Antidepressants

Question 1

Amitriptyline
Class
MOA

Answer 1

1. Tricyclic antidepressant (TCA)
2. CNS modulation of 5HT (strong effects) & NEpi (moderate effects) – increasing levels of both

Serotonin-NEpi reuptake inhibitor

Question 2

Amitriptyline

1. Indications
2. char

Answer 2

1. Major depression, bipolar disorder, migraine & tension HA, chronic pain

2.PO, IM
Usually taken at bedtime to minimize drowsiness/dizziness

Discontinuation syndrome: stopping tx abruptly causes withdrawal-like sx (nausea, HA, dizziness, lethargy, flu-like sx)

Question 3

Amitriptyline

side effects

Answer 3

Dizziness, marked drowsiness, anticholinergic effects (dry mouth, constipation, urinary hesitancy, blurred vision)

Question 4

Remeron

Class
Indications
MOA

Answer 4

1. Tetracyclic antidepressant
2. depression
3. 5-HT2 & 5-HT3 receptor antagonist

Also antagonizes H1 & peripheral alpha-1 adrenergic receptors

Question 5

Remeron Characterisitcs

Answer 5

Sedation, weight gain, increased appetite, dizziness, nausea, dry mouth, edema, increased cholesterol

Rare: agranulocytosis, neutropenia, NMS or serotonin syndrome, may lower seizure threshold

Question 6

Remeron CI

characterisitics

Answer 6

CI: EtOH, benzos, other CNS depressants, MAOIs

Monitor cholesterol, CBC, suicidal ideation

Question 7

Trazodone

c;ass
Indications
MOA

Answer 7

• Tetracyclic antidepressant
• Major depressive disorder, anxiety, panic disorder, insomnia

Many off-label uses

-Serotonin reuptake inhibitor & partial antagonist

Decreased 5HT reuptake at presynaptic cleft increased 5HT in synapse & increased 5HT available at post-synaptic receptor sites

Question 8

Trazadone Side effects

Answer 8

Sedation, orthostatic hypotension, fatigue, possible cardiac dysrhythmias, possible mania w/ bipolar disorder, increased suicide risk

Overdose: monitor for hypotension

Question 9

Fluoxetine
class
indications
moa

Answer 9

• SSRI
• Major depressive disorder, OCD, bulimia, panic disorder
• Decreased serotonin reuptake at presynaptic cleft = increased 5HT levels in synapse & Increased 5HT available at post-synaptic receptor sites

Question 10

Fluoxetine

SE

Answer 10

Sexual dysfunction (lack of interest, impotency, anorgasmia)
Serotonin syndrome: fever, agitation, diarrhea, elevated blood pressure

Question 11

Fluoxetine

Char

Answer 11

PO
½ life: 48-72 hours – why risk of serotonin syndrome

Caution w/ NSAID use – increased risk of GI bleeding & NSAIDs may interfere & reduce efficiency of SSRIs

Question 12

Duloxetine
class
MOA
Indications

Answer 12

• SNRI
• Major depressive disorder, generalized anxiety disorder, painful peripheral neuropathy, fibromyalgia, OA, lumbago
• Inhibits reuptake of 5HT & NEpi

Question 13

Duloxetine SE

CHar

Answer 13

HA, somnolence, fatigue, nausea, xerostomia, insomnia, erectile dysfunction

CI: heavy EtOH or chronic liver disease – causes elevation of liver enzymes which can -> acute hepatitis

Question 14

Buproprion
Class
Ind
MOA

Answer 14

• NDRI
• Major depression, bipolar disorder, ADD, smoking cessation (but called Zyban)
• Blocks NEpi & DA reuptake = increased pool of NT in synaptic cleft

Question 15

Buproprion
SE
Char

Answer 15

HA, insomnia, xerostomia, restlessness, tremors, agitation, anxiety, sweating, dizziness

Takes 5-7 days to reach steady-state blood level

Question 16

Veranicline
Class
Ind
MOA

Answer 16

• Partial nicotine agonist
• Smoking cessation
• Partial nicotine agonist

Question 17

Veranicline

SE
Char

Answer 17

Neuropsychiatric effects (depression, suicidal thoughts, suicide)

Neuropsychiatric effects occur when in population that never had predisposing psychiatric illness