Antidepressants

Question 1

Clinical effects of TCA’s: on normal and depressed people

Answer 1

normal people: no stimulating effect, makes them tired

Depressed patient: elevation in mood only after 2-3 weeks

Question 2

Neurochemical effects of TCA’s

Answer 2

• block reuptake of 5-HT and/or NE
• NE blocker is Desipramine
• 5-HT/NE blocker is Imipramine

Question 3

Adverse effects of TCA’s

Answer 3

• Orthostatic hypotension
• antimuscarinic effects
• weight gain
• tachycardia

Question 4

dosing, pharmacokinetics, enzyme that metabolizes TCA’s

Answer 4

• metabolized by CYP2d6
• therapeutic index is 5-10 (really low, don’t give more than one week supply)
• long half life, well absorbed–>one dose a day

Question 5

MAO Inhibitors: names

Answer 5

Phenelzine

Question 6

mechanism of MAO Inhibitors

Answer 6

• irreversibly blocks the oxidative deamination of monoamines
• blocks MAOA and MAOB (NE, 5HT, DA enzymes)
• begins working in 24-48 hours but symptoms don’t get better for 3+ weeks

Question 7

MAOI’s adverse effects

Answer 7

• can’t break down dietary tyramine as well
• tyramine builds up and causes hypertensive crisis
• Food high in tyramine: aged cheese, red wine, beer

Question 8

SSRI’s (selective serotonin re-uptake inhibitors) examples

Answer 8

• Fluoxetine
• Sertraline
• Escitalopram

Question 9

SSRI’s mechanism of action

Answer 9

• blocks re-uptake of 5-HT (wow! never guessed it)

- The clinical effect is the inhibition of 5-HT2a

Question 10

SSRI’s: adverse effects

Answer 10

-Nausea, Diarrhea, and weight loss
discontinue if patient gets
-stimulation effect (anxiety, nervousness, insomnia)
THE BIG SIDE EFFECT IS
-can cause increase risk of suicide in the young ones

Question 11

Venlafaxine

Answer 11

• dual action antidepressant
• does not have side effects of TCA
• Blocks 5-HT and NE reuptake
• can’t give if patient is on MAOI’s

Question 12

Mirtazapine

Answer 12

• Dual action antidepressant
• blocks presynaptic alpha2 on
• that increases NE and 5-HT

Question 13

Ketamine

Answer 13

• Binds NMDA
• works in about 2 hours
• lasts 2 weeks
• get hallucinations (the goods) and nightmares (the bads)

Question 14

Lithium Carbonate: used for, mechanism

Answer 14

• For bipolar disorder (manic phase mainly)
• starts improving clinical signs in 5-21 days
• unknown mechanism

Question 15

Adverse effects of lithium carbonate

Answer 15

-fatigue, muscular weakness, slurred speech, ataxia, fine tremor of the hands

Question 16

Valproic acid

Answer 16

-superior to lithium for rapid-cycling bipolar
-can combine with lithium if individual drugs don’t work
that’s all he wrote

Question 17

Carbamazepine

Answer 17

anticonvulsant approved for prophylaxis of bipolar disorder

Question 18

I’m going to treat my bipolar patient with an SSRI

Answer 18

well you sir are a moron

• never give an ssri as monotherapy for bipolar patients
• can cause rapid onset mania