Antidepressant Meds

Question 1

name the SSRIs

Answer 1

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

Question 2

name the serotinin targets iof each of these si/sx of SSRIs

HA

Somnolence

Sex Dysfunction

Weight Gain

N/V

Diarrhea

Answer 2

HA - 1

Somnolence - 2

Sex Dysfunction - 2

Weight Gain - 2c

N/V - 3

Diarrhea -4

Question 3

what SSRI is most likely to cause sex dysfunction & weight gain

Answer 3

paroxetine

Question 4

what SSRI is most anticholinergc

Answer 4

paroxetine

Question 5

what SSRI has the greatest INC QTc risk

Answer 5

Citalopram

Question 6

describe the targets of serotonin in serotonin syndrome

Tx?

Answer 6

5-HT1A and 5-HT2A overstimulation

Tx: 5-HT antagonist cyproheptadine

Question 7

sertraline is most likelt to cause what adverse effects

Answer 7

diarrhea & HA

Question 8

fluvoxamine is most likely to cause what adverse effect

Answer 8

somnolence & N/V

Question 9

what SSRI has the greast risk of withdrawl -

Answer 9

fluvoxamine

Question 10

name the SSRIs + (serotonin modulators)

Answer 10

Vilazodone (Viibryd)

Vortioxetine (Trintellix)

Trazodone

Nefazodone

Question 11

MOI of Vilazodone (Viibryd)

Answer 11

• SSRI
• 5-HT 1 partial agonist

Question 12

adverse effects of Vilazodone (Viibryd)

Answer 12

• Nausea
• Diarrhea
• Dizziness
• Sexual dysfunction = fluoxetine

Question 13

MOI of Vortioxetine (Trintellix)

Answer 13

• SSRI
• 5-HT 1a agonist
• 5-HT 7 antagonist

Question 14

name difference in MOI b/w

Vilazodone (Viibryd)

Vortioxetine (Trintellix)

Answer 14

Vilazodone (Viibryd) - 5-HT 1 partial agonist

Vortioxetine (Trintellix) - 5-HT 1a agonist

• 5-HT 7 antagonist

Question 15

MOI of trazadone

Answer 15

• 5-HT 2 antagonist
• Antihistamine (severe)*
• Alpha-1 antagonist

Question 16

MOI of Nefazodone

Answer 16

• 5-HT 2 antagonist
• NE reuptake pump inhibitor
• Antihistamine (moderate)

Question 17

compare / contrast MOI of

Trazodone

Nefazodone

Answer 17

BOTH: 5-HT 2 antagonist

Trazodone: Antihistamine (severe)*

• Alpha-1 antagonist

Nefazodone: Antihistamine (moderate)

• NE reuptake pump inhibitor

Question 18

name the SNRIs

Answer 18

Venlafaxine (Effexor)

Desvenlafaxine (Pristiq)

Duloxetine (Cymbalta)

Levomilnacipran (Fetzima)

Mirtazapine*

Bupropion (Wellbutrin)

Question 19

MOI of

Venlafaxine (Effexor)

Desvenlafaxine (Pristiq)

Answer 19

Block reuptake of serotonin, NE, & DA (dose dependent)

• Low dose = serotonin
• Mod dose = + NE
• High dose = + DA

Desvenlafaxine (Pristiq): Worse on BP then Venlafaxine - slightly more ↑NE

Question 20

MOI of

Duloxetine (Cymbalta)

Levomilnacipran (Fetzima)

Answer 20

Duloxetine (Cymbalta): Block reuptake of ↑serotonin > ↓NE

Levomilnacipran (Fetzima): Block reuptake of ↓serotonin < MORE ↑NE (less potent)

Question 21

which SNRI is hepatotoxic?

Answer 21

Duloxetine (Cymbalta)

Question 22

Mirtazapine is assoc w/ what 3 adverse side effects

Answer 22

• ­ appetite (INC weight gain)
• Hyperglycemia (C/I in DM)*
• Hypertriglyceridemia*

Question 23

which SNRIs has a side effect of urinary hesitancy

Answer 23

Duloxetine (Cymbalta)

Levomilnacipran (Fetzima)

Question 24

which antidep dec seiure threshold

Answer 24

Bupropion

Question 25

MOI of Mirtazapine

Answer 25

* Alpha-2 antagonist (indirect ­ iINC 5-HT & NE)\* * 5-HT 2 antagonist * 5-HT 3 antagonist (antiemetic)

Question 26

which SNRIs has shown to elevate BP significantly?

Answer 26

Venlafaxine (Effexor) Desvenlafaxine (Pristiq) - worse for BP

Question 27

which antidep is CI in DM

Answer 27

Mirtazapine\*

Question 28

MOI of BZD

Answer 28

­ INC effect of GABA

Question 29

MOI of Buspirone (Buspar) indication?

Answer 29

5-HT1 partial agonist - anxiety

Question 30

benefits of Buspirone (Buspar)

Answer 30

* No sedation * No cognitive impairment * No respiratory depression * No abuse potential

Question 31

adjuvants to anxiety

Answer 31

Buspirone (Buspar) Antiepileptics: Pregabalin Atypical antipsychotics: (not recc) Quetiapine Hydroxyzine Propranolol Clonidine

Question 32

adjuvants to dep

Answer 32

Selegiline transdermal patch Esketamine – nasal inhalation Brexanolone Atypical antipsychotics: * •Aripiprazole – fewer side effects * •Olanzapine w/ fluoxetine * •Quetiapine

Question 33

what antidep has a risk for Hypertensive crisis

Answer 33

Selegiline transdermal patch

Question 34

whixh SNRI is good for ## Footnote * Good w/ ADD & depression * Neuropathic Pain & depression notable adverse effect?

Answer 34

Levomilnacipran (Fetzima) tachycardia

Question 35

antidep serotonin targets goal agonist goal antagonist

Answer 35

5-HT 1\* (goal: agonist) 5-HT 2\*(goal: antagonist)

Question 36

Nefazodone had what notable adverse effect

Answer 36

Hepatotoxicity

Question 37

name TCAs and their MOI

Answer 37

Inhibit reuptake of serotonin & NEà same as SNRI (BUT a lot of side effects) * •Block muscarinic * •histamine 1 * •Alpha * Imipramine * Amitriptyline * Desipramine * Nortriptyline * Clomipramine

Question 38

notable side effects of TCAs

Answer 38

Arrythmia ## Footnote •Anticholinergic effects - avoid in elderly