effects of SSRIs? |
- Sexual dysfunction - Weight gain - Insomnia |
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Name two serotonin norepinephrine reuptake inhibitors (SNRIs) |
Venlafaxine, duloxetine |
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What are the indications for SNRIs? |
Depresion, anxiety disorders, diabetic neuropathy, neuropathic pain |
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What is the mechanism of action of SNRIs? |
SNRIs inhibit the reuptake of both serotonin and norepinephrine by inhibiting serotonin transporter (SERT) and norepinephrine transporter (NET).
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What are the side effects of SNRIs? |
- Hypertension - Insomnia - Agitation |
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Name two tricyclic antidepressants |
Amitryptiline, nortriptyline, protriptyline |
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Why are tricyclic antidepressants no longer widely used? |
Because they have numerous side effects, have multiple drug interactions and have potentially lethal overdose. |
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What are the indications for tricyclic antidepressants? |
- Depression - Diabetic neuropathy - Migraine prevention - OCD |
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What is the mechanism of action of tricyclic antidepressants? |
TCAs inhibit the reuptake of both serotonin and norepinephrine by inhibiting serotonin transporter (SERT) and norepinephrine transporter (NET). Unlike SNRIs they also block muscarinic, histamine H1 and α1 adrenergic receptors. They also block myocardial sodium channels. |
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What are the side effects of tricyclic antidepressants? |
- Sexual dysfunction - Dry mouth, constipation - Sedation - Orthostatic hypotension - Arrhythmia, prolonged QT - Seizures |
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Name the only important monoamine oxidase inhibitor |
Moclobemide |
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What are the indications for monoamine oxidase inhibitors? |
Depression (if SSRIs and SNRIs don't work) |
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What is the mechanism of action of MAO inhibitors? |
MAO inhibitors irreversibly inhibit monoamine oxidase, the enzyme that inactivates monoamine neurotransmitters. |
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What are the side effects of MAO inhibitors? |
- Sexual dysfunction - Orthostatic hypotension - Weight gain - Cheese reaction |
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What is the cheese reaction? |
When people taking MAO inhibitors eat foods rich in tyramine, like aged meat or cheese, they develop a severe sympathetic hyperactivity. Tyramine stimulates norepinephrine release. It's usually metabolised by MAO in the GI mucosa. |
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Name three atypical antidepressants |
Bupropion, mirtazapine and trazodone |
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When is bupropion preferred over other antidepressants? |
When maintainence of sexual function needs to be maintained and weight gain needs to be avoided. It also has a stimulatory effect, so it can be useful when the patient suffers from low energy |
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What can bupropion be used for, other than as an antidepressant? |
It can help with smoking cessation. In combination with naltrexone it can treat obesity |
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What is the mechanism of buproption? |
Bupropion inhibits reuptake of norepinephrine and dopamine. Its structure resembles amphetamine |
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Which natural plant could help with depression? |
St. Johns wort |
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Why should St. Johns wort be used with care in combination with other drugs? |
It induces CYP3A4 and CYP1A2 |
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What are the indications of mood stabilizers? |
Bipolar disorder |
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Which is the only important mood stabilizier? |
Lithium |
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Which life-threatening syndrome can occur with any drug that increases serotonergic transmisison? |
Serotonin syndrome |
