Antidepressants

Question 1

SSRIs

Answer 1

1st line treatment in depressive disorder -> Prozac 1st line for kids

-tine, -ine, -pram

MOA: Block serotonin reuptake pump

All L2 for lactation; Pregnancy C

BBW: suicidality

Question 2

SSRI DI and CI

Answer 2

DI: Azole antifungals, Macrolides, Omeprazole

CI: MAOI w/in 2 weeks - serotonin syndrome

-Paroxetine & fluoxetine CI w/ Tamoxifen

Caution with liver dysfunction

Question 3

SSRI

Less DI

QT prolongation or arrhythmias with high doses (>40mg)

Other CYP219 inhibitors

Answer 3

Citalopram (Celexa)

Question 4

SSRI

Citalopram isomer

Less DI

Approved for depression in children >12 yo

Answer 4

Escitalopram (Lexapro)

Question 5

SSRI

1st line in kids for Depression & OCD (>8 yo)

Long half-life = less withdrawal symptoms

Least problems with weight gain

CI w/ Tamoxifen

Answer 5

Fluoxetine (Prozac)

Question 6

SSRI

BID dosing

Weight gain

Nausea, sedation MC

Short half life = severe withdrawal

Answer 6

Fluvoxamine (Luvox)

Question 7

SSRI

Weight gain - most of all SSRIs

Nausea, sedation

Severe withdrawal - need slow taper

CI w/ Tamoxifen

Answer 7

Paroxetine (Paxil)

Question 8

SSRI

Often go-to, very well tolerated

Most likely to cause diarrhea

Answer 8

Sertraline (Zoloft)

Question 9

SNRI

Answer 9

Second line to SSRIs for depression

Inhibits both NE and serotonin reuptake

SE: Nausea, dizziness, diaphoresis

Also indicated for fibromyalgia and diabetic neuropathy

-faxine, Duloxetine

L3 for breastfeeding

Question 10

SNRI

Most common cause of nausea

Less DI

Need to monitor for increased BP

Answer 10

Desvenlafaxine (Pristiq)

Question 11

SNRI

Adjust with liver or renal impairment

Increase risk UGI bleed

Most withdrawal symptoms - need slow taper

QT prolongation

Answer 11

Venlafaxine (Effexor)

Question 12

SNRI

Indicated in diabetic neuropathy, fibromyalgia, & chronic pain

More drug interactions

Significant weight gain

CI: Uncontrolled angle closure glaucoma, avoid w/ severe renal or liver impairment

Answer 12

Duloxetine (Cymbalta)

Question 13

TCAs

Answer 13

-tryptyline, -ipramine, Doxepin

Avoid due to anticholinergic SE

Highly sedating - may use w/ insomnia or night-time pain/fibromyalgia

Poorly tolerated in elderly: orthostatic, anticholinergic SE, sedating, cardiac SE

Screen pts >40yo with cardiac conduction system disease (EKG)

Question 14

Tertiary Amines

Answer 14

More potent serotonin uptake blockers

More SE

Amitriptyline

Imipramine

Doxepin

Question 15

Secondary Amines

Answer 15

More potent NE blockers

Desipramine

Nortriptyline (L2)

Protriptyline

Question 16

Serotonin antagonist & reuptake inhibitor

Good for insomnia @ low doses

Antidepressant if pt can tolerate higher dose

Priapism

Answer 16

Trazodone (Desyrel)

Question 17

Commonly added on to SSRI/SNRI to reduce sexual SE

Also works well with comorbid ADHD, smoking cessation

Can cause anxiety, mildly stimulating

Decreased seizure threshold - CI bulimia

Can cause serotonin syndrome

Answer 17

Bupropion (Wellbutrin)

Question 18

Clocks adrenergic receptors - cause increased NE and serotonin

Sedation, anticholinergic SE, weight gain

Effective nausea treatment

Give to elderly pt who can’t sleep, won’t eat or chemo pt w/ nausea

Possible tx insomnia

Answer 18

Mirtazapine (Remeron)

Question 19

Used to treat depression

Have same SE profile as SSRIs w/ less sexual SE

Answer 19

Vilazodone (Viibryd)

Vortioxetine (Brintellix)

Question 20

MAOI

Answer 20

Phenelzine (Nardil), Tranylcypromine (Parnate)

Do not give

Serotonin syndrome

Hypertensive crisis w/ cold meds

Tyramine food restrictions