antidepressants

Question 1

What are the key monoamine oxidase inhibitors? Do they inhibit type A or B?

Answer 1

Phenelzine – MAO-A and MAO-B
Tranylcypromine – MAO-A and MAO-B
Selegiline – MAO-B at low doses

Question 2

What are the MAOIs used therapeutically for?

Answer 2

Atypical depression, treatment-resistant depression, treatment-resistant anxiety disorders (panic disorder and social anxiety disorder)

Question 3

What are the major side effects of the MAOIs?

Answer 3

Orthostatic hypotension, weight gain, insomnia, sexual dysfunction and hepatoxocity (rare)

Question 4

What are the signs of serotonin syndrome?

Answer 4

vomiting, diarrhea, sweating, hyperthermia, tachycardia, hypertension, tremor, myoclonus, rigidity, hyperreflexia. People can die from this.

Question 5

What drugs should you avoid with MAOIs to avoid serotonin syndrome? To avoid a hypertensive crisis?

Answer 5

Serotonin syndrome: SSRIs, tryptophan, dextromethorphan, tramadol, meperidine
Hypertensive crisis: noradrenergic drugs (ephedrine, pseudoephedrine, phenylephrine, amphetamines), appetitie suppressants, TCAs, SNRIs, buproprion, and food that are high in tyramine (soy, aged cheese, red wine, beer, fava beans, smoked fish and liver).

Question 6

What are the key tricyclic antidepressant drugs?

Answer 6

Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine

Question 7

What are the TCAs used therapeutically for?

Answer 7

Major depressive disorder, childhood enuresis (imipramine), anxiety disorders (GAD, panic, OCD), insomnia, neuropathic pain, migraines, fibromyalgia

Question 8

What receptors do TCAs block?

Answer 8

Presynaptic reuptake of norepi and serotonin, muscarinic receptors, Na channels, histamine receptors, adrenergic alpha 1 receptors

Question 9

What are the side effects of TCAs based on the receptors they block?

Answer 9

Muscarinic receptors in parasympathetic system – dry mouth, urinary hesitancy, constipation, tachycardia
Muscarinic receptors in the brain – memory impairment, drowsiness, delirium
Histamine receptors in the brain – drowsiness and weight gain
Na channels – heart block, ventricular tachycardia
Adrenergic alpha 1 receptors – orthostatic hypotension, priapism
Others – seizure

Question 10

What antihypertensives do TCAs block?

Answer 10

Guanethidine, beta blockers and clonidine

Question 11

What are the drugs that produce additive effects when combined with TCAs?

Answer 11

Antiarrhythmics (quinidine, amiodarone), QTc prolonging agents, anticholinergics, CNS depressants, sympathomimetics

Question 12

What are the drugs that increase TCA levels?

Answer 12

Cimetidine, fluoxetine, thiazides, acetazolamide, ritonavir, antifungals

Question 13

What are the drugs that decrease TCA levels?

Answer 13

Carbamazepine, rifampin, phenytoin, nicotine, barbiturates

Question 14

What are the key selective serotonin reuptake inhibitor drugs?

Answer 14

Fluoxetine, sertraline, paroxetine, fluxovamine, citalopram, escitalopram

Question 15

What are the therapeutic uses of SSRIs?

Answer 15

Major depressive disorder, anxiety disorders (GAD, OCD, PTSD, panic), premenstrual dysphoric disorder, bulimia

Question 16

What are the side effects of SSRIs?

Answer 16

Abdominal cramps, diarrhea, nausea, akathisia/inner feeling of restlessness, extrapyramidal symptoms, sexual dysfunction, weight gain, excessive sweating, bradycardia, thoughts of suicide in young adults/adolescents

Question 17

Which antidepressant is associated with a Discontinuation Syndrome? What are the symptoms of DS?

Answer 17

SSRIs, particularly paroxetine and fluvoxamine.

Symptoms are dysphoric mood, irritability, agitation, paresthesias, tinnitus, seizures

Question 18

Which SSRI has the least drug-drug interactions?

Answer 18

citalopram and escitalopram

Question 19

Which SSRI is not approved for depression? What is it used for instead?

Answer 19

Fluxovamine is not approved for depression but is used for OCD

Question 20

Which SSRI has the longest-half life/requires the most infrequent dosing?

Answer 20

fluoxetine

Question 21

What are the serotonin and norepinephrine reuptake inhibitors (SNRIs)? Which one acts like a SSRI at low doses?

Answer 21

Venlafaxine/desvenlafaxine – acts like an SSRI at low doses

Duloxetine – always acts like an SNRI

Question 22

What are the therapeutic uses for duloxetine?

Answer 22

Pain in diabetic neuropathy, fibromyalgia, osteoarthritis and lower back pain

Question 23

What is the mechanism of action of buproprion? What is it used for?

Answer 23

Mechanism – weak norepi and dopamine reuptake inhibitor, inhibitor of nicotine acetylcholine receptors
Used for major depressive disorder, seasonal affective disorder, smoking cessation and ADHD (off-label)

Question 24

What is trazodone used for?

Answer 24

Sleep aid because it is very sedating

Question 25

What are the side effects of trazodone?

Answer 25

Sedation (primary purpose, not side effect), orthostatic hypotension, priapism

Question 26

What is the mechanism of action of mirtazapine? What is it used for?

Answer 26

Blocks many of the 5HT receptors except the 5HT1A receptors so all the serotonin is directed at the 5HT1A receptors which causes antidepressive and anxiolytic effects. It also is an adrenergic alpha-2 antagonist -> increased norepi release