antidepressants

Question 1

TCAs (drugs)

Answer 1

amitriptyline, nortriptyline, clomipramine, desipramine, doxepin, imapramine, protriptyline, trimipramine

Question 2

TCA moa

Answer 2

inhibit the repute of 5-HT and NE, potentiating/prolonging their effects; also block mACh, alpha-adrenergic, and histamine receptors

Question 3

TCA adverse effects

Answer 3

anti-alpha adrenergic effects: orthostatic hypotension
anti-muscarinic effects: burred vision, worsening of glaucoma, dry mouth, constipation, urinary retention, tachycardia, confusion
histamine block: sedation
weight gain and sexual disturbances

Question 4

TCA overdose

Answer 4

low therapeutic index
CV effects - arrhythmias, myocardial depression, worsening of CHF,
acidosis, delerium, seizures

Question 5

serotonin syndrome

Answer 5

hyperpyrexia, hyperreflexia, tremor shivering, myoclonus, seizure, confusion, delerium, CV collapse, coma; can be fatal

Question 6

SSRIs recommended for breastfeeding

Answer 6

paroxetine and sertraline

Question 7

meds for OCD

Answer 7

SSRIs

Question 8

SSRI overdose

Answer 8

serotonin syndrome

Question 9

SSRIs adverse effects

Answer 9

nausea, decreased libido, sexual dysfunction, low incidence of CV and anti-ACh effects

Question 10

paroxetine in pregnancy

Answer 10

increased risk of birth defects; category D

Question 11

SSRIs with most CYP interactions

Answer 11

fluoxetine, paroxetine, fluroxamine

Question 12

trazadone moa

Answer 12

moderate inhibition of 5-HT repute; primarily acts as a 5-HT2a antagonist and a 5-HT1a partial agonist

Question 13

trazodone use

Answer 13

depression characterized by anxiety and sleep disturbances

Question 14

vilazodone moa

Answer 14

potent 5HT1a partial agonist and SSRI

Question 15

vortioxetine moa

Answer 15

potent blocker of SERT and high efficacy partial 5-HT1a and 1b agonist and 5-HT1d, 3a, and 7 antagonist; weak NET and beta1-AR blocker

Question 16

venlafaxine and duloxetine moa

Answer 16

inhibit 5-HT and NE reuptake (SNRI), without having anti-cholinergic, histaminergic, or dopaminergic properties

Question 17

most potent SNRI

Answer 17

duloxetine

Question 18

SNRIs

Answer 18

venlafaxine, duloxetine, amoxamine, mertazepine,

Question 19

amoxatine moa

Answer 19

SNRI; retains some DA receptor antagonism; mixed inhibition of NET>SERT=DAT

Question 20

amoxatine adverse effects

Answer 20

risk of extrapyramidal motor symptoms

Question 21

buproprion moa

Answer 21

weak blocker of DAT, SERT, and NET; active metabolite is an NE reuptake inhibitor

Question 22

buproprion adverse effects

Answer 22

agitation, restlessness, anxiety, risk of seizure

Question 23

maprotiline adverse effects

Answer 23

seizure risk

Question 24

maprotiline moa

Answer 24

selective NE reuptake inhibitor

Question 25

MAOIs

Answer 25

tranylcypromide, isocarboxazid, phenelzine

Question 26

MAOI moa

Answer 26

blocks oxidative metabolism of monamines by irreversible inhibition of MAO-A and MAO-B in nerve terminals

Question 27

MAO-A oxidizes what NTs?

Answer 27

NE, 5-HT, and tyramine

Question 28

MAO-B oxidizes what NT?

Answer 28

DA

Question 29

MAOI adverse effects

Answer 29

sleep disturbances, orthostatic hypotension, weight gain, sexual dysfunction

Question 30

MAOI interactions

Answer 30

tyramine foods (aged wine, cheese steak, etc) sympathomimetics - acute HTN reaction merperidine and dextromethorphan cause hyperpyrexia, delerium, convulsions, coma, and death SSRIs (serotonin syndrome)

Question 31

MAOI indications

Answer 31

unresponsive to other anti-depressants and for whom ECT is not suitable; panic disorder; agoraphobia

Question 32

lithium moa

Answer 32

poorly understood; possible inhibition of IP3 signaling

Question 33

litium adverse effects

Answer 33

narrow therapeutic index; tox at > 1.5mEq/L neuro: tremor, ataxia, hyperactive, aphasia, sedation, fatigue glandular: edema, hypothyroid renal: nephrogenic DI CV: bradycardia and tachycardia ("sick sinus") derm: acne, folliculitis, psoriasis exacerbation

Question 34

lithium interactions

Answer 34

diuretics and NSAIDs

Question 35

anticonvulsants for bipolar disorder

Answer 35

valproate and carbamazepine

Question 36

valproate moa

Answer 36

inhibits Na and T-type Ca channels; stimulates GABA synthesis; increases K conductance

Question 37

carbamazepine moa

Answer 37

Na channel inhibition

Question 38

valproate metabolism

Answer 38

Cyp 2C - inhibits its own metabolism; reduce dose over time

Question 39

carbamazepine metab

Answer 39

CYP 3A4 and 2C inducer - induces own metab.; increase dose over time

Question 40

carbamezepine adverse effects

Answer 40

diplopia, ataxia, rash idiosyncratic reaction; aplastic anemia

Question 41

SSRI effect on NE

Answer 41

SSRIs also cause NE release when NE is low, as it is in depression

Question 42

norfluoxetine (active metabolite of fluoxetine) pharmacokinetics

Answer 42

half life of 7-10 days; CYP inhibitor

Question 43

SSRIs

Answer 43

escitalopram, fluoxetine, paroxetine, sertraline, fluroxamine, citalopram

Question 44

lithium PK

Answer 44

rapid distribution to total body water