Anti-depressants

Question 1

Give examples of TCAs?

Answer 1

Amitriptyline.

Lofepramine.

Question 2

What is the advantage of using lofepramine?

Answer 2

Less anti-muscarinic side effects.

Question 3

What is the MOA of TCAs?

Answer 3

Block the reuptake of NA & 5HT.

Question 4

What are the side effects of TCAs?

Answer 4

Sedation.
Confusion.
Ataxia.
Weight gain.

Question 5

What are the anti-muscarinic effects of TCAs?

Answer 5

Constipation.
Blurred vision.
Dry mouth.
Urinary retention.

Question 6

What some other side effects of TCAs?

Answer 6

Vagal blockage leads to:
> Tachycardia.
> Ventricular dysrhythmias.
> Prolonged QT.

A1 adrenoceptor blockage:
> Postural hypotension.

Question 7

What are the contra-indications for TCAs?

Answer 7

Recent MI.
Narrow angle glaucoma.
Heart block.
LUTs.

Question 8

Give some examples of MAOi?

Answer 8

Phenelzine.
Iscocarboxazid.
Moclobemide.

Question 9

Which drug is a selective MAO-A inhibitor?

Answer 9

Moclobemide.

Question 10

What is the MOA of MAOi?

Answer 10

Block MAO which breaks down monoamines.

Question 11

Which monoamine is MAO-A more selective for?

Answer 11

5HT.

Question 12

What are the side effects of MAOi?

Answer 12

Postural hypotension.
Weight gain.

CNS stimulation:
> Insomnia.
> Restlessness.
> Hallucinations.

Question 13

Explain a serious interaction of MAOi?

Answer 13

"Cheese" reaction > severe hypertension:
Caused by taking tyramine (sympathomimetic) containing products whilst on an MAOi.
> Beer.
> Cheese.
> Pickled herring.

Question 14

What drug do MAOi interact with?

Answer 14

Pethidine - inhibits monoamine reuptake.

Question 15

Give some examples of SSRIs?

Answer 15

Citalopram.
Fluoxetine.
Sertaline.

Question 16

What anti-depressant would you use following a recent MI or in a patient with cardiac disease?

Answer 16

Sertaline.

Question 17

Which anti-depressant has a long half life and doesnt need to be stopped gradually?

Answer 17

Fluoxetine.

Question 18

Name some side effects of SSRIs?

Answer 18

Insomnia.
GI bleeding.
Hyponatraemia - increases ADH activity.
Serotonin syndrome - tremor & hyperthermia.
Prolonged QT interval.

Question 19

Which SSRI causes a prolonged QT interval?

Answer 19

Citalopram.

Question 20

When are SSRIs contra-indicated?

Answer 20

Patients < 18 years - increases risk of self harm & suicide.

Question 21

Give examples of receptor blockers?

Answer 21

Mitrazapine.

Trazadone.

Question 22

What is the MOA of mitrazapine?

Answer 22

Blocks alpha-2 adrenoceptors > increased NA & 5HT release.

Question 23

What is the MOA of trazadone?

Answer 23

Similar to TCAs.

Question 24

What is the advantage of receptor blockers over TCAs?

Answer 24

Less cardiotoxic.

Question 25

What are the side effects of receptor blockers?

Answer 25

Sedative.
Sexual dysfunction.
Increased appetite & weight gain.

Question 26

Give examples of non-selective reuptake inhibitors?

Answer 26

Venlafaxine.

Duloxetine.

Question 27

When are non-selective reuptake inhibitors used?

Answer 27

3rd line treatment for severe depression.

Question 28

What is the risk of venlafaxine?

Answer 28

High risk of death in OD.

Question 29

What can duloxetine also be used to treat?

Answer 29

Urinary incontinence & diabetic nephropathy.

Question 30

Give examples of hypnotic benzo’s? What are they used to treat?

Answer 30

Short acting benzo’s used for insomnia.

Temazepam.
Z-compounds:
> Zopiclone.
> Zolpidem.

Question 31

Give examples of anxiolytic benzo’s? What are they used to treat?

Answer 31

Long acting benzo’s used as anti-psychotics.

Diazepam.
Lorazepam.

Question 32

What is the MOA of benzo’s

Answer 32

Allosteric activator of GABA - enhances GABA effects but does not directly cause channel opening.

Question 33

Which drugs cause GABA receptor activation?

Answer 33

Barbiturates.

Alcohol.