Antidepressant

Question 1

What’s the 2nd or 3rd line for major depressive disorder

Answer 1

Tricyclic antidepressants

Question 2

List tricyclic antidepressants

Answer 2

Imipramine
Desipramine
Clomipramine
Amitriptyline
Nortriptyline

Question 3

Tricyclic antidepressants mechanism of action

Answer 3

Inhibit presynaptic erupts me of serotonin and norepinephrine by binding to NET and SERT-> increasing mono amines in the synapse

Question 4

When is Tricyclic antidepressants usually used

Answer 4

Treatment of depression not responsive to other antidepressants
(Resistant depression)

Question 5

Tricyclic antidepressants therapeutic uses

Answer 5

Neruopathic pain or chronic pain 
Migraine prophylaxis 
OCD 
Bed wetting 
Phobic disorders

Question 6

Which tricyclic antidepressants is used for migraine prophylaxis

Answer 6

Amitriptyline

Question 7

Which tricyclic antidepressants is used for OCD

Answer 7

Clomipramine

Question 8

Which tricyclic antidepressants is used for bed wetting

Answer 8

imipramine

Question 9

What’s the first line drug in treatment of OCD

Answer 9

SSRIs

Question 10

Tricyclic antidepressants side effects

Answer 10

Sexual dysfunction
AntiMuscarinic side effects
Antihistamine side effects
A1 antagonism

Question 11

Which tricyclic antidepressant mostly shows AntiMuscarinic side effects

Answer 11

Amytriptyline - mostly seen as urinary retention

Question 12

Antihistamine side effects seem in tricyclic antidepressants

Answer 12

Sedation weight gain and increased appetite

Question 13

a1 antagonist side effects seem in tricyclic antidepressants

Answer 13

Orthostatic hypotension

Question 14

What’s tricyclic antidepressants most common cause of death

Answer 14

Cardiotoxicity by blocking of Na+ fast channels

Question 15

What happens if TCAs and MAOIs are given together

Answer 15

Serotonin syndrome

Question 16

List SSRIs

Answer 16

Fluoxetine
Paroxetine
Sertraline
Citalopram

Question 17

SSRI mechanism of action

Answer 17

SSRIs inhibit the presynaptic resp take of serotonin by blocking SERT

Question 18

What are SSSRIs first line treatment for

Answer 18

Depression 
Panick attacks 
OCD 
Eating disorders 
Chronic pain - diabetic neuropathy 
Menstural sundrome

Question 19

Which SSRI is used in OCD treatment

Answer 19

Fluvoxamine

Question 20

Which SSRI is used to treat menstural syndrome

Answer 20

Fluoxetine

Question 21

SSRIs side effects

Answer 21

Serotonin syndrome, sexual dysfunction, anxiety and GI disturbances

Question 22

SSRI exception in having an active metabolite

Answer 22

Only fluoxetine has an active metabolite which is norfluoxetine which is more potent and selective half life = 30 days so even after treatment is stopped the drug lingers in the blood
- P450 inhibitors

Question 23

SSRI + MAOI

Answer 23

Serotonin syndrome

SSRI Should be taken 2 weeks after MAOI and MAOI 5 weeks after SSRI

Question 24

Atypical depression vs depression

Answer 24

In atypical we have hypersomina, increased apetite and brief periods of pleasure, indulge in pleasure seeking behaviour

Question 25

What is usually given for atypical depression

Answer 25

Bupropion or venlafaxine

Question 26

Why aren’t MAOIs used often

Answer 26

More adverse effects than other antidepressants and limited use due to complicated dietary restrictions

Question 27

what does MAO A breakdown

Answer 27

5-HT (serotonin), NE and Tyramine

Question 28

What does MAO B breakdown

Answer 28

Dopamine and tyramine

Question 29

MAOI mechanism of action

Answer 29

Works by inactivation of monoamine oxidase increasing concentration of neurotransmitters causing them to leak in to the synaptic cleft

Question 30

List non selective irreversible MAOIs

Answer 30

Phenelzine Isocarboxazid Tranylcypromine

Question 31

Irreversible MAO B inhibitor

Answer 31

Selegiline

Question 32

Reversible MAO A inhibitor

Answer 32

Moclobemid

Question 33

MAOIs therapeutic uses

Answer 33

3rd line for ATYPICAL DEPRESSION Depression with sting anxiety Resistant depression Facial pain

Question 34

What’s a cheese reaction

Answer 34

Tyramine not inactivated by MAOs -> increase catecholamine release-> tachycardia headache nausea hypertension and cardiac arrhythmias Happens within 30mins - 1 hr after eating

Question 35

MAOIs contraindications

Answer 35

Pheochromocytoma, CHF and liver failure

Question 36

List SNRIs

Answer 36

Duloxetine and venlafaxine

Question 37

Duloxetine indication

Answer 37

Depression and neuropathic pain

Question 38

Mlinacipran indication

Answer 38

In fibromyalgia

Question 39

Atomexetine indication

Answer 39

ADHD

Question 40

Atypical antidepressants:

Answer 40

Bupropion Mirtazapine Nefazodone Trazodone

Question 41

Bupropion mechanism of action

Answer 41

Selective D and 5HT reuptake inhibitor

Question 42

Bupropion indication

Answer 42

First line for atypical depression | Could be helpful in smoking cessation

Question 43

Mirtazapine mechanism of action

Answer 43

Inhibits post synaptic 5HT2a and 5HT2c and presynaptic a2 receptors (Increase NE neurotransmission)

Question 44

Mirtazapine special feature

Answer 44

Doesn’t cause sexual dysfunction

Question 45

Mirtazapine side effects

Answer 45

Sedation and appetite stimulation

Question 46

Trazadone and nafazadone mechanism of action

Answer 46

Selective 5-HT 2a/2c agonists

Question 47

Trazadone and nafazadone indications

Answer 47

Used in Schizophrenia | Used in depression and insomnia

Question 48

Trazadone and nafazadone side effects

Answer 48

Somnorific agent (sedation)