Antidepressants

Question 1

Side effects of SSRIs

Answer 1

fluoxetine, paroxetine, sertraline, citalopram
cause fewer side effects/toxcities than TCAs, but can cause GI distress and sexual dysfunction. serotonin syndrome may be seen with any drug that increases 5-HT (MAO inhibitors, SNRIs, TCAs). casues hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures.
treatment: cyproheptadine (5-HT2 receptor antagonist)

Question 2

SNRIs: drugs, uses, side effects

Answer 2

venlafaxine, duloxetine. inhibit 5-HT and NE reputake. both good for depression; venlafaxine also used in GAD and panic disorders; duloxetine also good for diabetic peripheral neuropathy.
most common side is high BP

Question 3

treatment of OCD

Answer 3

SSRIs, clomipramine (TCA)

Question 4

TCAs: uses, names

Answer 4

most end in -iptyline (amitriptyline, nortriptyline) or -ipramine (imipramine)
used for major depression; clomipramine used for OCD, fibromyalgia.
block reuptatke of NE and 5-HT.

Question 5

TCAs: toxicity

Answer 5

Tri-Cs: convulsions, coma, cardiotoxicities (arrhythmia). respiratory depression, hyperpyrexia. confusion and hallucinations in elderly d/t anticholinergic effects. Use NaHCO3 for CV toxicity (incr. binding of TCA to plasma proteins, decr. free TCA).
they also have alpha1-blocking effects (hypotension), and atropine like effects (tachycardia, urinary retention, dry mouth)

Question 6

MAO inhibitors

Answer 6

tranylcypromine, phenelzine, isocarboxazid, selegiline
mechanism: nonselective MAO inhibition to increase the levels of amine neurotransmitters (NE, 5-HT, DA).
used for atypical depression, anxiety, hypochondriasis

Question 7

MAO-inhibitors: side effects and contraindications

Answer 7

can cause a hypertensive crisis (esp. with ingestion of tyramine), CNS stim. contraindicated with SSRIs, TCA, St. John’s Wart, meperidine, and dextromethrophan (synthetic codein analog for cough) to prevent seratonin syndrome.
phentolamine is a reversible alpha blocker given to pts on MAO-Is who take tyramine containing foods.

Question 8

trazodone

Answer 8

primarily blocks 5-HT and alpha-1 adrenergic receptors. mostly used for insomnia; high doses needed for antidepressent effects. toxicity: sedation, nausea, priapism (trazo”BONE”), hypotension

Question 9

buproprion

Answer 9

used for smoking cessation too. incr. NE and DA via unknown mechanism. toxicity: stimulant effects, headache, seizure in bulimic pts. no sexual side effects.

Question 10

mirtazapine

Answer 10

alpha-2 antagonist (incr. release of NE and 5-HT) and potent 5-HT2 and HT3 receptor antagonist.
toxicity; sedation, incr. appetite, weight gain, dry mouth.

Question 11

How do you treat narcolepsy? What causes narcolepsy?

Answer 11

decreased orexin production in the lateral hypothalamus causes narcolepsy
teat with daytime stimulants (modafinil, amphetamines), and nighttime sodium oxybate (GHB)