Antidepressant Medication

Question 1

In depression, what is there increased function of?

Answer 1

somatodendritic 5-HT1A receptor

Question 2

In depression, what is there a decrease of?

Answer 2

postsynaptic 5-HT1A receptor number and function

Question 3

What is the function of SSRIs?

Answer 3

inhibit 5-HT/serotonin uptake

down-regulate 5-HT autoreceptors

Question 4

What do SSRIs increase the stimulation of?

Answer 4

postsynaptic 5-HT1A receptors

Question 5

What does NRI stand for?

Answer 5

Norepinephrine reuptake inhibitor

Question 6

What is the function of NRIs?

Answer 6

Down regulates a2 receptors
decreases inhibition of 5-HT release
increased postsynaptic 5-HT1A receptor stimulation

Question 7

What does NaSSA stand for?

Answer 7

Noradrenergic and specific serotonergic antidepressants

Question 8

What is the function of NaSSAs?

Answer 8

Antagonize the a2-adrenergic receptor

increases 5-HT and noradrenaline concentrations

Question 9

Major classes of antidepressant drugs

Answer 9

Selective serotonin re-uptake inhibitors & serotonin-norepinephrine re-uptake inhibitors
Tricyclic
Monoamine Oxidase Inhibitors

Question 10

Tricyclic drug examples

Answer 10

imipramine
amitriptyline
clomipraline

Question 11

Function of tricyclic antidepressants

Answer 11

block uptake of amines by nerve terminals
compete for binding site of amine transporter
most inhibit noradrenaline and 5-HT uptake

Question 12

Mono-amine oxidase inhibitor examples

Answer 12

phenelzine
tranylcypromine
isocarboxazid
moclobemide

Question 13

What is the importance of mono-amine oxidase inhibitors?

Answer 13

MAO-A enzyme has substrate preference for 5-HT

Question 14

Which mono-amine oxidase inhibitor may be used for major depression and social phobia?

Answer 14

Moclobemide

Question 15

Why do tricyclic drugs have low rates of elimination?

Answer 15

plasma protein binding

tissue binding

Question 16

Main adverse effects of tricyclic antidepressants

Answer 16

sedation (H1 block)
postural hypotension (a-adrenoceptor block)
dry mouth
blurred vision
constipation (muscarinic block)

Question 17

Less common adverse effects of tricyclic antidepressants

Answer 17

occasional mania and convulsions

risk of ventricular dysrhythmias

Question 18

Tricyclic antidepressant drug interactions

Answer 18

alcohol
anaesthetics
hypotensive drugs
NSAIDs

Question 19

What drug should not be given with tricyclics?

Answer 19

Monoamine oxidase inhibitors

Question 20

Why is postural hypotension a common side effect of monoamine oxidase inhibitors?

Answer 20

amines accumulate within peripheral sympathetic nerve terminals
displaces Noradrenaline from storage vesicles
reduces vasoconstriction

Question 21

Adverse effects of Monoamine-oxidase inhibitors

Answer 21

excessive central stimulation
increased appetite, weight gain
anticholinergic effects (dry mouth, blurred vision)

Question 22

How does MAO inhibition cause the ‘cheese reaction’?

Answer 22

allows tyramine to be absorbed

Question 23

What are the effects of tyramine absorption?

Answer 23

enhances the sympathomimetic effect
severe acute hypertension
severe throbbing headache
intracranial haemorrhage

Question 24

What do Paroxetine and Fluoxetine inhibit, and what should they not be used in combination with?

Answer 24

hepatic metabolism by CYP2D6

should not be used in combination with TCAs

Question 25

Common adverse effects of SSRIs

Answer 25

Nausea
anorexia
insomnia
loss of libido

Question 26

Additional Major side effects of antidepressant drugs

Answer 26

Hyponatraemia
Suicidal behaviour
Serotonin syndrome

Question 27

What drug and symptoms link to Hyponatraemia?

Answer 27

SSRIs
drowsiness
confusion
convulsions

Question 28

Which drug is usually linked to Serotonin syndrome?

Answer 28

Monoamine Oxidase Inhibitors

Question 29

Symptoms of Serotonin Syndrome

Answer 29

neuromuscular hyperactivity
autonomic dysfunction
altered mental state

Question 30

Tricyclic drug suffix

Answer 30

’‘-ine’’