Anti-depressants

Question 1

List MAOI (3)

Answer 1

Phenelzine
Tranylcypromine
Selegiline

Question 2

List TCA (3)

Answer 2

Amitriptyline
Imipramine
Clomipramine

Question 3

List SNRI (2)

Answer 3

Venlafaxine

Duloxetine

Question 4

List SSRI (5)

Answer 4

Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Citalopram

Question 5

MOA of MAOI

Answer 5

Classical MAOIs (phenelzine, tranylcypromine): Irreversible and nonselective, blockers of MAO A (5-HT, DA, NE) and MAO B (DA)

Selegiline: irreversible MAO B inhibitor

Action is long-lasting (weeks) → even after drug cessation, effects last 2-3 weeks

Question 6

MOA of TCA

Answer 6

Block NE and 5-HT reuptake

Question 7

MOA of SNRI

Answer 7

Serotonin and norepinephrine reuptake inhibitors

Question 8

MOA of SSRI

Answer 8

Inhibit the uptake of 5-HT from the synaptic cleft

Inhibit p450

Question 9

MOA of Buproprion

Answer 9

Norepinephrine and Dopamine Reuptake Inhibitor (NDRI)

Question 10

MOA of Trazadone

Answer 10

Serotonin reuptake inhibitor and 5-HT2 antagonist

Also blocks alpha1 and H receptors

Question 11

Uses of TCA

Answer 11

Depression 
Chronic pain disorders
Incontinence 
OCD: clomipramine (blocks 5-HT > NE)
Enuresis: imipramine (decreases sleep stage IV)

Question 12

Uses of SNRI

Answer 12

MDD
Chronic pain disorder: duloxetine
Fibromyalgia: milnacipran
Perimenopausal symptoms

Question 13

Uses of SSRI

Answer 13

DOC for MDD
OCD (fluvoxamine)
Bulimia 
Anxiety disorder 
Panic attack 
Premenstrual dysphoric dysorder
DOC for depressive patients with heart disease

Question 14

Uses of Buproprion

Answer 14

Antidepressent

Smoking cessation

Question 15

Uses of Trazadone

Answer 15

Insomnia

Question 16

ADR of MAOI

Answer 16

Cheese reaction*
Serotonin syndrome*
Weight gain 
CNS stimulation, insomnia
Hepatotoxicity 
Orthostatic hypotension
Hypertension

Question 17

ADR of TCA

Answer 17

Anti H1: weight gain, sedation
Anti-α: orthostatic hypertention, sexual dysfunction
Anti M: dry mouth, blurred vision, constipation, urinary retention, tachycardia
Quinidine-heart toxicity (prolonged QT)
Overdose: Coma, Convulsions, Cardiac toxicity (3 Cs)

Question 18

ADR of SSRI

Answer 18

Sexual dysfunction
Anxiety for first several weeks; increases suicidal ideation in patients who are younger than 24 years old
Insomnia
Nausea, diarrhea, vomiting
Weightloss for first few weeks, then weight gain
Bruxism

Question 19

ADR of Buproprion

Answer 19

Seizures

Question 20

ADR of Trazadone

Answer 20

Extremely sedating
Priapism
Cardiac arrhythmia

Question 21

Contraindications of TCA

Answer 21

BPH
narrow angle glaucoma
recent MI, heart block, heart disease
Epilepsy

Question 22

Contraindications of SSRI

Answer 22

Teratogenic: Paroxetine can cause fetal ventricular septa defect (category D). Other SSRIs are category C . SSRIs can cause pulmonary hypertension in newborn (rare).
Do not use with MAOIs → serotonin syndrome

Question 23

Drug - Drug interactions involving MAOI

Answer 23

Foods with increased tyramine

TCA, SSRI, meperidine, St John’s wort, ginseng, sumatriptan (serotonin syndrome)

Question 24

Drug - Drug interactions involving TCA

Answer 24

Hypertensive crisis if used with MAOI
Serotonin syndrome if used with SSRI, MAOI, meperidine
α2 agonists and guanethidine

Question 25

Antidotes for cheese reaction

Answer 25

IV Phentolamine, phenoxybenzamine, labetolol

Question 26

Antidotes for serotonin syndrome

Answer 26

stop drugs, give cyproheptadine

Question 27

Antidote for cardiac side effects of TCAs

Answer 27

Sodium bicarbonate (NaHCO3)