Antidepressants

Question 1

Name the tertiary amine (tricyclic) antidepressants

Answer 1

I CAD’T: Imipramine, clomipramine, amitriptyline, doxepin, trimipramine.

Question 2

Describe tricyclic and tetracyclic antidepressant side effects

Answer 2

Anticholinergic side effects ass’c w/ tricyclics: Xerostomia, blurry vision, urinary retention, constipation, QT prolongation, orthostatic hypotension (alpha-adrenergic blockade), weight gain (anti-histamine 1 side effect). Tricyclics are also very sedating.

Question 3

Which tricyclic antidepressant is specifically useful for OCD?

Answer 3

Clomipramine. Also useful for depressive features in OCD.

Question 4

Name the secondary amine antidepressants.

Answer 4

DNP: Desipramine, nortriptyline, protriptyline.

Question 5

Which secondary amine antidepressant can cause psychomotor stimulation?

Answer 5

Protriptyline

Question 6

Name the tetracyclic antidepressant and its dangerous potential side effects.

Answer 6

Amoxapine. Can cause extrapyramidal syndrome and neuroleptic malignant syndrome (metabolite of loxapine).

Question 7

How do tricyclic and heterocyclic antidepressants work?

Answer 7

Reducing reuptake of serotonin and norepinephrine which increases synaptic monoamine levels.

Question 8

Why are tricyclics dangerous in overdose?

Answer 8

Narrow therapeutic index can cause fatal cardiac arrhythmias through QT prolongation.

Question 9

Name the SSRI’s

Answer 9

Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro)

Question 10

Name the SNRI’s

Answer 10

Venlafaxine (Effexor) & duloxetine (Cymbalta)

Question 11

Review specific SSRI side effects

Answer 11

Sertraline causes diarrhea more often than others. Paroxetine is mildly anticholinergic. Fluvoxamine causes nausea and vomiting more commonly. Citalopram possibly has fewer sexual side effects.

Question 12

Name common side effects in all SSRI’s

Answer 12

Most important: GI disturbance and sexual dysfunction. Can increase suicidal thoughts in pts under age 24. Also akathisia, anxiety, panic, insomnia, headache.

Question 13

Name the MAOI’s

Answer 13

Naming the MAOI’s “IS PT”: Isocarboxazid (Marplan), selegiline (Eldepryl), phenelzine (Nardil), tranylcypromine (Parnate).

Question 14

What dietary restrictions must be observed when taking MAOI’s?

Answer 14

No tyramine-containing foods, eg red wine and aged cheese.

Question 15

What meds can’t be prescribed concurrently with MAOI’s and why?

Answer 15

Concurrently prescribing SSRI’s can cause serotonin syndrome; MAOI prescription must be min. 5 weeks after cessation of SSRI.

Question 16

Name four “miscellaneous” antidepressants

Answer 16

BMNT: Buproprion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), and trazodone (Desyrel).

Question 17

What is trazodone?

Answer 17

Antidepressant. Serotonin-2 antagonist and serotonin reuptake inhibitor (avoid with MAOI’s). Sedating, also used as sleep aid. Can cause priapism and hypotension.

Question 18

What is mirtazapine?

Answer 18

Antidepressant. Remeron; noradrenergic and specific serotonin antagonist. Sedating, also used as sleep aid. Can cause weight gain. Does not interfere with sexual function. No nausea or diarrhea.

Question 19

What is buproprion?

Answer 19

Antidepressant. Wellbutrin. Norepinephrine and dopamine reuptake inhibitor. Often used for smoking cessation. Lowers seizure threshhold, contraindicated in pts with seizure disorders. Causes anorexia, contraindicated in pts with eating disorders.

Question 20

What is nefazodone?

Answer 20

Antidepressant. Serzone. Serotonin-2 antagonist and serotonin reuptake inhibitor (avoid with MAOI’s). Can cause sedation and hepatotoxicity.