Question

Harold is a 62 year old man who was found to be suffering from depression one year after a diagnosis of heart failure. Sertraline was added to his current prescription of irbesartan.

a) Compare the mechanism of action and clinical effects of these two drugs.

b) A move to a healthy lifestyle is recommended for people with heart failure. Discuss how the adverse effects of antidepressant medication may interfere with this. (1 mark)

Answer 1

Answer a)

****Sertraline increases the 5 HT ( 5 Hydroxytryptamine ) monoaminergic and help against depression and Irbesartan block the Angiotensin receptor 2 and decrease the blood pressure .

***Depression results due to Decreased monoaminergic ( 5 Hydroxytryptamine and Noradrenergic ) activity in Brain and therefore drugs increasing their activity are called Typical antidepressant and drugs acting by other mechanism are atypical Antidepressants.

***Sertraline is SSRI ( Selective Serotonin Reuptake inhibitors )

*Mechanism of action --> Sertraline inhibit the Reuptake of 5 HT only and Not NA( Nor adrenaline ) and thereby Increasing 5 HT ( monoaminergic ) and act as antidepressant .

*Uses --> Sertraline(SSRI) are now first line drugs for 1) Depression

2)Phobia

3) Obsessive Compulsive disorder

4)PTSD( Post traumatic stress disorder )

5)Bulimia ( eating disorder )

6) Premenstrual tension disorder

7) Panic attacks

****Irbesartan ---> Angiotensin Receptor blocker ( ARB)

*Mechanism of action ---> It antagonises the action of Angiotensin 2 on AT 1 receptor ( Angiotensin Receptor 1) .Normally Angiotensin 2 by Constriction of vessels increases the Blood pressure .

Normal mechanism of how Renin to Angiotensin 2 formation occur---- in response to low GFR( Glomerular filtration rate ) (Renin -----> RAAS( Renin angiotensin Aldosterone axis ) -----> Angiotensin 1 -------> Angiotensin converting enzyme ----->Angiotensin 2 ----> Constriction of efferent arteriole and Increase the GFR ( glomerular filtrarion rate ) .

*Uses -->1) Hypertension ( Increased Blood pressure )

2)Congestive Heart failure

3) Evolving MI ( Myocardial infarction )

4)Diabetic retinopathy and Nephropathy

5) Non-diabetic renal disease

6) Scleroderma crisis .

Answer B) In case of heart Failure ,healthy life styles are advised like Weight loss ,daily exercise etc.

Use of Antidepressant itself cause weight gain ( abdominal and generalised obesity ) excessive fats deposition ,Insulin resistance ,Increase in lipid contents in blood so in this way Sertraline interferes with the lifestyle modifications advised in heart failure .