antidepressants

Question 1

tranylcypromine

Answer 1

• MAOI
• irreversibly inhibit MAOa and MAOb
• hypertensive crisis with tyramine
• serotonin syndrome with SSRI

Question 2

Phenelzine

Answer 2

• MAOI
• inhibits both MAOa and MAOb
• hypertensive crisis with tyramine (MAOI also inhibit the metabolism of tyramine which is a precursor of NE –> too much tyramine –> too much NE)
• serotonin syndrome with SSRI

Question 3

Desipramine

Answer 3

• tricyclic

Question 4

tricyclics

Answer 4

”–amine” and “–triptyline”

• amine reuptake inhibitor
• dirty drugs: block muscarinic, alpha adrenergic and histamine receptors (blurred vision, hypotension, sedation)
• cardiac arrhythmias, conduction defects (also due to alpha-adrenergic blockade)
• have active metabolites –> wide duration of effect

Question 5

Imipramine

Answer 5

tricyclic

Question 6

amitriptyline

Answer 6

tricyclic

Question 7

nortriptyline

Answer 7

tricyclic

Question 8

fluoxetine (prozac)

Answer 8

• SSRI
• inhibit P450 enzymes drug-drug interactions

Question 9

Paroxetine (paxil)

Answer 9

• SSRI
• inhibit P450’s: drug-drug interactions (will result in higher levels of another drug)

Question 10

sertraline (zoloft)

Answer 10

SSRI

Question 11

escitalopram (lexapro)

Answer 11

SSRI

Question 12

citalopram

Answer 12

SSRI

Question 13

duloxetine (cymbalta)

Answer 13

SNRI

Question 14

venlafaxine

Answer 14

SNRI

Question 15

properties of SSRI (advantages and disadvantages)

Answer 15

• not any more effective that tricyclics
• (+): longer duration of action, no seizures, cardiac arrhythmias
• (-): Nausea, sexual dysfunction, drug-drug interactions (inhibit p450 enzymes), serotonin syndrome with MAOI

Question 16

bupropion (wellbutrin)

Answer 16

• atypical
• selectivity for DA uptake transporter
• side effects: seizures
• nicotine abstinence in smokers

**think DA circuit = reward/addiction circuit

Question 17

ketamine

Answer 17

• atypical
• NMDA receptor antagonist
• increases synaptogenesis

Question 18

Lithium

Answer 18

• mood stabilizer for bipolar
• action on 2nd messenger system: depletes IP3 and DAG
• side effects: polydipsia, polyuria, weight gain, diabetes, nephrotoxicity, cardiac toxicity, drowsiness, N+V

Question 19

tx of bipolar

Answer 19

• lithium
• anticonvulsant: carbamazepine, valproate
• SGA

Question 20

side effects of MAOIs

Answer 20

• orthostatic hypotension, sexual dysfunction, some anticholinergic, weight gain
• hypertensive crisis with tyramine rich foods
• 5HT syndrome with SSRIs