Antidepressant Drugs

Question 1

Explain the biogenic amine hypothesis of mood disorder.

Answer 1

Depression is associated decreased functional amine- dependent synaptic transmission.
Hypothesis formulated from witnessing depression in patients treated with Resperine (which depletes biogenic amines)

Depression= too little CNS NE and/or 5-HT (amounts &/or activity)

Question 2

Mechanism of most antidepressants

Answer 2

block re-uptake of NE and 5-HT to varying degrees

Question 3

Major mystery behind antidepressants

Answer 3

Pharmacologic effect seen in minutes
Clinical effect takes weeks or months

May be due to neutrophic hypothesis, takes time for BDNF (Brain derived neurotrophic factor) to increase and cause gene transcription and neurogenesis

Question 4

Name two MAOIs (monoamine oxidase inhibitors)

Answer 4

tranylcypromine and phenelzine

Question 5

Mechanism of MAOIs

Answer 5

irreversibly inhibit both
MAOa (oxidizes NE, 5-HT)
and
MAOb (oxidizes DA)

Question 6

Life threatening SE of MAOI

Answer 6

Hypertensive crisis, due to inhibition of liver MAO

which protects against tyramine in fermented foods.

Question 7

Consequence of use of MAOI and SSRI

Answer 7

serotonin syndrome

hyperthermia, muscle rigidity, myoclonus, rapid change in mental status & vital signs

Question 8

SE of MAOI

Answer 8

anticholinergic, orthostatic hypotension, sexual dysfunction, weight gain, sedation

Question 9

Two general features of Tricyclics, SSRIs, Atypicals (Amine re-uptake inhibitors)

Answer 9

1) varying potencies and selectivity for NE &/or 5-HT transporters
2) many have active metabolites (usually longer acting than parent compound)

Question 10

Name the four Tricyclics

Answer 10

Desipramine, Imipramine, Amitriptyline, Nortriptyline

Question 11

Mechanism of Tricyclics

Answer 11

block reuptake of NE or 5-HT (varying selectivity and potency)

Also block muscarinic, a-adrenergic, histamine receptors and DA reuptake

Question 12

SE of tricyclics

Answer 12

antimuscarinic- blurred vision, constipation, confusion

orthostatic hypotension, sedation, seizures

Question 13

What are MAOIs, Tricyclics, SSRIs, SNRIs, and atypicals used to treat?

Answer 13

Depression, anxiety, PTSD, chronic pain, enuresis (inability to control urination), bulimia, alcoholism

Question 14

What is Lithium used to treat?

Answer 14

Bipolar disorder- Antimanic/ mood stabilizer

long term cluster headache prevention

Question 15

SE of lithium

Answer 15

drowsiness, weight gain, tremor, polydipsia, polyuria

Question 16

Mechanism of Lithium

Answer 16

Unknown
Lithium depletes 2nd messengers IP3 and DAG
important in a-adrenergic and musc-cholinergic transmission

Question 17

SE of lithium if given at high doses

Answer 17

neurotoxicity, cardiac toxicity, renal dysfunction

N/V early sign of lithium OD

Question 18

Important SE of Tricyclics

Answer 18

sympathomimetic- tremor, insomnia

cardiac arrhythmias, conduction defects esp w/ OD

Question 19

Name 5 SSRIs

Answer 19

Fluxetine, Paroxetine, Sertraline, Escitalopram, Citalopram

Question 20

Mechanism of SSRI

Answer 20

inhibit reuptake of 5-HT (limited NE)

Question 21

Name 2 SNRIs

Answer 21

Duloxetine and Venlafaxine

Question 22

Mechanism of SNRI

Answer 22

inhibit reuptake of NE (limited 5-HT)

Question 23

Name three Atypical Antidepressants

Answer 23

Buproprion, Mirtazapine, Ketamine

Question 24

What can Bupropion be use to treat that none of the other antidepressants can?

Answer 24

Smoking cessation

Question 25

Bupropion mechanism

Answer 25

Blocks DA and NE reuptake

Question 26

Mirtazapine

Answer 26

5HT2a antagonist, inhibit 5HT reuptake

Question 27

Main differences between SSRI and tricyclics?

Answer 27

SSRIs have longer duration and are metabolized by P450 enzymes
SSRIs much safer in OD- no seizures or cardiac arrhythmia

Question 28

Reversal treatment of Tricyclic OD for cardiac arrhythmia?

Answer 28

Sodium Bicarb

Question 29

SE of SSRI

Answer 29

Serotonin Syndrome (in combo w/MAOI)
nausea, sexual dysfunction

Question 30

When is ECT considered?

Answer 30

if patient not being helped by drugs/ too long to wait (impending suicide)

Question 31

Symptoms of MAOI OD

Answer 31

agitation, delirium»> seizures

Question 32

Anti-convulsant treatments of Bipolar

Answer 32

Carbamazepine and valproate