ANTIDEPRESSANTS

Question 1

Give the classes of drugs used in Major Depressive disorder

Answer 1

Selective Seratonin Reuptake inhibitors
Seratonin - Norepinephrine reuptake inhibitors
5HT2 Receptor modulators
Tetracyclic and Unicyclic antidepressants
Monoamine oxidase inhibitors
NMDA receptor antagonists
Allosteric modulators of GABA

Question 2

Give the MOA of SSRIs

Answer 2

They inhibit Seratonin Transporter (SERT) and thus prevent seratonin reuptake

Question 3

Give the examples pf SSRIs

Answer 3

Fluoxetine
Citalopram
Fluvoxamine
Paroxetine
Sertraline

Question 4

The SSRIs need atleast how many weeks to produce a significant effect and maximum benefit needs atleast how many weeks

Answer 4

2 weeks ,12 weeks

Question 5

Why are SSRIs the most used antidepressants

Answer 5

Cost
Relative tolerance
Relatively safe in overdose
Broad spectrum of use - mainly MDD but also anxiety disorders , PMDD , premature ejaculation

Question 6

What SSRI is indicated for bulimia nervosa

Answer 6

Fluoxetine

Question 7

In comparison to other SSRIs Fluoxetine has a longer half life of ?

The metabolite called Norfluoxetine has an even longer half life of

Answer 7

48-72hrs
7.5 days

Question 8

Due to this long half life , which classes of drugs should be discontinued and what duration and why

Answer 8

MAOI should be discontinued over 4 weeks prior to prevent seratonin syndrome

Question 9

Give A/ E of SSRIs

Answer 9

Sweating , fatigue
GIT symptoms
Hyponatremia
Weight gain esp paroxetine
Sexual dysfunction and reduced interest
Insomnia , Somnolence
Agitation - reduced with BZDs

Question 10

SSRIs are metabolised by

Answer 10

CYP450 then sulfate or glucoronide conjugation

Question 11

Care should be taken with use of SSRIS in cjildren and teenagers because of

Answer 11

Reported suicidal ideation

Question 12

Seratonin syndrome includes

Answer 12

Use of MAOI .
hyperthermia , muscle rigidity , sweating , clonic muscle twitching, changes in mental status and vital signs

Question 13

Explain about discontinuation syndrome with seratonin

Answer 13

Occurs after withdrawl of drugs especially those with shorter halflives and inactive metabolites such as paroxetine sertraline

Question 14

Discontinuation syndrome occurse and what are the symptoms

Answer 14

1 to 2 weeks after stopping the drugs
Malaise , Headache , Agitation, Irritability , Tremor , palpitations, changes in sleep pattern

Question 15

Fluoxetine and Paroxetine are potent inhibitors of which isoenzyme

Answer 15

CYP2D6

Question 16

Fluvoxamine is an inhibitor of which isoenzyme

Answer 16

CYP3A4

Question 17

Paroxetine Sertraline are increase plasma levels of

Answer 17

TCA , warfarin
Theophylline - paroxetine

Question 18

Seratonin Norepinephrinereuptake inhibitors can be classified into

Answer 18

TCA
Selective Seratonin Norepinephrine reuptake inhibitors

Question 19

Give examples of TCAs

Answer 19

Amitriptyline
Clomipramine
Doxepin
Desipramine

Question 20

Give the MOA of TCAs

Answer 20

Inhibit reuptake of seratonin and norepinephrine

Question 21

Give the A/ E of TCAs

Answer 21

1) Blurred vision , xerostamia , constipation , urinary retention
2) Arrhythmias
3) Weight gain
4) Postural hypotension , Diziness and reflex tachycardia
5) Sexual dysfunction

Question 22

Overdose with the TCAs may cause

Answer 22

Lethal arrhythmias