AntiDepressants

Question 1

Fluoxetine

Answer 1

Prozac
SSRI
longest T1/2 - no need to taper - weekly dosing available
safe in pregnancy, children
more common sleep changes, anxiety
CYP inhibitor - can increase neuroleptic levels

Question 2

Sertraline

Answer 2

Zoloft
SSRI
highest risk of GI disturbance
more common sleep changes

Question 3

Paroxetine

Answer 3

Paxil
SSRI
short T1/2 about 1d - withdraw phenomenon

Question 4

Fluvoxamine

Answer 4

Luvox
SSRI
only one FDA approved for OCD
n/v, lots of drug interactions

Question 5

Citalopram

Answer 5

Celexa
SSRI
fewest drug interactions
fewer sexual side effects

Question 6

Escitalopram

Answer 6

Lexapro

SSRI

Question 7

Venlafaxine

Answer 7

Effexor
SNRI
treats Depression, Anxiety, ADHD
XR form for daily dosing
can increase BP
new form = Desvenlafaxine (pristiq)

Question 8

Duloxetine

Answer 8

Cymbalta
SNRI
treats Depression and neuropathic pain, fibromyalgia
more side effects in those with liver disease or heavy EtOH use

Question 9

Buproprion

Answer 9

Wellbutrin
NE/Dopa Reuptake Inhibitor
no sexual side effects
treats depression, ADHD, Anxiety
increase risk of seizure and psychosis at high dose
contraindicated in those with seizure disorder or active eating disorder or taking MAOI

Question 10

Trazodone, Nefazodone

Answer 10

Desyrel, Serzone
Serotonin receptor antagonist/agonist
treat refractory MDD, MDD with anxiety, insomnia
no sexual side effects, does not affect REM sleep
SE: nausea, dizzy, orthostatics arryhthmias, priapism, sedation
*Nefazodone has black box warning for rare but serious liver failure

Question 11

Mirtazepine

Answer 11

Remeron
Alpha adrenergic receptor antagonist
treats refractory MDD (especially when patients need weight gain)
SE: sedation, wt gain, dizzy, somnolence, tremor, dry mouth, constipation, rare agranulocytosis
no sexual side effects

Question 12

TCAs

Answer 12

inhibit reuptake NE and serotonin
long T1/2 - qd dosing
toxicity: cardiotoxicity, convulsions, coma
treat TCA OD with NaHCO3
SE: anti-HAM, wt gain, sexual dysfunction
Contraindicated in preexisting conduction abnormality, recent MI

Question 13

Amitriptyline

Answer 13

Elavil
TCA - tertiary amine
treat chronic pain, migraines, insomnia
SE: highly anti-cholinergic, more sedating, more lethal in OD

Question 14

Imipramine

Answer 14

Tofranil
TCA - tertiary
IM form
treats enuresis, panic disorder
SE: highly anti-cholinergic, more sedating, more lethal in OD

Question 15

Clomipramine

Answer 15

Anafranil
TCA - tertiary amine
SE: anticholinergic, more sedating, more lethal in OD
most serotonin specific
treats: OCD

Question 16

Doxepin

Answer 16

Sinequan
TCA - tertiary amine
anticholinergic, more sedating, more lethal in OD
treats chronic pain, sleep aid at low dose

Question 17

Nortriptyline

Answer 17

Pamelor, Aventyl
TCA - secondary amine - less anticholinergic, less sedating than tertiary
treats chronic pain
least orthostatic

Question 18

Desipramine

Answer 18

Norpramin

TCA - secondary amine - least anticholinergic

Question 19

Amoxapine

Answer 19

Asendin
TCA - tetracyclic
metabolite = Loxapine which is an antipsychotic

Question 20

Maprotiline

Answer 20

Ludiomil
TCA - tetracyclic
SE: increase rate of seizure, arrythmia, lethal in OD

Question 21

MAOI

Answer 21

MAOI-A - deactivates serotonin, dopamine, tyramine
MAOI-B- deactivates NE/E, dopamine, tyramine
more effective in atypical depression
SE: SSRI + MAOI leads to serotonin syndrome (also need to avoid opiates, decongestants) hypertensive crisis, orthostatics most common, pts with pyridoxine deficiency can have parasthesias (treat with Vit. B6)

Question 22

Phenelzine

Answer 22

Nardine

MAOI

Question 23

Tranylcypromine

Answer 23

Parnate

MAOI

Question 24

Isocarboxazid

Answer 24

Marplan

MAOI

Question 25

Selegiline

Answer 25

MAOI

comes in patch form - less dietary restrictions at low dose

Question 26

SSRI

Answer 26

inhibits presynaptic pump that takes up serotonin
3-4 weeks for effect
withdraw phenomenon - dizziness, h/a, insomnia, malaise
SE: sexual dysfunction, seizure, serotonin syndrome, can increase levels of warfarin