Antidepressants

Question 1

What kind of drugs are tranylcypromine and phenelzine / what enzymes do they affect?

Answer 1

Antidepressants; MAOI’s: they inhibit both MAO-A and MAO-B

Question 2

What are 2 possibly life-threatening side effects of taking tranylcypromine and phenelzine?

Answer 2

Hypertensive crisis (with tyramine-rich foods) and serotonin syndrome (with SSRIs)
(this is part of the reason MAOIs are now rarely used)

Question 3

How do the MAOIs treat depression? Which of the enzymes that they inhibit is responsible for oxidizing serotonin and norepi?

Answer 3

inhibit MAO-A and MAO-B to slow monoamine degradation; MAO-A oxidizes serotonin and norepi

Question 4

What kind of drugs are desipramine, imipramine, nortriptyline, and amitriptyline, what enzymes do they affect, and how?

Answer 4

Tricyclic antidepressants; inhibit reuptake transporters for 5HT and NE (and also block the muscarinic, a-adrenergic, dopamine, and histamine receptors)

Question 5

Of the 4 tricyclic antidepressants, which 2 are active metabolites of the other 2 drugs?

Answer 5

Desipramine is the active metabolite of imipramine, nortriptyline is the active metabolite of amitriptyline

Question 6

What organ is most affected by tricyclic overdoses? Name 2 possible effects.

Answer 6

Heart: cardiac arrhythmias and conduction defects (this is part of the reason tricyclics are no longer commonly used)

Question 7

Which antidepressant is useful for treating tension headaches and migraines, as well as the usual depression/anxiety/PTSD/etc.?

Answer 7

Amitriptyline

Question 8

What kind of drugs are fluoxetine and paroxetine, and how do they work molecularly?

Answer 8

SSRI antidepressants, inhibit reuptake of 5HT (and, to a lesser extent, of NE)

Question 9

What kind of drugs are sertraline, escitalopram, citalopram, and how do they work molecularly?

Answer 9

SSRI antidepressants, inhibit reuptake of 5HT (and, to a lesser extent, of NE)

Question 10

Which antidepressant drug can also be used to treat premenstrual dysmorphic disorder?

Answer 10

Fluoxetine

Question 11

What side effects do the SSRIs cause, and how do they compare to the side effects of the tricyclics?

Answer 11

SSRIs can cause nausea and sexual dysfunction, but in general their side effects are less intense than that of the tricyclics (this is part of the reason tricyclics are no longer commonly used)

Question 12

Which 2 antidepressant drugs can inhibit P450 and can therefore interfere with the metabolism of other drugs?

Answer 12

Fluoxetine and paroxetine

Question 13

What is the active metabolite of fluoxetine? Does the original drug have a longer or shorter half-life than its active metabolite?

Answer 13

Norfluoxetine; the original drug has a shorter half-life than its active metabolite

Question 14

What kind of drugs are duloxetine and venlafaxine, and how do they work molecularly?

Answer 14

SNRI antidepressants, inhibit reuptake of 5HT and NE equally

Question 15

Name the 2 atypical antidepressants. Which one can be used to maintain nicotine abstinence?

Answer 15

Buproprion and mirtazapine; buproprion is used in smoking cessation

Question 16

How does buproprion treat depression?

Answer 16

By inhibiting dopamine and norepi reuptake

Question 17

How does mirtazapine treat depression?

Answer 17

By antagonizing the 5HT-2a receptor as well as by inhibiting 5HT reuptake

Question 18

List all the antidepressants that can cause seizures if overdosed.

Answer 18

All the MAOIs (phenelzine, tranylcypromine), all the tricyclics (desipramine, imipramine, amitriptyline, nortriptyline), and buproprion

Question 19

Give 2 therapeutic uses for lithium.

Answer 19

Bipolar disorder (mood stabilization) and long-term cluster headaches (prevention)

Question 20

How does lithium help treat bipolar disorder?

Answer 20

Lithium depletes the neuron of IP3 and DAG second messengers, which seems to depress the α-adrenergic and muscarinic signaling pathways

Question 21

Elevated levels of lithium can cause damage to what 3 organs?

Answer 21

Heart, kidney, and neurons/brain (nausea and vomiting are early signs of lithium overdose)

Question 22

What 2 classes of antidepressants can cause serotonin syndrome if taken together?

Answer 22

MAOIs and SSRIs

Question 23

What mood stabilizing drug can cause side effects of drowsiness, weight gain, tremor, polydipsia, and polyuria?

Answer 23

Lithium

Question 24

List 7 disorders which can be treated by any of the antidepressants (MAOIs, tricyclics, SSRIs, SNRIs, and atypicals).

Answer 24

Depression, anxiety, PTSD, chronic pain, enuresis (loss of urinary retention control), bulimia, and alcoholism

Question 25

What anesthetic drug and NMDA antagonist is also an atypical antidepressant?

Answer 25

Ketamine

Question 26

A bipolar patient on lithium presents to the emergency room with altered mental status, nausea, and vomiting. Give 2 drugs the patient might have taken, which could have precipitated this Li overdose.

Answer 26

Indomethacin (NSAID) or a Na-depleting diuretic