Antidepressants

Question 1

SSRIs:

Answer 1

Fluoxetine, Paroxetine, Sertraline, Citalopram

“Flashbacks Paralyze SEnior CITazens”

Question 2

SSRI mech:

Answer 2

5-HT specific reuptake inhibitors

Question 3

SSRI uses:

Answer 3

Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD, PMDD

Question 4

SSRI tox:

Answer 4

Fewer than TCAs. *GI distress, *sexual dysfunction (anorgasmia and decreased libido).
Serotonin syndrome with any drug that increases 5-HT (MAO inhibitors, SNRIs, TCAs) - hyperthermia, confusion, myoclonus, cardiovascular collapse, flushing, diarrhea, seizures.
Tx: cyproheptadine (5-HT2 receptor antagonist)

Question 5

Tx for Serotonin syndrome

Answer 5

Cyproheptadine (5-HT2 receptor antagonist)

Question 6

“Activation syndrome”: what drug

Answer 6

Fluoxetine - makes symptoms worse before making them better

Question 7

“Discontinuation syndrome”: what drug

Answer 7

Paroxetine - stop problem, when drug is stopped, symptoms get really bad before they get better

Question 8

SNRIs:

Answer 8

Venlafaxine, duloxetine

VD

Question 9

SNRI mech:

Answer 9

Inhibits 5-HT and NE reuptake

Question 10

SNRI uses:

Answer 10

Depression.
Venlafaxine is also used in generalized anxiety and panic disorders, PTSD;
Duloxetine is also indicated for diabetic peripheral neuropathy

Question 11

SNRIs tox:

Answer 11

*Increases BP most common; also stimulant effects, sedation, nausea

Question 12

Tricyclic Antidepressants:

Answer 12

Amitriptyline, nortriptyline, imipramine, despramine, clomipramine, doxepin, amoxapine
All TCAs end in -iptyline or -ipramine except doxepin and amoxapine

Question 13

TCA mech:

Answer 13

Block reuptake of norepinephrine and 5-HT

Question 14

TCA uses:

Answer 14

Major depression, OCD (clomipramine), fibromyalgia, urinary incontinence (imipramine), neuropathic pain

Question 15

TCA tox:

Answer 15

Sedation, alpha1-blocking efects including postural hypotension, and atropine-like (anticholinergic) side effects (tachycardia, urinary retention, dry mouth). Tertiary TCAs (amitriptyline) have more anticholinergic effects than Secondary TCAs (nortriptyline) have. Despiramine is less sedating, but has higher seizure incidence.

Question 16

Tri-C’s: tox

Answer 16

Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia.
Confusion and hallucinations in elderly due to anticholinergic side effects (use nortriptyline).
Tx: NaHCO3 for cardovascular toxicity

Question 17

Monoamine Oxidase Inhibitors (MAO inhibitors):

Answer 17

Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor).
MAO Takes Pride In Shanghai

Question 18

Selective MAO-B inhibitor:

Answer 18

Selegiline

Question 19

MAO mech:

Answer 19

Nonselective MAO inhibition increases levels of amine neurotransmitters (norepinephrine, 5-HT, dopamine) by decreasing metabolic breakdown of trasmitters

Question 20

MAO uses:

Answer 20

Atypical depression, anxiety

Question 21

MAO tox:

Answer 21

Hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese); CNS stimulation. Contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)

Question 22

Atypical antidepressants:

Answer 22

Bupropion, Mirtazapine, Trazodone

Question 23

Bupropion: mech

Answer 23

selectively blocks DA reuptake “Psychic Energizer”

Increases NE and DA via unknown mechanism

Question 24

Bupropion: uses

Answer 24

Used for smoking cessation, cocaine, amphetamines

Question 25

Bupropion: tox

Answer 25

Stimulant effects (tachycardia, insomnia), HA, SEIZURE in bulimic patients. NO SEXUAL SIDE EFFECTS!

Question 26

Mirtazapine: mech

Answer 26

alpha2-antagonist (increases release of NE and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist.

Question 27

Mirtazapine: tox

Answer 27

Sedation (which may be desirable in depressed pts with insomnia), increases appetite, weight gain (which may be desirable in elderly or anorexic patients), dry mouth.

Question 28

Trazodone: mech

Answer 28

Primarily blocks 5-HT2 and alpha1-adrenergic receptors

Question 29

Trazodone: use

Answer 29

Used primarily for insomnia, as high doses are needed for antidepressant effects.

Question 30

Trazodone: tox

Answer 30

sedation, nausea, priapism, postural hypotension

Called TrazoBONE due to male-specific side effects