Antidepressants

Question 1

What are the symptoms of major depressive disorder

Answer 1

This disorder causes a persistent feeling of sadness and loss of interest in everyday activities.

Question 2

How do selective serotonin reuptake inhibitor work?

Answer 2

They work by increasing the levels of serotonin to alleviate the symptoms of depression.

Question 3

List 6 mild selective serotonin reuptake inhibitors

Answer 3

escitalopram, 
fluoxetine, 
fluvoxamine, 
sertraline, 
paroxetine,
 and citalopram.

Question 4

Upon taking SSRIs, how long can it take before improvements are seen and why?

Answer 4

It can take 4-6 weeks because they are slow acting as it takes time for serotonin to accumulate within the synaptic cleft

Question 5

What are the side effects of SSRIs?

Answer 5

Anxiety
Sexual dysfunction
Insomnia
GI stress
syndrome of inappropriate antidiuretic hormones
Suicidal ideations
Serotonin syndrome

Question 6

What is serotonin syndrome and what are its symptoms?

Answer 6

a life threatening condition caused serotonin accumulation which causes over stimulation of the nervous system.
Symptoms are
 skin flushing,
 hyperthermia,
 agitation, 
muscle rigidity, 
seizure, 
and coma.

Question 7

What is the treatment of Serotonin syndrome?

Answer 7

administration of cyproheptadine, which is a serotonin antagonist that blocks 5HT2 receptors.

Question 8

What are the risks of taking fluoxetine, fluvoxamine, and paroxetine?

Answer 8

They are inhibitors of cytochrome P450 enzymes.

These are liver enzymes responsible for the metabolism of a variety of drugs and toxins in our body.

So, when combined with other drugs that are metabolized by cytochrome P450 enzymes, such as benzodiazepines, SSRIs will reduce their rate of elimination and cause them to build up in the body..

Question 9

List common Serotonin norepinephrin reuptake inhibitors

Answer 9

duloxetine,
 venlafaxine, 
 desvenlafaxine, which is actually an active metabolite of venlafaxine, 
milnacipran, 
and levomilnacipran.

Question 10

What are other uses of duloxetine?

Answer 10

can be used to treat urinary incontinence, and fibromyalgia, a condition characterized by chronic muscle pain, fatigue, and sleep problems.

Question 11

What are some other uses of venlafaxine?

Answer 11

Can be used for social anxiety,
panic disorders,
PTSD and obsessive-compulsive disorder or OCD.

venlafaxine can also treat postmenopausal hot flashes, sudden feelings of heat, usually most intense over the face, neck, and chest.

Question 12

What are side effects of SNRIs?

Answer 12

Nausea
sexual dysfunction
Insomnia
Due to high levels of epinephrine they can also cause
high blood pressure, sweating 
and Headaches

Question 13

What are medicine specifis side effects of venlefaxine?

Answer 13

It is an inhibitor of cytochrome P450 enzymes, liver enzymes responsible for the metabolism of a variety of drugs and toxins in our body.
when combined with other drugs that are metabolized by cytochrome P450 enzymes, such as benzodiazepines, SSRIs will reduce their rate of elimination and cause them to build up in the body.

Question 14

What are medicine specific side effects of duloxetine?

Answer 14

It can cause liver damage because its hepatotoxic

Question 15

How many groups of Tricyclic antidepressants are there? Name them

Answer 15

There are 2 main groups,
Tertiary TCAs (non specific TCAs and inhibit both SERTs and NETs) and Secondary (specific TCAs that inhibit only NETs) TCAs

Question 16

List some tertiary TCAs

Answer 16

amitriptyline,
imipramine,
and clomipramine;

Question 17

List some secondary TCAs

Answer 17

Nortriptyline

Desipramine

Question 18

Upon using TCAs, how long can it take to see improvements and why?

Answer 18

2-4 weeks because they are slow acting

Question 19

What are other medical uses of clomipramine?

Answer 19

Can be used for OCD

Question 20

What are other uses of Imipramine?

Answer 20

Can be used to treat nocturnal enuresis

Question 21

What else can TCAs block?

Answer 21

They can also block histamine H1 receptors, causing sedation;
alpha 1 receptors, causing orthostatic hypotension;
and muscarinic receptors, causing atropine-like side effects.
Atropine-like side effects occur more commonly with tertiary TCAs and they include dry mouth, tachycardia, urinary retention, confusion, and hallucinations.

Question 22

What is a toxic side effect of TCAs?

Answer 22

They are cardiotoxic and can lead to arrhythmias and prolong the QT interval.

Question 23

How is cardiotoxicity treated?

Answer 23

By administration of sodium bicarbonate in order to prevent arrhythmias.

Question 24

What are the most common causes of death when using TCAs?

Answer 24

the most common causes of death when using TCAs are

convulsion, coma, and cardiotoxicity.

Question 25

How do TCAs affect liver enzymes?

Answer 25

are inhibitors of cytochrome P450 enzymes.

These liver enzymes are responsible for the metabolism of a variety of drugs and toxins in our body.

So, when combined with other drugs that are metabolized by cytochrome P450 enzymes, such as benzodiazepines, TCAs will reduce their rate of elimination and cause them to build up in the body.

Question 26

What happens if you take TCAs with ethanol or sedative hypnotics?

Answer 26

If taken with ethanol or sedative hypnotics, TCAs can cause severe respiratory depression and death.

Question 27

How do individuals with atypical depression act?

Answer 27

They are able to improve their mood in response to positive events and circumstances.

They also experience increased appetite, weight gain, sleepiness, and fatigue.

Question 28

How many groups of Monoamine oxidase inhibitors are there? name them

Answer 28

There are 2 groups, Non-selective and selective

Question 29

List down non selective MAOIs, and what they do

Answer 29

isocarboxazid,
phenelzine,
and tranylcypromine

They inhibit monoamine oxidase A and monoamine oxidase B, so serotonin, norepinephrine, and dopamine levels will increase.

Question 30

Why are non selective MAOIs also called irreversible MAOs?

Answer 30

These medications are also called irreversible MAOIs because they bind irreversibly to the enzymes, permanently blocking their function.

Question 31

What happens when non selective MAOIs bind to the enzymes?

Answer 31

Once these enzymes are inhibited, the monoamines neurotransmitters get packed into pre-existing vesicles.

So, the next time an action potential reaches the presynaptic membrane, more neurotransmitters are released into the synaptic cleft and thus alleviating the symptoms of depression.

Question 32

List selective MAOIs and what they do

Answer 32

selegiline
and rasagiline
They only inhibit MAO B, so they only increase the level of dopamine and more more commonly used to treat parkinsons

Question 33

Before starting another antidepressant, how long should you stop taking MAOIs beforehand and why?

Answer 33

For 2 weeks because this is the time it takes to replenish the MAO enzymes

Question 34

How can MAOIs lead to hypertensive crisis?

Answer 34

hypertensive crisis is a condition characterized by hyperthermia, increased blood pressure, increased heart rate (tachycardia), arrhythmias, and agitation.

It’s commonly seen in individuals that combine MAOIs with tyramine-rich food and drinks, such as cheese, wine, and beer.

within the cells of the gut wall, both monoamine oxidase A and monoamine oxidase B break down tyramine.

But when they’re inhibited, more tyramine is absorbed.

High concentration of tyramine increases norepinephrine release, which leads to hypertensive crisis.

Question 35

How is hypertensive crisis treated?

Answer 35

Treatment of this condition consists of administration of phentolamine, which is an adrenergic antagonist that blocks norepinephrine receptors.