Antidepressant Pharm

Question 1

8 conditions to remember that indicate antidepressants?

Answer 1

MDD, several types of anxiety, PTSD, Panic Disorder, OCD, Seasonal Affective Disorder, Premenstrual Dysphoric Disorder, Disruptive Mood Disorder.

Question 2

What is the primary MOA of antidepressants?

Answer 2

They are trying to increase the level of serotonin or NE

Usually, do this by blocking the re uptake of these NTs

Question 3

What are the 5 families/classifications of antidepressants?

Answer 3

SSRIs, SNRIs, TCAs, MAOIs, Atypical antidepressants

Question 4

MOA of SNRIs?

What are SNRIs also effective in treating besides depression that SSRIs are not and give 4 examples?

Answer 4

Block serotonin re uptake via SERT and NE re uptake via NET

Chronic pain symptoms in conditions like diabetic neuropathy, postherpetic neuralgia, fibromyalgia and low back pain.

Question 5

What is the MOA of SSRIs?
what are they the drug of choice for?
What 3 receptors do SSRIs have very little effect on?

Answer 5

Selectively inhibit re uptake of serotonin via SERT and a little bit of NE re uptake blocking, but mostly serotonin.

Depression

Histamine, muscarinic and adrenergic

Question 6

4 more common side effects of SSRIs?
3 rare but serious adverse effects of SSRIs?
What serious side effects is seen in kids/teens/YA?

Answer 6

CNS problems, sexual dysfunction, weight gain in adults and weight loss in teens, acute withdrawal reaction, GI effects

QT prolongation, hyponatremia, and serotonin syndrome

Suicide

Question 7

3 distinct features of neuroleptic malignant syndrome and what drug precipitates it?
4 distinct features of serotonin syndrome?

Answer 7

Hypo reflexia, normal pupils, and normal or decreased bowel sounds…dopamine agents

Hyperreflexia, clonus dilated pupils and hyper active bowels

Question 8

What two other drug families, if combined with antidepressants, can cause serotonin syndrome?

Answer 8

Opioids and migraine meds

Question 9

Fluoxetine and paroxetine are strong inhibitors of what?

Citalopram and setraline are weak inhibitors of what?

Answer 9

CYP 450

Question 10

Paroxetine and fluvoxamine are used in patients with what and why?
Fluoxetine or sertraline are used in patients with what and why?

Answer 10

Insomnia because they are more sedating than activating when treating depression

Patients who are fatigued because they are more activating than sedating

Question 11

Bupropion or mirtazapine are good to use in patients with depression with what?

Answer 11

If patients are experiencing sexual dysfunction, these two are good to switch to.

Question 12

Fluoxetine, Sertraline and fluvoxamine is approved to treat what in kids?
Fluoxetine and Escitalopram is approved to treat what in kids?

Answer 12

OCD

Depression

Question 13

What is the MOA of TCAS?
What 3 other receptors do TCAS block?
Amoxapine blocks which additional receptor?

Answer 13

Block re uptake or serotonin and NE
Histamine, muscarinic and adrenergic
Dopamine

Question 14

Indication for amitrityline?
What other antidepressant family should not be given with amitriptyline?
Back box warning?
Drug interaction?

Answer 14

Depression, it is sedative
MOAI
Suicide
Cyp 450 2d6

Question 15

4 actions/effects of TCAs?

Answer 15

Elevate mood
Improve mental alertness
Increase physical activity
Reduce morbid preoccupation

Question 16

3 C’s of toxic ingestion of TCAs?

Answer 16

Coma, cardiotoxicity (conduction abnormalities), and convulsions

Question 17

3 CV side effects of TCAs because of adrenergic interaction?
3 anticholinergic side effects of TCAs?
2 CNS effects because of blocking histamine?

Answer 17

Tachycardia, orthostatic hypotension, dysrhythmias

Dry mouth, urinary retention/constipation, blurred vision

Sedation and dizziness

Question 18

What is the black box warning for Amoxapine?

Answer 18

Suicide and worsening of depression in patients with MDD

Question 19

MOA of bupropion?

2 clinical uses?

Answer 19

Weak dopamine and NE re uptake blocker

Depression and withdrawal symptoms of nicotine

Question 20

MOA of mirtazapine?
Clinical use?
One common effect?

Answer 20

Enhances serotonin and NE transmission by blocking alpha 2 and
Also blocks 5ht2 receptors
Depression
Sedation because of antihistamine activity, but no anti muscarinic activity or sexual dysfunction

Question 21

MOA of vilazodone and Vortioxetine?

Answer 21

Serotonin re uptake inhibitor

Question 22

What do the following three atypical antidepressants have in common?
Mirtazapine, nefazodone, and trazodone?

Answer 22

Sedative

Question 23

Effect of using a MOAI, basically the MOA and then effect?

Clinical use of MAOIs?

Answer 23

Irreversible blocks MOA increasing NE, dopamine, and serotonin

Depression when there other ones don’t work or allergy issues and anxiety.

Question 24

What are the 5 R’s of general antidepressant efficacy?
Response?
Remission?
Recovery?
Relapse?
Recurrence?

Answer 24

Greater than 50% reduction in symptoms, partial response is between 25% and 50% reduction
Symptom free
2-6 months of ongoing remission
Return of symptoms after remission but before recovery
Return of symptoms after recovery

Question 25

How long should we give a drug before we switch to another MOA drug?

Answer 25

8 weeks

Question 26

How do we take people off antidepressants?

Answer 26

Need to slowly titrate down the dose because of withdraw syndrome