Antidepressants

Question 1

Antidepressants are used to tx

Answer 1

Depression, anxiety, depression and anxiety assoc’d with other condition (like PD, AD, cardiac pt’s), PTSD, chronic pain

Question 2

MAO-A oxidizes mainly what?

Answer 2

NE, 5-HT, tyramine

Question 3

MAO-B oxidizes mainly what?

Answer 3

DA, phenyethylamine

Question 4

What 2 drugs inhibits both MAOs used for depression?

Answer 4

Tranylcypromine & phenelzine

Question 5

Side effects of MAOIs (not boldened on Brown’s handout)

Answer 5

Some anticholinergic, pronounced OTN, often sexual dysfunction, wt gain, sedation varies

Question 6

Life-threatening S.E.s of MAOIs

Answer 6

Hypertensive crisis precipitated by tyramine-rich foods. MAOI+SSRI = serotonin syndrome

Question 7

Tricyclic antidepressants include which four drugs?

Answer 7

Imipramine, desipramine, amitriptyline, nortriptyline

Question 8

Presumed thx effect of TCAs

Answer 8

Block reuptake pumps for NE and 5-HT

Question 9

“Dirty” drugs producing various degrees of block at several other nt receptors, thus contributing to more S.E.s

Answer 9

TCAs

Question 10

AEs of TCAs include antimuscarinic effects (vision, constip, confusion), a-antagonist (OTN), histamine antagonist (sedation), sympathomimetic (tremor, insomnia), seizures and one more very important effect…

Answer 10

Cardiac arrythmias, conduction defects - esp at overdose

Question 11

Name the SSRIs

Answer 11

Fluoxetine (prozac), paroxetine (paxil), sertraline (zoloft), escitalopram (lexapro), citalopram (celexa)

Question 12

Name the SNRIs

Answer 12

Duloxetine, venlafaxine

Question 13

Main differences of the SSRIs from TCAs

Answer 13

Longer duration of action, some SSRIs inhibit P450 enzymes, much safer (no cardiac arr or seizures), less S.E.s, however more nausea and dec’d sexual function

Question 14

SSRI adverse reactions

Answer 14

Inhibitors of P450 enzymes (notably CYP2D6, also 3A and 2C by fluo and paro), serotonin syndrome from MAOI+SSRI

Question 15

Hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status and vitals characterize what syndrome?

Answer 15

serotonin syndrome from increased stores and inhibited reuptake of serotonin

Question 16

Atypical antidepressants include the tetracyclics & unicyclics. Name 2 examples

Answer 16

Mirtazapine & bupropion

Question 17

The notable exception to primarily inhibiting reuptake transporters for NE and 5-HT is? What uptake transporter is it most selective for? What pot’l S.E.s? What other thing group of ppl does it help?

Answer 17

Bupropion - DA-T. Lowers seizure threshold. Improves nicotine abstinence

Question 18

This Very Atypical Antidepressant produces a rapid antidepressant response and is effective in treating tx-resistant depressed patients. Name it and the receptor it antagonizes.

Answer 18

Ketamine- NMDA receptor

Question 19

What drugs are used to tx mood swings in pts with bipolar affective disorder?

Answer 19

Lithium and/or anti-convulsants (carbamazepine and valproate)

Question 20

The depressive phase of BAD often requires concurrent use of what type of drug, often of which type therein? Why aren’t tricyclics used?

Answer 20

Antidepressant, often MAOI. TCAs may precip mania

Question 21

Because onset of Li is slow, often concurrent use of what drugs are used?

Answer 21

Benzodiazepines

Question 22

For more severe BAD, benzos or what type of drugs are added to Li?

Answer 22

Antipsychotics like olanzapine, risperidone, aripiprazole

Question 23

Best reported effect of Li is its action on what?

Answer 23

Second messenger systems (depletion of IP3 and DAG; both important for alpha-adrenergic and muscarinic-cholinergic transmission, thus Li may cause selective depression of overactive circuits)

Question 24

Common S.E.s of Li include what?

Answer 24

drowsiness, wt gain, tremor, polydipsia, polyuria

Question 25

Elevated levels of Li may cause what?

Answer 25

Neurotoxicity, cardiac toxicity, renal dysfunction. N/v is an early warning of Li overdose.