B7 Pharmacology Final Exam (Lectures 12-22) with Correct Answers.

B7 Pharmacology Final Exam (Lectures 12-22) DSM5 Criteria for Major Depressive Disorder - 1+ maj depr eps w/o hx man/hypoman - 5+ SIGECAPS sx nearly everyday 2w per w/ change from prev func lev - MUST impair func/cause subst distr - 1 sx MUST be depr mood/anhed SIGECAPS sx of MDD - - Suic ideation w/ w/o plan; suic att; recur thoughts of death - Interest (loss int/pleas in activs; anhed) - Guilt (inappr/excess, feeling worthlessness) - Energy decr - Conc decr; diff making decis - Appet ch (typ decr, change 5% wt from basel) - Psychomot agit/retard - Sleep impair (typ insom but maybe hypersom) Pathophysiology of MDD (Biogenic Amine Hypothesis) - results from monoam NT def cort+limb brain areas - Dopa, 5-HT, and/or NE neurotransm abnorms -- decr cort resp to emo activ -- affective dysf+depr w/ impair serot NT - Noradr fibs proj from loc cerul to cer cort+dopa fibs innerv nuc accumb also reg mood - monoam def -- upreg postsynR Monoamine NT Neuronal Regulation & Antidepressant MOA - interf w/ transp mols inhib NT reup incr amts in synapse Monoamine System Feedback - DO NOT func indep ie. med enh NE transm may sec alter 5-HT+Dopa activ & 5-HT known to inhib NE+Dopa rel in cert brain areas NE Synthesis, Binding, Reuptake - - tyramine conv to NE, stored in vesics/degr by MAO - binds postsyn alpha/beta adrenR; binds/agonizes presyn alpha2R inhib NE rel - Recyc back presyn by NET transp Serotonin Synthesis, Binding, Reuptake - - tryp conv to 5HT - Binds many postsyn/presynR -- activ presynR to decr neur firing - SERT transp for reup Problems w/ Monoamine Hypothesis - antideps rap changing monoam concs have delayed onset to effic -- effs maybe sec to alter R dens/sensits OR sec sig PW (ie. inositol synth disr in bipol disord) Neurotropic Hypothesis of MDD - infl+overexc -- decr neuroplas+neur diff - n GF (ie. BDNF br-der neurotroph fac) reg neuron plasticity, resil, neurogen (incr syn conns) B7 Pharmacology Final Exam (Lectures 12-22) - depr assoc w/ decr BDNF -- decr neurotroph supp (also assoc w/ DM+other nonneuro/psych dis) - sust NE/5HT sig incr BDNF expr - antideps incr neurogen+syn conn cort areas (ie. hippocamp) Altered Glutamate Neurotransmission in MDD - overexcit in cert brain areas Neuroendocrine Factors in MDD - hypoT+low sex sters (estrog in menop, testos) assoc w/ depr - neuroactive steroids like progest metabolite Allopregnanolone def correl w/ PPD Goals of Treatment in Depression - - ac depr sx resol - prev func lev return - suic prev - fut depr eps (recur/relapse) prev Nonpharmacologic Interventions for MDD - - Psychother = **1st LINE for mild-mod** depr, addit effs w/ pharm ther, maybe cost+resource prohib - ECT = **LAST LINE** for refrac MDD - Exercise -- incr BDNF **Use pharm ther+CBT for mod-sev depr** Acne treatment that may Exacerbate Depression - Isotretinoin - mon psych sx per REMS program iPledge CV Meds that may Exacerbate Depression - - Reserpine = depl symp biogen amines NE+Dopa; used for HTN but pulled from market due to fatigue, decr energ, sex dysf? - ARBs - BBs = classically linked to depr but evid supps just phys sx fatigue+low energ - CCBs - Clonidine - Methyldopa