Pharmacology tutorial at Darwin Court

Luckily for me, we have been instructed to prepare pharmacology tutorials at Darwin Court and between us, we should have the basics covered. My contribution is shown below:




ANTIDEPRESSANT DRUGS

TYPE	ACTION	COMMON DRUGS	SIDE EFFECTS
TRICYCLIC ANTIDEPRESSANTS (TCAs)	Increase neurotransmitter levels at receptors By blocking re-uptake of: Serotonin Norepinephrine (Noradrenaline) (Venlafaxine has the same action – see “other drugs” below)	Amitriptyline Amoxapine Clomipramine Dosulepin Doxepin Imipramine Lofepramine Nortriptyline Trimipramine	Anticholerginic effects: Blurred vision Dry mouth Difficulty urinating Some cause drowsiness – useful for sleep problems in depression (eg amitriptyline) Overdose can cause: Coma Fits Fatal disturbed heart rhythm Prescribed with caution for people with heart problems or epilepsy
SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS (SSRIs) Not generally prescribed before 18 years of age	Block re-uptake of: Serotonin	Citalopram/ Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline	Nausea Vomiting Possibly at beginning of treatment: Anxiety Headache Restlessness (Fewer side effects than TCAs)
MONOAMINE OXIDASE INHIBITORS (MAOIs) Issued with a card detailing prohibited drugs & foods Used less frequently than TCAs & SSRIs	Block breakdown of neurotransmitters, mainly: Serotonin Norepinephrine (Noradrenaline)	Moclobemide Phenelzine Isocarboxazid Tranylcypromine	Combined with certain drugs or foods rich in tyramine (eg cheese, meat, yeast extracts, red wine) may cause a dramatic rise in BP with headache or vomiting Overdose can cause: Muscle spasms Death Prescribed with caution for people with heart problems or epilepsy Positive side effects: Especially effective in people who are also anxious or suffer from phobias

Other drugs: Duloxetine, Flupentixol, Maprotiline, Mianserin, Mirtazepine, Riboxetine, Trazodone, Tryptophan, Venlafaxine.

Lithium is used to treat manic depression. In some cases it is used with an antidepressant for treating resistant depression.

ANTIDEPRESSANT DRUGS

Depression is thought to be caused by a reduction in the level of neurotransmitters (excitatory chemicals) released in the brain.

Neurotransmitters are constantly being reabsorbed into the brain cells, where they are broken down by the enzyme monoamine oxidase.

Antidepressants increase the level of these neurotransmitters.

Moderate to severe depression (with despair, lethargy, loss of appetite &/or sex drive) requires drug treatment, often over many months.

Treatment usually begins with a TCA or SSRI.

Antidepressant effects start after 10-14 days and may be 6-8 weeks before full effect is seen,  but side effects may happen at once.

Tolerance to side effects usually occurs.

When stopping, the dose should be gradually reduced over several weeks to avoid withdrawal symptoms.

DIAZEPAM / LORAZEPAM

An anti anxiety drug / anxiolytic / minor tranquilizer.

Also classed as a muscle relaxant & anticonvulsant.

A benzodiazepine.

Benzodiazepines:

Depress activity in the part of the brain that controls emotion

By promoting the action of the neurotransmitter GABA

Which binds to neurons & blocks the transmission of electrical impulses, thus reducing communication between cells

Preventing the excessive brain activity that causes anxiety

Side effects:

Daytime drowsiness

Dizziness / unsteadiness

Headache

Blurred vision

Forgetfulness/ confusion

Rash

Can be habit forming if taken regularly over a long period.

(Source: BMA New Guide to Medicine & Drugs, 7^th Ed, DK)

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