Antidepressant Drugs

Question 1

gepirone

Answer 1

TRADE: Exxua
CLASS: serotonin receptor partial agonist
FDA approval: tx of MDD in adults
MAIN points:
1) acts as a selective partial agonist of the 5-HT1A receptor
2) it is part of a unique pharmacologic class called azapirones that appears to act as an antidepressant and anxiolytic
3) newer drug only recently approved by FDA so important to closely monitor and observe for side effects
4) currently being studied for tx of GAD and hypoactive sexual desire disorder

Question 2

escitalopram

Answer 2

TRADE: Lexapro, Cipralex
CLASS: SSRI (rapidly absorbed)
FDA approval: MDD in adults and adolescents acute and maintenance tx; acute tx of GAD in adults
MAIN points:
1) generally a fairly safe drug (no reported concern of dependence or fatal OD)
2) does not usually have interactions with highly protein-bound drugs
3) commonly prescribed oral med for GAD and MDD

Question 3

paroxetine

Answer 3

TRADE: Paxil
CLASS: SSRI (increases serotonin levels in brain, improve mood and reduce anxiety)
FDA approval: MDD, PTSD, OCD, SAD, GAD, Panic Disorder, & PMDD
MAIN points:
1) stronger inhibitor of serotonin reuptake than other members of SSRIs, is just as effective as other SSRIs
2) it is rarely fatal but can occur and is safer in OD than TCAs –> patients have survived OD up to 3600 mg
3) individuals with SAD may be more dependent on this drug

Question 4

esketamine

Answer 4

TRADE: Spravato
CLASS: dissociative hallucinogen
FDA approval: MDD & tx resistant depression
MAIN points:
1) nasal spray used in conjunction with other antidepressants as a short-term assistance (in a medical facility with constant monitoring)
2) high abuse potential, classified as a schedule 3 drug – individuals with hx of drug abuse or dependence at greater risk

Question 5

In large doses, tricyclics can be _____.

Answer 5

cardiotoxic

Question 6

wine and cheese effect

Answer 6

associated with use of monoamine oxidase inhibitors (MAOIs) in which consumption of foods containing high levels of tyramine can cause hypertension (increase in blood pressure)

Question 7

Which MAOI drug was developed as a transdermal applicator?

Answer 7

selegiline

Question 8

Which TCA is epileptogenic (induces seizures)?

Answer 8

maprotiline (Ludiomil)

Question 9

While amoxapine (Ascendin) is better than TCAs at relieving anxiety and behavioral agitation, its blockage of DA receptors can induce . . .

Answer 9

Parkinson-like extrapyramidal side effects

Question 10

Which second-generation antidepressant has heavy sedative effects and is primarily used as a hypnotic?

Answer 10

trazodone (Desyrel)

Question 11

Clomipramine (Anafranil) is second-generation antidepressant used to treat . . .

Answer 11

anxiety, pain, depression, OCD, & panic disorder

Question 12

Which was the first SSRI to be released?

Answer 12

fluoxetine (Prozac)

Question 13

Which SSRI has a higher risk of serotonin syndrome and withdrawal syndrome?

Answer 13

sertraline (Zoloft)

Question 14

_____ is an SSRI that has the shortest half-life of all SSRIs and inhibits CYP1A2, which is increased by elements of tobacco smoke & means smokers require a higher dose to experience therapeutic effects.

Answer 14

fluvoxamine (Luvox)

Question 15

____ are analgesics (pain-relieving).

Answer 15

SSNRIs

Question 16

Nefazodone (Serzone) is an SSNRI that has increased risk for severe _____ damage.

Answer 16

liver

Question 17

Which SSNRI is approved for the treatment of fibromyalgia?

Answer 17

milnacipran (Savella)

Question 18

Which SSNRI may induce mania and is therefore not recommended for bipolar patients?

Answer 18

duloxetine (Cymbalta)

Question 19

Which tetracyclic antidepressant increases appetite and weight gain and is associated with very few sexual side effects?

Answer 19

mirtazepine (Remeron)