Anti-Affectives-Pechnick

Question 1

Major Depressive Disorder

Answer 1

• Depressed mood most of the day, nearly every day

- Sx: weight gain/loss, insomnia/hypersomnia, fatigue, decreased pleasure in everything

Question 2

Bipolar Disorder

Answer 2

• Extremely heritable
• Cycles of depression and mania
• Manic sx: decreased need for sleep, distractibility, more talkative, psychomotor agitation

Question 3

What is the MOA of tricyclic anti-depressants?

Answer 3

Block the reuptake of biogenic amines (NE and serotonin) (also blocks muscarinic cholinergic-Rs and alpha-1 adrenergic-Rs= responsible for SE)

Question 4

Which drugs are tricyclic anti-depressants? (5)

Answer 4

(CANDI)
Clomipramine
Amitriptyline
Nortriptyline
Desipramine
Imipramine

Question 5

What are some pharmacological effects of tricyclic anti-depressants?

Answer 5

• Take 2-3 weeks to work, but SE start immediately
• Can produce sedation and/or seizures
• Anti-muscarinic effects
• CV effects (tachycardia, arrhythmia)

Question 6

What are the clinical uses of tricyclic anti-depressants?

Answer 6

• Depression
• Anxiety disorders
• OCD (clomipramine)
• Chronic pain (amitriptyline)
• Enuresis (bed-wetting) (imipramine)

Question 7

What are some SE of tricyclic anti-depressants?

Answer 7

• Behavioral (sedation, confusion)
• CV (orthostatic hypotension is limiting factor in older pts)
• ANS: Anti-muscarinic effects (2nd most common limiting factor)
• Weight gain
• Withdrawal if abruptly stopped
• Overdose can be fatal! (tx by controlling arrhythimas and seizures)

Question 8

What is the black box warning for tricyclic anti-depressants?

Answer 8

Increases risk of suicidal thinking and behavior in children, adolescents and young adults

Question 9

Mirtazapine

Answer 9

• 2nd gen antidepressant

- MOA: blocks 5HT NOT reuptake

Question 10

Trazadone

Answer 10

• 2nd gen antidepressant
• MOA: inhibits 5HT reuptake and blocks 5HT-2-Rs
• SE: priapism!

Question 11

Buproprion

Answer 11

• 2nd gen antidepressant
• MOA: weakly inhibits reuptake of NE, 5HT and DA
• SE: seizures! (don’t give to people w/ seizure d/o or eating d/o)

Question 12

Which drugs are Selective Serotonin Reuptake Inhibitors (SSRIs)? (6)

Answer 12

1. Fluoxetine
2. Paroxetine
3. Fluvoxamine
4. Sertraline
5. Citalopram
6. Escitalopran
   SE: sexual dysfunction (decreased libido and anorgasmia)

Question 13

Which drugs are Serotonin/Norepinephrine Reuptike Inhibitors (SNRIs)? (3)

Answer 13

1. Duloxetine
2. Venlafaxine
3. Desvenlafaxine
   SE: HTN (due to NE) + same as SSRIs

Question 14

What is serotonin syndrome?

Answer 14

• Rare SE in pts taking SSRIs w/MAOIs

- SE: confusion, hyperreflexia, penile erection, seziure, coma

Question 15

Which drugs are used for the tx of Bipolar Disorder? (Mood stabilizers)

Answer 15

1. Carbamazepine (anti-epileptic)
2. Valproate (anti-epileptic)
3. Lamotrigine (anti-epileptic)
4. Lithium

Question 16

Lithium

Answer 16

• Not metabolized, only by renal excretion
• Calms mania & dampens mood swings
• No autonomic blocking activity
• Low therapeutic index!
• MOA: unknown