Anti-depressants (exam 2)

Question 1

Clomipramine

Answer 1

TCA used specifically for OCD

inhibits norepinephrine and serotonin re-uptake

Question 2

Amitriptyline (most antimuscarinic effect)

Nortriptyline

Answer 2

-tricyclic antidepressants
-block NE and 5HT re-uptake
-TOX: antimuscarinic effects
-sedation, weakness, fatigue, CV effect like tachycardia, arrhythmias
-can transition to mania
-has quinidine effects when overdosed
Many drug interactions!!!

Question 3

Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)

Answer 3

• selective serotonin re-uptake blocker
• takes up to two weeks for full effect
• leads to reduced serotonin and increased transmission
• less anti-muscarinic and arrhythmia risk
• much greater risk for nausea vomiting diarrhea
• Serotonin syndrome can occur with MAO inhibitors (hyperthermia, tremor, CV collapse)

Question 4

Bupropion (wellbutrin)

Answer 4

-selective norepinephrine uptake inhibitor
-blocks NE re-uptake
-inhibits DA uptake
-treat depression related to anxiety
-Zyban= treat nicotine addiction
TOX: dry mouth, headache, agitation, insomnia

Question 5

Mirtazapine (Remeron)

Answer 5

-monoamine receptor antagonist
-blocks alpha 2 receptor, increasing NE and serotonin release
TOX: sedation and dry mouth

Question 6

Trazadone

Answer 6

-monamine receptor antagonist
-blocks 5HT receptor, and also blocks 5HT reuptake
TOX: sedation, NVD, blurred vision, hypotension

Question 7

Phenelzine (Nardil

Answer 7

-MAO inhibitor
-efficacy similar, but requires strict diet and has higher toxicity (last try use only)
-inhibits MAO A and B; A type breaks down serotonin, NE, and DA; involved in depression
-inhibits hepatic enzymes so lots of drug interactions due to altered metabolism
-USES: bulimia
-TOX: orthostatic hypotension, REM suppression, liver damage
“paradoxical hypertensive crisis” when ingested with beer wine cheese= releases tyramine and norepinephrine

Question 8

Venlafaxine (effexor)

Answer 8

• atypical anti-depressant; increase neuronal transmission
• less antimuscarinic effect than TCA; still risk seizure and anti-alpha actions
• less likely to cause death in OD compared to TCA

Question 9

St. John’s Wort

Answer 9

• natural anti-depressant
• hyperforin: natural uptake inhibitor
• interferes with other drugs, incudes metabolism

Question 10

Lithium

Answer 10

-treats mania phase of bipolar disorder
-sometimes used with anti depressant
-no impact on normals
-inhibits NE release while increasing 5HT release
-enters cells via Na+ channel and accumulates
-blocks innositol phosphate pathway
-lithium has long onset, so must use anti-convulsant/psychotic/anxiety meds to get through acute phase
TOX: very toxic, must monitor chronic use patients closely
-low TI=2
-polydipsia and poly urea (kidney failure); contraindicated with loop diuretics and thiazides