Antidepressants 2

Question 1

Names of SSRIs

Answer 1

Citalopram

Escitalopram

Fluoxetine

Paroxetine

Sertraline

Question 2

Lithium, TCAs, warfarin alprazolam, theophylline cause Increased blood levels

PK and drug interactions of which drug?

Answer 2

SSRIs

Question 3

What toxicity is associated with SSRIs?

Answer 3

sexual dysfunction

Question 4

Doses greater than 40 mg/day not recommended due to QT prolongation

maximum daily dosage = 20mg for CYP2C19 poor metabolizers

which drug?

Answer 4

Citalopram

Question 5

What ADR is common to all antidepressants and what must you monitor for due to this?

Answer 5

ADR: suicidality

Monitor: behavioral changes, mental status

Question 6

What is the black box warning on all antidepressants?

Answer 6

caregivers should be alerted to monitor for acute changes in behavior (especially early in treatment)

Question 7

Which additional ADRs are common to all SSRIs?

Answer 7

Anxiety or nervousness

Insomnia

Nausea

Serotonin syndrome

Sexual dysfunction

Question 8

Which SSRI may be more activating (keeping you awake)?

Answer 8

Fluoxetine

Question 9

Which SSRIs may be more sedating?

Answer 9

fluvoxamine

paroexetine

Question 10

What is the main ADR of citalopram?

Answer 10

OT interval prolongation

Question 11

What is the main ADR of fluoxetine?

Answer 11

anorexia

Question 12

What is the main ADR of fluvoxamine?

Answer 12

somnolence

Question 13

What is the main ADR of paroxetine?

Answer 13

anticholinergic effects

Question 14

Indications of SNRIs?

Answer 14

MDD

GAD

Pain disorders: neuropathies and fibromyalgia

Stress urinary incontinence

Vasomotor symptoms of menopause

Question 15

What are the 4 SNRIs?

Answer 15

Venlafaxine

Desvenlafaxine

Duloxetine

Levomilnacipran

Question 16

What is the toxicity of venlafaxine?

Answer 16

HTN

Question 17

What is the main ADR common to all SNRIs?

Answer 17

CV changesL inc. BP; hearr rate

Question 18

What is the main ADR to Desvenlafaxine?

Answer 18

dose-related hyperlipidemia

Question 19

What is the main ADR to venlafaxine?

Answer 19

dose-related HTN

Question 20

Indications for 5-HT2 receptor antagonists?

Answer 20

MDD

hypnotic

Question 21

Combo SSRI & 5-HT1A

which drug?

Answer 21

Vilazodone

Question 22

Inhibits 5-HT, a 5-HT1A agonist and a 5-HT3 receptor antagonist

which drug?

Answer 22

Vortioxetine

Question 23

What mixed 5-HT would you use for depressed pts with anxiety?

Answer 23

Vilazodone

Question 24

Which mixed 5-HT should you use with pt with depression & cognitive difficulties?

Answer 24

Vortioexetine

Question 25

Bupropion is an \_\_\_\_\_.

Answer 25

Bupropion is an NDRI (norepinephrine and dopamine reuptake inhibitor)

Question 26

Mirtazapine is a \_\_\_\_\_\_\_\_\_\_\_

Answer 26

serotonin and alpha 2 receptor antagonist

Question 27

What are the 4 heterocyclics?

Answer 27

amoxapine bupropion maprotiline mirtazepine

Question 28

What heterocyclic can you use for smoking cessation?

Answer 28

bupropion

Question 29

PK of heterocyclics

Answer 29

hepatic metabolism

Question 30

Which 2 heterocyclics lower seizure threshold (toxicity)?

Answer 30

amoxapine, bupropion

Question 31

WHich heterocyclic causes sedation & weight gain?

Answer 31

mirtazepine

Question 32

ADR of Nefazodone

Answer 32

Liver toxicity Clitoral priapism (case report)

Question 33

ADRs of trazodone

Answer 33

orthostatic hypotension priapism in males

Question 34

ADRs of Vilazodone

Answer 34

serotonin syndrome male decreasd libido

Question 35

ADR of vortioxetine

Answer 35

GI & sexual dysfunction

Question 36

What 9 things should you keep in mind when choosing an antidepressant?

Answer 36

Indication Cost Availability Adverse effects Potential drug interactions Patient’s history of response or lack Patient preference Age and gender Medical status

Question 37

**T/F:** When medication and psychotherapy are not effective in treating severe depression or depression with psychosis, ECT can be highly effective.

Answer 37

True

Question 38

**T/F:** ECT involves transmitting short electrical impulses into the brain.

Answer 38

True

Question 39

**T/F:** ECT does cause some side effects, including some memory loss, but it is much safer than methods used in the past.

Answer 39

True

Question 40

a type of brain stimulation that uses a **magnet** instead of an electrical current to activate the brain It is a relatively **new treatment** for people whose **depression has not responded to medication or psychotherapy** What treatment is this?

Answer 40

Repetitive Transcranial Magnetic Stimulation (rTMS)

Question 41

**T/F:** Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acids **cannot** be used as augmentation in the treatment of MDD.

Answer 41

**False** Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acids **can** be used as augmentation in the treatment of MDD.

Question 42

**T/F:** EPA alone or the combination of EPA/DHA is likely **more effective than DHA alone**

Answer 42

True

Question 43

Lack of consensus regarding use in the treatment of MDD Induces **hepatic metabolic enzymes** and is associated with significant drug interactions APA Task Force conservatively states that this may be reasonable for some individuals with mild to moderate MDD Which herb?

Answer 43

St. Johns Wort

Question 44

The use of this has received a favorable review by the APA Task Force However, the final consensus was that more rigorous studies need to confirm the efficacy of this for treating MDD What supplement?

Answer 44

SAMe

Question 45

What are the 3 components in folate?

Answer 45

folic acid folinic acid 5-MTHF

Question 46

What does the task force state about folate?

Answer 46

The task force states that augmentation with these compounds is reasonable, but more work is needed to clarify which subgroup of patients may achieve the greatest response.