Antidepressants

Question 1

What is the goal of most antidepressants?

Answer 1

Increase NTs in the synapse

Question 2

Out of the 2 theories about how antidepressants work, which one is more accepted?

Answer 2

Eventual down-regulation of pre-synaptic receptors - it takes 3-4 weeks for them to work

Question 3

Name 2 nonselective MAOIs.

Answer 3

Phenelzine and Tranycypromine

Question 4

What is the original and oldest class of drugs intended to treat depression? How did they discover them?

Answer 4

MAOIs

Iproniazid - tx of TB that improved mood

Question 5

What NTs do MAOIs increase? A vs. B?

Answer 5

A - Epi, NE, 5-HT

B - DA

Question 6

What is the major limitation of MAOIs? What foods/drugs should you avoid regarding this issue?

Answer 6

potential for HTN crisis
AVOID
1. Foods high in tryamine
2. Alpha agonist (sudafed- sympathomimetic amine)

Question 7

What is the main difference between phenelzine and tranylcypromine?

Answer 7

Phen - sedating (like phenergan)

Tanyl - activating

Question 8

Precautions with MAOI apply up to ________ following D/C of MAOI.

Answer 8

3 weeks

Question 9

what other drugs should you avoid like taking an MAOI? Does the wash out period apply?

Answer 9

TCAs
SSRI
Meperidine (narcotic)
YES - avoid for 3 weeks

Question 10

T or F. Because of all the precautions with MAOIs, they are not considered first line.

Answer 10

T.

Question 11

What is the father of the TCAs? What was their old name?

Answer 11

Imipramine - historically referred to as the thymoleptics

Question 12

TCAs are highly effective and inexpensive, so why aren’t these used as readily any more?

Answer 12

They are dirty and toxic.

Question 13

What does TCA stand for (tox)? What is the antidote to TCA overdose?

Answer 13

T - tonic clonic seizsure
C - cardiac arrythmia
A - anticholinergic
antidote - bicarb

Question 14

Secondary amines are metabolites of tertiaries, and are generally ____________ tolerated when compared to tertiary amines.

Answer 14

BETTER TOLERATED

Question 15

T or F. Secondary amines are metabolized into tertiary amines.

Answer 15

F. Tertiary are metabolized into secondary.

Question 16

What are the side effects of TCAs?

Answer 16

ANTICHOLINERGIC - anti parasympathethic - sympathetic
tachycardia
sedation
peristalsis stops = constipation, dry mouth
urinary retention
orthostatic hypotension, visual disturbances, conduction disturbances

Question 17

Using TCAs in patients with histories of __________ is dangerous.

Answer 17

(ASS)
Arrythmias
Seizure
Suicidal ideation/attempts

Question 18

TCAs interact with what 3 drug classes?

Answer 18

MAOIs
antiarrythmics
CNS depressants/stimulants

Question 19

Patients are told that TCA anticholinergic effects may subside in ___ weeks and that the antidepressant effect may take up to __ weeks to develop.

Answer 19

2-3 weeks

2-4 weeks

Question 20

Name 3 off label uses of TCAs. Are TCAs more commonly used for these things?

Answer 20

YES

1. insomnia
2. Neuropathic pain
3. enuresis

Question 21

What is the father of the SSRIs?

Answer 21

Fluoxetine (Prozac) “wonder drug”

Question 22

name some other brand name SSRIs.

Answer 22

Paxil
Zoloft
Celexa
Lexapro

Question 23

What is the big advantage/disadvantage of SSRIs compared to TCAs?

Answer 23

Lacks anticholinergic, CV, toxic effects

more $$$

Question 24

What is the most common AE of SSRIs? Keep in mind that there are other AEs related to specific drugs. What about drug reactions?

Answer 24

sexual dysfunction

some CYP inhibition

Question 25

Patient presents with confusion, sweating, fever, rigidity, tachycardia, hypotension. They were taking a SSRI and a MAOI. What is going on?

Answer 25

Serotonin syndrome

Question 26

How does Bupropion work? What is the major benefit of using this drug over SSRI?

Answer 26

Weak inhibitor of DA reuptake with little/no effect on NE or 5HT
little effect on CV or sexual dysfunction

Question 27

Bupropion increases/lowers seizure threshold.

Answer 27

Lowers

Question 28

T or F. Bupropion causes weight gain.

Answer 28

F. weight loss

Question 29

What antidepressant drug is also used for smoking cessation?

Answer 29

Bupropion

Question 30

How does Trazodone work? It seems illogical…

Answer 30

Serotonin 2 receptor antagonist and weak SSRI.

Question 31

What group of people may benefit the most from Trazodone?

Answer 31

People with depression and insomnia (it is highly sedating)

Question 32

How does Venlafaxine (Effexor) work?

Answer 32

Blocks reuptake of NE and 5HT

not chemically related to TCAs or SSRIs

Question 33

What are the major AEs of venlafaxine?

Answer 33

CV effects - HTN, tachycardia, increases serum lipids

sexual dysfunction

Question 34

Which drug is typically reserved for last line/Pre-ECT therapy?

Answer 34

Venlafaxine.

Question 35

How does Duloxetine (Cymbalta) work?

Answer 35

SSRI with NE blocking properties

Question 36

What 3 conditions are Duloxetine used for other than depression? (claim to fame)

Answer 36

peripheral neuropathy, fibromyalgia, incontinence

Question 37

Mirtazepine has what 3 side effects?

Answer 37

sedation
weight gain
no sexual effects

Question 38

What herbal remedy is a weak SSRI, MAOI?

Answer 38

St. John’s Wart

Question 39

Sometimes, people are given 5-10mg of _________ to get over the hump when starting an antidepressant.

Answer 39

Ritalin - amphetamine

Question 40

What Abx has weak MAOI properties?

Answer 40

Linezolid