Antidepressants

Question 1

Amitriptyline Brand Name

Answer 1

Elavil

Question 2

Amitriptyline Indication/Dosage

Answer 2

Relief of depression symptoms: 40-150mg/day in divided doses or at HS

Question 3

Amitriptyline mechanism

Answer 3

inhibits membrane pump mechanism responsible for reuptake of NE and 5-HT at presynaptic nerve terminals, potentiating activity at postsynaptic terminals
One of the more sedative TCA’s
Onset may take up to 30 days

Question 4

Amitriptyline Drug Interactions

Answer 4

may increase action of dicumarol
may decrease effectiveness of clonidine and guanethidine
fluoxetine: may increase toxicity
may increase effects of direct-acting sympathomimetics
MAO-I’s: may produce toxic effects when used together!
alcohol and other CNS depressants: increased CNS depression
cimetidine: increased Amitriptyline plasma concentrations

Question 5

Amitriptyline CI’s/precautions

Answer 5

CI: patients currently or within past 14 days taking MAO-I, and during acute recovery phase following MI
caution: pregnancy, impaired liver function, angle-closure glaucoma, urinary retention, increased intraocular pressure, epilepsy, CV disorders, and hyperthyroidism

Question 6

Amitriptyline Pregnancy Category

Answer 6

C

Question 7

Amitriptyline ADR’s

Answer 7

Tachycardia, dry mouth, blurred vision, N/V, dizziness, weakness, headache, constipation, urinary retention, drowsiness, weight gain

Question 8

Amitriptyline Patient Educaion

Answer 8

do not discontinue unless otherwise directed
caution when operating machinery or when mental alertness required
avoid alcohol

Question 9

Bupropion brand names

Answer 9

Wellbutrin, Forfivo XL, Zyban

Question 10

Bupropion indications/dosages

Answer 10

treat depression and prevent SAD episodes: ER 150-300mg daily.
IR: start at 100mg BID, increase by no more than 100mg/day at minimum 3 day intervals. usual dose is 100mg TID, max dose is 450mg/day (as 150mg TID)
SR: up to 400mg/day in 2 doses, target dose is 300mg/day
SMOKING CESSATION: (Zyban) 150mg/day for 3 days, then increase to 150mg BID

Question 11

Bupropion mechanism

Answer 11

dose-related CNS stimulant effect
weak inhibitor of neuronal uptake of NE and DA, does not inhibit MAO
mediated by noradrenergic and/or dopaminergic mechanisms

Question 12

Bupropion metabolism and excretion

Answer 12

metabolized by 2B6 in liver to active metabolites
excreted in urine and feces
up to 80% protein bound

Question 13

Bupropion drug interactions

Answer 13

MAO-Is and L-dopa increase toxicity effects
alcohol may lower seizure threshold
drugs that affect 2B6 enzyme (orphenadrine, thiotepa, cyclophosphamide, ticlopidine) may affect plasma levels of Bupropion
ritonavir and lopinavir: reduce plasma levels
Bupropion inhibits 2D6 and may increase plasma levels of TCA’s, paroxetine, fluoxetine, sertraline, Haldol, Risperdal, thioridazine, metoprolol, propafenone, and flecainide

Question 14

Bupropion CI/precautions

Answer 14

CI: seizure disorder, history of bulimia or anorexia nervosa, MAO-I use in past 14 days.
may increase suicidal thoughts/actions
May lower seizure threshold (10x higher between 450mg and 600mg/day)
psychomotor disturbances may be seen, such as mania, psychosis, and hallucinations
Caution in liver or kidney dysfunction

Question 15

Bupropion pregnancy category

Answer 15

C

Question 16

Bupropion ADRs

Answer 16

dizziness, constipation, weight loss, dry mouth, insomnia, sweating, agitation, tremor

Question 17

Bupropion patient education

Answer 17

IR should be taken at regular intervals
ER should be taken in AM to avoid insomnia
swallow SR and XL tabs whole!
consult pharmacist for OTC meds
refrain from alcohol
weight loss or gain may be temporary
pay close attention to mental changes
may take ~2 weeks to show improvement, full benefit seen around 2 months

Question 18

Citalopram brand name

Answer 18

Celexa

Question 19

Citalopram indication/dosage

Answer 19

treatment of depression: begin with 20mg daily, gradually increasing to 40mg daily

Question 20

Citalopram mechanism

Answer 20

blocks neuronal uptake of 5-HT, but not NE or DA

much less potent binding to muscarinic, histaminergic, and alpha-receptors than classical TCAs

Question 21

Citalopram metabolism

Answer 21

CYP3A4 and 2C19

Question 22

Citalopram drug interactions

Answer 22

coadmin with MAO-Is may produce serious reactions resembling NMS
inhibitors of 3A4 have NO EFFECT on plasma clearance
cimetidine increases plasma levels
coadmin with aspirin or NSAIDs may increase risk of GI bleeding

Question 23

Citalopram CI/precautions

Answer 23

Antidepressants may increase suicidal thoughts/actions
CI: MAO-I use in past 14 days
caution when dispensing large quantities of medication
caution in liver disease

Question 24

Citalopram pregnancy category

Answer 24

C

caution during nursing

Question 25

Citalopram ADRs

Answer 25

nausea, dry mouth, somnolence, insomnia, diarrhea, ejaculation disorders, and impotense
abrupt discontinuation may cause adverse effects including dysphoric mood, irritability, agitation, dizziness, anxiety, confusion, insomnia, and headache

Question 26

Citalopram patient education

Answer 26

may impair cognitive and motor performance
may take 2-4 weeks to see effects
do not abruptly discontinue
avoid alcohol
pay attention to mood or mental changes, let those close to you know.