Antidepressants

Question 1

Major categories of antidepressants

Answer 1

Selective Serotonin Reuptake Inhibitors (SSRIs)
Heterocyclic antidepressants (TCAs and tetracyclic antidepressants)
Monoamine Oxidase Inhibitors (MOAIs)

Question 2

Most antidepressants require a trial of how long for noticeable effects

Answer 2

3-4 weeks

Question 3

antidepressant withdrawal phenomenon sx?

Answer 3

dizziness, headaches, nausea, insomnia, and malaise

Question 4

why are SSRIs the most commonly prescribed antidepressants?

Answer 4

low incidence of side effects and most resolve with time, no food restrictions, and much safer in overdose

Question 5

6 examples of SSRIs

Answer 5

Fluoxetine, Sertraline, paroxetine, fluvoxamine, citalopram, escitalopram

Question 6

SSRI with highest rick of GI disturbances

Answer 6

Sertraline (zoloft)

Question 7

SSRI safe in pregnancy and used in children

Answer 7

Fluoxetine (prozac)

Question 8

SSRI with anticholinergic like side effects of sedation, constipation, weight gain

Answer 8

Paroxetine (paxil)

Question 9

SSRI with short half life leading to the withdrawal phenomena more often

Answer 9

Paroxetine

Question 10

SSRI with fewest drug-drug interactions and fewer sexual side effects

Answer 10

Citalopram

Question 11

what should you worry about in somebody who is taking a high dose SSRI and cough medicine

Answer 11

serotonin syndrome- over the counter cold remedies have drugs that increase serotonin

Question 12

sexual side effects of SSRIs can be treated how?

Answer 12

augmenting the regimen with buproprion, changing to a non-SSRI antidepressant or by adding a medication like sildenafil for men

Question 13

what is the FDA’s black box warning against all SSRIs for

Answer 13

“increased suicidal thinking and behavior”

Question 14

side effects of SSRIs

Answer 14

sexual dysfunction, GI disturbances, insomnia, headache, anorexia, weight loss, restlessness, seizures and of course serotonin syndrome

Question 15

what drugs taken with SSRIs increases risk for serotonin syndrome

Answer 15

MAOIs, triptans, over the counter cough remedies

Question 16

SSRIs can increase levels of which drug which requires increased monitoring when starting and stopping these medications

Answer 16

warfarin

Question 17

Venlafaxine, and duloxetine are what class of drug?

Answer 17

serotonin-norepi reuptake inhibitors (SNRIs)

Question 18

Venlafaxine is often used for what?

Answer 18

generalized anxiety disorder

Question 19

Venlafaxine should not be used in what kind of patients

Answer 19

patients with untreated or labile blood pressure (can increase blood pressure)

Question 20

Duloxetine is often used for ?

Answer 20

depression and neuropathic pain or in fibromyalgia

Question 21

Duloxetine may show more side effects in which kind of patients

Answer 21

liver disease or heavy alcohol use patients may have increased liver side effects

Question 22

antidepressant with relative lack of sexual side effects

Answer 22

Bupropion (wellbutrin)

Question 23

antidepressant that can lower seizure threshold

Answer 23

Bupropion

Question 24

Bupropion should be used with caution in which patients?

Answer 24

patients with epilepsy and eating disorders (lowers seizure threshold)

Question 25

Serotonin Receptor Antagonists and agonists

Answer 25

Trazodone and Nefazodone

Question 26

Positives of Trazodone and Nefazodone

Answer 26

do not have sexual side effects and do not affect rapid eye movement sleep

Question 27

Indications for Trazodone and Nefazodone

Answer 27

refractory major depression, major depression with anxiety and insomnia

Question 28

Nefazodone carries a black box warning for?

Answer 28

rare but serous liver failure

Question 29

alpha2-adrenergic receptor antagonist used as antidepressant

Answer 29

Mirtazapine (remeron)

Question 30

used for depression in elderly because it helps with sleep and appetite

Answer 30

mirtazapine

Question 31

Mirtazapine side effects?

Answer 31

sedation, WEIGHT GAIN (useful in pts who need to gain weight), dizziness, somnolence, tremor, dry mouth, constipation and rare agranulocytosis

Question 32

mainstay for TCA overdose

Answer 32

IV sodium bicarbonate

Question 33

TCA useful in enuresis and panic disorder

Answer 33

Imipramine

Question 34

TCA useful in treatment of OCD

Answer 34

Clomipramine

Question 35

TCA least likely to cause orthostatic hypotension

Answer 35

Nortriptyline

Question 36

TCAs in general are useful in treating?

Answer 36

chronic pain

Question 37

major complications of TCA’s

Answer 37

cardiotoxicity, convulsions, coma

Question 38

EKG changes due to TCAs

Answer 38

widening qrs, qt and pr intervals

Question 39

what must you assess before prescribing TCAs

Answer 39

SUICIDE RISK - they are lethal in overdose

Question 40

prevent the inactivation of biogenic amines such as norepi, serotonin, dopamine, and tyramine

Answer 40

MAOIs

Question 41

MAOIs are very effective in treating which conditions?

Answer 41

refractory depression and refractory panic/anxiety disorders

Question 42

Name 3 MAOIs

Answer 42

phenelzine, tranylcypromine, isocarboxazid, selegiline

Question 43

which MAOI used to treat depression does not require following dietary restrictions when used in low doses but decongestants and serotonergic drugs must still be avoided

Answer 43

selegiline

Question 44

foods to avoid when taking a MAOI

Answer 44

foods with tyramine (red wine, cheese, chicken liver, fava beans, cured meats). will give you a hypertensive crisis

Question 45

most common side effect of MAOIs

Answer 45

orthostatic hypotension