10-17 PsychoPHARM: Anxiety and Depression

Question 1

Name the 5 SSRIs we learned
—Which lengthen QTc?
—ADRs

Answer 1

paroxetine
fluvoxamine
fluoxetine
(sertraline)
citalopram*
escitalopram*
*lengthen QTc
—ADRs (citalopram):
—GI (90% 5-HTRs on GIT), sex, sleep, sweat, Na+, mania
—BlackBox SI to 25yo

Question 2

SNRIs

—ADRs

Answer 2

venlafaxine
duloxetine
—ADRs (venlafaxine):
—GI, sex, sleep, sweat, Na+, mania
—BlackBox: SI to 25yo

Question 3

TCAs
—1°ly Serotonergic?
—1°ly noradrenergic?
—ADRs

Answer 3

3° AMINES —?—> 2° AMINES
imipramine*—?—> desipramine**
amiltriptyline* —?—> nortriptyline**
chlomipramine*
*1°ly 5-HT, also 1A anti-arryth (Na+ blockade)
**1°ly noradrenergic, weaker ADRs

ADRs
wt gain, sedation, ACh, hypotension, arryth, sex, sweat; lethal in overdose

NOTES
—3° get metab’d to 2° in vivo
—Imipramine was first TCA

Question 4

MAOIs
—Which neurotransmitters do they act on?
—ADRs

Answer 4

tranylcipramine: stimulating
phenelzine: sedating
—act on all: DA, NE, 5-HT
—HTN CRISIS (Tyramine)
—SEROTONIN SYNDROME: TRIAD of SX:
1. COGNITIVE: headache, agitation, hypomania, mental confusion, hallucinations, coma

2. ANS: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea.
3. SOMATIC: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.

Question 5

NDRIs
—ADRs
—advantages

Answer 5

bupropion

ADRs
—Insomnia, tremor, seizures

ADVANTAGES:
—least likely to cause mania or sexual SE

Question 6

which nuclei supply 5-HT to rest of the brain?

Answer 6

raphe nuclei in brainstem

—site of SSRI fxn

Question 7

Where is NE made?

Answer 7

Locus coeruleus

Question 8

Main anatomic site of dopaminergic anti-depressants?

Answer 8

VTA

Question 9

mirtazapine

Answer 9

dual-action: 5-HT & anti-histamine
–SEDATION + WEIGHT GAIN
—multiple uses

Question 10

trazodone and nefazodone

Answer 10

Serotonin antagonists and reuptake inhibitors

Question 11

benzos: six effects

Answer 11

1. sedative
2. hypnotic
3. anxiolytic
4. sz ctrl
5. muscle relaxant
6. Anterograde amnesia (anesthesia)

Question 12

drug to reverse benzos?

Answer 12

flumazenil

Question 13

which benzo is renally cleared?

Answer 13

lorazepam; best for EtOH withdrawl b/c decr risk of cirrhosis

Question 14

α1-selective

Answer 14

ZzZ
—zolpidem (Ambien)
—zaleplon (Sonata)
—eszopiclone (Lunesta)

Question 15

buspirone

Answer 15

5HT-1A (A for Anxiety)

—treats GAD; augments MDD tx