Shared Flashcard Set

Details

Neuro/Psych-Pharm
Antidepressants
36
Pharmacology
Graduate
01/13/2011

Additional Pharmacology Flashcards

 


 

Cards

Term
What are the Norepinephrine and Serotonin pathways in the brain
Definition

Serotonin:Raphe Nucleus to Spinal cord(pain, visceral, motor) and Forebrain(mood, cognition, neuroendocrine)

Norepinephrine: Locus Ceruleus to Spinal cord(pain) and Forebrain(mood, cognition, arousal)

Term
How is serotonin and norepinephrine released from neurons
Definition
Through varicosities into projecting areas
Term
Describe the synthesis of Norepinephrine
Definition
Tyrosine(tyrosine hydroxylase)->DOPA(AAADC)->Dopamine(Dopamine B-hydroxylase)-> Norepinephrine
Term
What is the mechanism of Reserpin
Definition
Inhibits Norepinephrine transport into vesicles causing cytoplasmic degradation by MAO-A on mitochondrial membrane
Term
What is the feedback inhibition for Norepinephrine and Serotonin releasing neurons
Definition

Norepi bind Alpha-2 adrenergics decreasing cAMP in both Noradrenergic and Serotonergic neurons

Serotonin binds 5HT1A(Somatodendritic) and 5HT1B/D(Presynaptically) decreasing cAMP to serotonergic neurons, also 5HT2A decreases norepinephrine release

Term
What are the major hypotheses of depression
Definition

Monamine Hypothesis

Neurotrophic hypothesis: Low BDNF

Neuroendocrine: Increased cortisol, thyroid defieciency, sex hormone defeciency

Term
What are the transporters used to uptake serotonin and norepinephrine from the synapse and also into the vesicle
Definition

NET: Noreepi selective(cocaine blocks)

Serotonin Selective Reuptake Transporter

VMAT: Serotonin and Norepi into vesicles(blocked by reserpine)

Term
What are the major SSRI's
Definition

Fluoxetine(prozac)

Sertraline(zoloft)

Citalopram(celexa)

Fluvoxamine(luvox)

Paroxetine(paxil)

Term
What is the cause of therapeudic lag in SSRI treatment
Definition

Presynaptic: overactivity of 5HT1A decreases as receptors desensitize

Postsynaptic: Increased activation of 5HT2 causes desensitization that is eventually overcome

Term
What are the uses of SSRI's
Definition

Depression

Anxiety

Panic

OCD

PTSD

PMDD

Term
What SSRI has the longest half life and how does this effect its use
Definition

Active metabolic Norfluoxetine has a 8 day half life

Switching from Fluoxetine requires a 4 wk interval before switching to a MAO-I

Term
What are the Major Side effects of SSRI's and how are they caused?
Definition

Nausea(5HT3)Area Postrema and afferent vagus

Diarrhea(5HT4)

Sex Dysfunction(5HT2A) Block orgasm and decrease doapmine

Anxiety, Agitation, Insomnia(5HT2A)

Bleeding if with NSAIDs or Aspirin(5HT2)

Serotonin Syndrome: CV collapse, Flushing, Hyperthermia, Muscle rigidity

Sweating

Suicide

Tingling, Numbing, Dizzy: Discontinuation of Zoloft or Paxil

Term
What Antidepressants are metabolized by the p450s and which are potent inhibitors
Definition

Trazodone: CYP3A4

Fluvoxamine: CYP3A4

Fluoxetine: CYP2D6 (potent)

Paroxetine: CYP2D6(potent)

Duloxetine: CYP2D6(moderate)

Tricyclics: CYP2D6

Term
What are the uses of NSRI
Definition

Depression

Anxiety

Stress Incontinence

Vasomotor of Menopause

Pain of Diabetic neuropathy

Term
What are the NSRI's
Definition

Duloxetine(Cymbalta)

Venlafaxine(Effexor)

Term
What is desvenlafaxine(Pristiq)
Definition
Active metabolite of venlafaxine
Term
Which antidepressant has a high protein binding capacity
Definition
Duloxetine
Term
What are the adverse effects of SNRIs?
Definition

Serotonin Syndrome

Discontinuation Syndrome

Insomnia, Agitation, Anxiety

Increase BP, HR

Term
Which tricyclic antidepressants have the most anti-cholinergic effects
Definition
Tertiary Amines: Amitryptyline, Imipramine, Clomipramine
Term
What are the major tricyclic anti-depressants
Definition

Nortriptyline

Amitriptyline(Tertiary amine)

Desipramine

Imipramine(tertiary amine)

Clomipramine

Term
What are the uses of tricyclic anti-depressants
Definition

Resistant Depression

Pain at low dose

Imipramine(Nocturnal Enuresis)

Clomipramine(OCD)

Term
Adverse Effects of Tricyclic Anti-depressants
Definition

Serotonin Syndrome

Discontinuation Syndrome

Sex Dysfunction(Clomipramine)

Alpha Block: Postural Hypotension

Anticholinergic

Antihistamine: Weight Gain and Sedation

Toxicity: Coma, Covulsions, Cardiotoxicity, Confusion and Hallucinations(elderly)

Term
What is the mechanism and use of Trazodone
Definition

5HT2A Antagonist

Postsynaptic 5HT1A 5HT2 agonists

SSRI

Low dose: Only antihistamine, anti-alphaadrenergic

Use: Hypnotic

Term
What is the mechanism of tricyclic antidepressant toxicity, how would you recognize it and how is it treated?
Definition

Sodium channel blockade

Signs: Coma, Convulsions, Cardiotoxicity

Confusion and Hallucinations in Elderly

Tx: Sodium Bicarb

Term
What is the mechanism and use of Mirtazapine
Definition

Block: 5HT2A/2C, 5HT3

Presynaptic alpha 2

Use: Melancholic Depression or Depressed with sleep disturbances

Term
Adverse effects of Mirtazipine
Definition
Weight Gain and Sedation
Term
What is the uses of Bupropion
Definition

Smoking cessation

Atypical Depression

Term
What drug is contraindicated with bupropion?
Definition
MAO-I Use
Term
What are the major MAO-I's and which is MAO-B selective
Definition

Phenelizine

Tranylcypromine

Isocarboxazid

Selegiline-MAO-B selective

Term
What are the uses of MAO-I's
Definition

Resistant Depression

Anxiety

Social Anxiety

Panic Disorder

Term
What are the adverse effects of MAO-I's
Definition

Serotonin Syndrome

Tyramine Foods-> Norepi-> Increased BP

CNS Stimulation

Postural Hypotension(Octopamine or dopamine)

Weight Gain

Term
What anti-depressant should be used in a patient with concerns about daytime tiredness?
Definition
SSRI's
Term
What drug is used in bed Wetting
Definition
Imipramine
Term
What is RIMA?
Definition

Reversible Inhibitor of Monoamine Oxidase Type A

MAO-A inhibitors are more effective as anti-depressants

Term
What is the mechanism of the CNS stimulation and the postural hypotension of MAO-Is
Definition

CNS Stimulation: resembles Amphetamine

Postural Hypotension: Octopamine metabolite is a false neurotransmitter

Term
What side effect is specific to SSRI mecahnism? Which trycyclic displays the most SSRI action and which tricyclic displays the most Norepi reuptake block
Definition

SSRI: sex dysfunction(Clomipramine)

Norepi reuptake Block: Desipramine

 

Supporting users have an ad free experience!