Antidepressants

Question 1

Moa ssri?

Answer 1

• Inhibit sert: 5ht reuptake transporter
• 5-ht1 receptor stimulation and ultimate down-regulation of receptors
Therefore more serotonin in synapse to bind

Question 2

Name 3 adverse effects ssri by bind to 5ht-2 R, 3 by 5ht-3, 3 serious ones

Answer 2

5ht-2
• Agitation or anxiety, panic attacks
• insomnia
• sexual dysfunction

5ht-3
• Nausea
• diarrhoea
• Headache

Serious
• serotonin syndrome
. Hyponatremia
• gi bleed

Question 3

Name 5 ssri

Answer 3

• Escitalopram
• fluoxetine
• sertraline
• paroxetine
• fluvoxamine
• citalopram

Question 4

Which ssri has most sexual dysfunction?

Answer 4

Paroxetine

Question 5

Name 3 snri

Answer 5

Serotonin noradrenaline reuptake inhibitor
•Venlafaxine
• desvenlafaxine
• duloxetine

Question 6

Name 5 tricyclic antidepressants

Answer 6

• Amitryptilline
• clomipramine
• desipramine
• doxepine
• imipramine
• lofepramide
• nortriptiline
• trimipraline

Question 7

Moa tricyclic antidepressants?

Answer 7

Block sert and net (reuptale transporters)

Also block postsynaptic histamine, muscarinic, adrenergic receptors (side effects)

Question 8

Name 5 side effects tricyclic antidepressants

Answer 8

• Dry mouth, blurred vision, constipation, urinary retention (block muscarinic cholinergic r)
• sedation, weight gain (h1 r)
• Orthostatic hypotension (alpha 1 adrenergic r)
• cardiotoxic (arrythmias, prolong qt interval) (noradrenaline uptake block)
• dangerous overdose: confusions, mania, delirium
• pro convulsant

Question 9

Name 2 drug interactions with tricyclic antidepressants

Answer 9

• Alcohol: potentiate effects, may cause severe respiratory depression
• fluoxetine and paroxetine (ssri): inhibit tricyclic metabolism
• lidocaine: fatal

Question 10

Name 3 classes maoi and example each

Answer 10

• Classical irreversible nonselective: phenelzine, tranylcypromine
• rima: moclobemide
. Selective inhibitors mao-b: selegiline (Parkinson’s)

Question 11

Name 3 adverse effects maoi

Answer 11

• CNS stimulation: excitement, tremor
. Antimuscarinic: dry mouth, blurred vision
. Hepatotoxic (especially phenelzine classic maoi)

Question 12

Name 3 interactions with maoi

Answer 12

• Fermented cheese reaction: tyramine not metabolised causing acute hypertension!, throbbing headache, intracranial haemorrhage
• sympathomimetic amines: eg cough mixtures, nasal decongestants. Cause hypertensive crisis
• barbiturates, opioids, alcohol: reduce metabolism
• serotonin syndrome: other antidepressants, phenylpiperidine opioids, cocaine, ecstasy, St John wort (hyperpyrexia, restless, coma)

Question 13

Name type NDRI

Answer 13

Noradrenaline dopamine reuptake inhibitor

Bupropion

Question 14

Name type nassa

Answer 14

Noradrenergic and specific serotonergic antidepressant

Mirtazapine

Question 15

Moa nassa? (3)

Answer 15

• Alpha 2 adrenoreceptor blocking to increase noradrenaline and serotonin In synaptic cleft.
• block 5ht 2 and 3 so increased binding to 1: less adverse effects
• block h1: sedation, weight gain

Question 16

Name 3 adverse effects mirtazapine

Answer 16

• Agranulocytosis

* sedation, weight gain

Question 17

Which antidepressants can be given if patient complain of sex dysfunction? (2)

Answer 17

• Bupropion (NDRI)

* mirtazipine (nassa)

Question 18

Name example NARI

Answer 18

Noradrenaline reuptake inhibitor

Reboxetine

Question 19

Name example massa

Answer 19

Melatonin agonist and selective serotonergic antidepressant

Agomelatine

Question 20

Tricyclic antidepressants contraindications? (3)

Answer 20

• Suicide risk
• recent mi or arrhythmia, (cardiotoxic)
• epilepsy (lower seizure threshold)

Question 21

Maoi indications in anxiety disorders? (2)

Answer 21

• Panic disorder

. Social phobia/anxiety disorder

Question 22

Name 2 treatment options for acute anxiety

Answer 22

“B” drugs
Benzos
Buspirirone: 5-ht 1 r agonist

Question 23

Name treatment options for short term insomnia (6)

Answer 23

“Z” drugs

Benzos:
• loprazolam
• temazepam
• triazolam

Benzo receptor agonists BZRA:
• Zolpidem
• Zopiclone
• Zaleplon

Question 24

Describe 4 possible fates neurotransmitters

Answer 24

• Effusion across synapse
• presynaptic reuptake
• enzymatic breakdown: moa presynaptically, COMT in synapse
• presynaptic autoinhibition

Question 25

Name 3 adverse effects snri

Answer 25

• 5ht2 stimulation: agitation, akathisia, anxiety, panic attacks, insomnia, sexual dysfunction
• 5ht3 stim: nausea, diarrhoea, headache
• cardiotoxic: hypertension!

Question 26

What type antidepressants more likely to cause discontinuation effects?

Answer 26

Short half lives

Question 27

How does pregabalin work in anxiety disorders?

Answer 27

Anti epileptic. Alpha 2 delta ligand of vgccs (voltage gated calcium channels). Inhibit calcium entry and suppress electrical activity

Question 28

Name antidote to benzodiazepines

Answer 28

• Flumazenil

Block Benzo binding site: GABA A r antagonist

Question 29

Name 5 drug interactions with monoamine oxidase inhibitors

Answer 29

• Ssri: increased serotonin-serotonin syndrome
• tricyclic antidepressants: increased catecholamines- hypertensive crisis, psychosis, serotonin syndrome
• catecholamine releasers or reuptake inhibitors: increased catecholamines - hypertensive crisis, psychosis, serotonin syndrome
• local anaesthetics with adrenaline: increased bp- hypertensive crisis
• tyramine containing food: increase catecholamine release - hypertensive crisis

Question 30

Name 5 adverse effects benzodiazepines

Answer 30

• respiratory depression
• sedation
• vertigo
• memory disturbances
• blurred vision, diplopia

Question 31

Name 5 features lithium toxicity

Answer 31

• Hypothyroidism
. Confusion
• ataxia
• renal failure
• INCREASED reflexes
•slurred speech