Anti-depressants

Question 1

fluoxetine (prozac)

Answer 1

SSRI
longest half life (creates active metabolites)
interactions with other drugs
safe in pregnancy

Question 2

fluvoxamine (luvox)

Answer 2

SSRI
most drug interactions, shortest half life
(must taper)= least used
used for tx resistant OCD

Question 3

paroxetine (paxil)

Answer 3

SSRI
most anticholinergic effects (sedation, constipation, weight gain)
short half life= worst withdrawal symptoms
(needs gradual taper)

Question 4

sertraline (zoloft)

Answer 4

SSRI
GI disturbances
good first choice

Question 5

citalopram (celexa)

Answer 5

SSRI
well tolerated- clean fewer drug interactions
fewer side effects

Question 6

escitalopram (lexapro)

Answer 6

SSRI
S-enantiomer of citalopram
fewest side effects

very clean twice as potent

Question 7

venlafaxine (effexor)

Answer 7

SNRI

good for an, menopause hot flashes, inc BP, GI disturbances, unpleasant withdrawal symptoms (taper off slowly)

Question 8

desvenlafazine (pristiq)

Answer 8

SNRI
active metabolite of venlafaxine
less side effects

Question 9

duloxetine (cymbalta)

Answer 9

SNRI
good for diabetic neuropathic pain
GI disturbance, sedation, dizzy, liver SE in pots with hepatic insuff or heavy alc use

Question 10

bupropion (wellbutrin, zyban)

Answer 10

NDRI- NE/dopa reuptake inhibitor
good for smoking cessation, hypersomnia, bad for an (CNS stim)

no sex dysfunction, causes weight loss, lowers seizure threshold, tachy, higher BP

Question 11

mirtazapine (remeron)

Answer 11

NaSSA- pre synaptic a2 block= increase NE/5HT

good for an, insomnia, refractory MDD, inc appetite, weight gain, very sedation

no sex SE, reduces GI SE

use in depressed elderly- inc sleep and appetite

Question 12

trazadone (desyrel)

Answer 12

very sedating (low dose)
risk of priapism

Question 13

selegiline (eldepryl, emsam)
phenelzine (nardil)
tranylcypromine (parnate)
isocarboxazid (marplan)
moclobemide (auroix, manerix)

Answer 13

MAOi- blocks breakdown of NE/5HT
atypical dep
orthostatic hypotension, HTN crisis, serotonin syndrome

must use 2-44 weeks grace period btn MAOi/SSRI (5-6 weeks for fluoxetine

lethal in OD

Question 14

tertiary (more anticholinergic, antihistamine)
amitriptyline
imipramine
clomipramine
doxepin 
nortiptyline 
desipramine

Answer 14

TCAs- reuptake inhibitors of NE/5HT
good for chronic pain
clomipramine- good for OCD
antiHAM
TCA 3Cs: cardiotox, convulsion, coma

Question 15

serotonin syndrome

Answer 15

SSRI + MAOi

HARM: hyperthermia, cyproheptadine (5HT blocker)

Question 16

serotonin discontinuation syndrome

Answer 16

following interruption, dose reduction, or discontinuation of SSRI, SNRI

short half life- venlafaxine , paroxetine

N/V, dizzy, insomnia, SHOCK like sensations

prevent- slow taper off drugs, sub fluoxetine in final stages of SSRI discontinuation

tx- symptoms if intolerable, or start back on drug

Question 17

HTN crisis

Answer 17

irreversibly bind MAOi - phenelzine, tranylcypromine

tyramine rich foods- soy sauce, red wine, cured meats, cheese

tx- phenoxybenazmine (alpha blocker)