Antidepressants

Question 1

what are the main classes of antidepressants?

Answer 1

• SNRI’s
• SSRI’s
• others: MAOI, Trazodone, bupropion

Question 2

what are the two types of SNRI’s

Answer 2

TCA and venlafaxine

Question 3

what receptors does the TCA block?

Answer 3

blockage of M, alpha-1, and H1 receptors

Question 4

what are the common M-block adverse effects?

Answer 4

• Dry mouth
• Constipation
• Urinary retention
• Mydriasis
• Blurred vision
• Confusion

Question 5

what are the common alpha-1 block adverse effects?

Answer 5

• Orthostatic hypotension
• Sedation
• Sexual dysfunction

Question 6

what are the common H-1 block adverse effects?

Answer 6

• weight gain
• sedation/drowsiness

Question 7

what are some other adverse effects of TCA that is not from the receptor blockage

Answer 7

• sexual dysfunction - serotonin acting at 5-HT2a receptors
• weight gain

Question 8

overdosing on TCA can lead to what?

Answer 8

life-threatening cardiac arrhythmias

Question 9

what type of drug is venlafaxine

Answer 9

SNRI

Question 10

how does venlafaxine differ from TCA?

Answer 10

• weakly inhibits dopamine reuptake
• no significant alpha1, H1 or M-block - so less adverse effects

Question 11

what is the most commonly prescribed antidepressant class?

Answer 11

SSRI

Question 12

which has more severe adverse effects? TCA or SSRI?

Answer 12

TCA, SSRI receptor blocks less potent than with TCA

Question 13

what is serotonin syndrome

Answer 13

occurs in response to increased serotonin levels
- can also be caused by “high-normal” dose in a sensitive individual

Question 14

what are the triad of symptoms of the serotonin syndrome

Answer 14

§ Altered mental status
§ Autonomic hyperactivity
§ Neuromuscular abnormalities

Question 15

when a patient has autonomic hyperactivity, what does it look like

Answer 15

patient is often hot and sweating with a fast heart rate and high blood pressure that goes up and down

Question 16

when a patient has neuromuscular abnormalities from serotonin syndrome, what does it look like?

Answer 16

hyperreflexia and clonus are particularly common and are more often pronounced in the lower extremities

Question 17

how to treat serotonin syndrome?

Answer 17

○ Remove the causative agent
§ Most cases typically resolve 24 hrs after
○ Interfere with serotonin action
§ Cyproheptadine can be given – serotonin antagonist
○ Symptomatic treatment
§ Treat the agitation with benzodiazepines (BDZ)

Question 18

how does MAOI’s work

Answer 18

block monoamine oxidase, the enzyme that metabolizes NE, resulting in higher NE levels

Question 19

MAOI can induce a hypertensive crisis when combined with foods containing

Answer 19

tyramine

Question 20

Trazodone is a ?

Answer 20

Inhibits serotonin reuptake, but not considered an SSRI
○ Also acts directly as an antagonist at serotonin 5-HT2A receptors

Question 21

trazodone has a strong sedative effect. why?

Answer 21

H1-block and potent alpha-1 block effects

Question 22

what’s so important about brand names for bupropion

Answer 22

to distinguish therapeutic uses

Question 23

what are the two brand names of bupropion and their therapeutic uses?

Answer 23

wellbutrin = antidepressant
Zyban = smoking cessation therapy

Question 24

what is the mechanism of Bupropion?

Answer 24

relatively weak inhibition of NE and dopamine reuptake