Anti-Depressants

Question 1

Biogenic amine hypothesis

Answer 1

A functional deficit of monoamines (NE and 5-HT) is thought to be most involved in the pathophysiology of depression

Question 2

Remember, the FDA has issued a black box warning on antidepressant medications for patients up to the age of 24 years.

Answer 2

ok

Question 3

St. John’s Wart interferes with what types of medications

Answer 3

Meds for HIV, heart disease, seizures, some cancers, and organ transplant

Question 4

TCA’s we need to know

Answer 4

• Amitriptyline
• Nortriptyline
• Imipramine

Question 5

How do TCAs work?

Answer 5

Inhibit the reuptake of serotonin and norepinephrine into presynaptic terminals

Question 6

Clinical use of TCAs

Answer 6

Major Depression, bedwetting, OCD, fibromyalgia

Question 7

Adverse effects of TCAs

Answer 7

1) Orthostatic HTN- due to blockade of Alpha 1 receptor
2) Dry mouth constipation, urinary retention, tachycardia- due to blockade of Cholinergic receptors
3) Sedation - due to histamine blockade

Question 8

Narrow angle glaucoma and TCAs

Answer 8

DON”T FUCKING GIVE THEM

Question 9

Atypicals we need to know

Answer 9

MTV Be Very Dumb

Mirtazapine
Trazodone
Vilazodone

Buproprion
Venlafaxine
Duloxetine

Question 10

How does Trazodone work

Answer 10

• Partially inhibits serotonin reuptake but primarily acts as a serotonin 2a antagonist and 1a partial agonist.

Question 11

How does Mirtazepine work

Answer 11

Antagonizes serotonin receptors. Potent antihistamine which means that it is a strong sedator.

Question 12

How does Bupropion work

Answer 12

weak blocker of Dopamine, Serotonin, and Norepinephrine

The active metabolite of bupropion is what? A NE reuptake blocker

Question 13

What are the important side effects of bupropion

Answer 13

anxiety, restlessness, risk of seizure

Question 14

Venlafaxine mech

Answer 14

SNRI

Question 15

What is important about the sideeffects of venlafaxine

Answer 15

It does NOT cause antihistaminergic, anticholinergic, and antiadrenergic side-effects

Question 16

Duloxetine?

Answer 16

Most POTENT SNRI on the market.

Question 17

SSRIs we need to know

Answer 17

Fluoxetine (prozac), Citalopram (Celexa), Paroxetine (Paxil), Sertraline (zoloft)

Fluvoxamine

Question 18

Major side-effects of SSRIs

Answer 18

sexual side-effects and GI unrest

Question 19

SEROTONIN SYNDROME AND SSRIs

Answer 19

Characterized by hyperpyrexia, hyperreflexia, tremor, seizures, cv collapse, and coma

Question 20

MAOIs

Answer 20

Tanylcypromine

Question 21

MAOI mech

Answer 21

irreversible inhibition of MAO-A and MAO-b in nerve terminals….remember that MAO primarily metabolizes NE and 5-HT

Question 22

Adverse effects

Answer 22

sleep disturbances, orthostatic htn, wt gain, some sexual dysfunction

Question 23

Adverse effects of MAOI

Answer 23

sleep disturbance, orthostatic htn, wt gain, some sex dysfnction

Question 24

Hypertensive crisis occurs in pts who are taking MAOIs along with foods that are….

Answer 24

high in Tyramine

Question 25

What is Lithium used for

Answer 25

Mood stabilization

Question 26

LIthium has a VERY NARROW therapeutic window

Answer 26

Toxic effects seen when: 1.5

Question 27

Toxic Effects of LIthium:

Answer 27

1) Neurologic/psychiatric: tremor, ataxia, aphasia, sedation 2) Glandular: hypothyroidism 3) Renal: Polyuria (nephrogenic diabetes insipidus) 4) Cardiac: bradycardia Other: acne NGRCO

Question 28

Look at Valproic acid, carbamezapine,

Answer 28

ok