antidepressants

Question 1

Name the SSRIs

Answer 1

Fluoxetine, Paroxetine, sertraline, citalopram. (flashbacks paralyze senior citizens). Also escitalopram, fluvoxamine

Question 2

toxicity of SSRIs

Answer 2

< TCAs. GI distress, sexual dysfxn. Serotonin syndrome. Suicide?

Question 3

Serotonin syndrome: what causes it? symptoms? treatment?

Answer 3

any drug that increases 5HT (MAOI, SNRI, TCA, SSRI). Hyperthermia, confusion, myoclonus, CV collapse, diarrhea, seizures. Cyproheptadine.

Question 4

Interactions of SSRIs with CYPs

Answer 4

degraded by 1A2. Inhibit 2D6 (TCAs are substrates)

Question 5

Name the SNRIs

Answer 5

Venlafaxine, Duloxetine. Also, desvenlafaxine.

Question 6

Toxicity of SNRIs

Answer 6

increased BP. Also some stimulant effects, sedation, nausea

Question 7

atypical antidepressants

Answer 7

buproprion, mirtazapine, maprotiline, trazodone

Question 8

buproprion: mech and toxicity

Answer 8

increases NE and DA. Stimulant effects (tachycardia, insomnia), HA, seizure in bulimic pts. No sexual disfxn

Question 9

mirtazapine: mech and toxicity

Answer 9

Alpha 2 antagonist. increases release of NE and 5HT. Sedation, increased appetite, dry mouth.

Question 10

trazodone: mech and toxicity

Answer 10

inhibits 5HT reuptake. sedation, nausea, priapism, postural hypotension

Question 11

maprotiline: mech, vilazodone: mech

Answer 11

NE reuptake inhibitor, 5HT reuptake inhibitor

Question 12

TCAs: names

Answer 12

-iptyline or -ipramine except doxepin and amoxapine. amitryptyline, nortryptiline, imipramine, desipramine, clomipramine, doxepin, amoxapine

Question 13

TCAs: scondary vs tertiary

Answer 13

more selective for NE reuptake, block 5HT and NE reuptake equally

Question 14

Toxicity of TCAs

Answer 14

anti-cholinergic (dry mouth, constipation, urinary retention). Anti-adrenergic (block alpha 1) (sedation, sexual dysfxn, orthostasis). Anti-histaminic (block H1) (sedation, wt gain). Tri-C’s: convulsions, coma, cardiotoxicity.

Question 15

Names of MAOIs

Answer 15

nonspecific: Tranylcypromine, phenelzine, isocarboxazid. Selective MAO-B: Selegiline. (MAO takes pride in shanghai)

Question 16

MAOI toxicity

Answer 16

hypertensive crisis, CNS stimulation.

Question 17

MAOI htn crisis: what did they just do? how to avoid?

Answer 17

tyramine rich foods like wine and cheese. 2-wk washout period before adding SSRI or general anesthesia.