Antidepressants

Question 1

classification of anti-depressants

Answer 1

1. TCAs
2. SSRIs
3. SNRIs
4. Serotonin (5-HT2) receptor antagonists
5. heterocyclic anti-depressants
6. MAOIs

Question 2

TCA
block NE and 5-HT transporters with significant blockade of ANS and histamine receptors
for MAJOR DEPRESSIVE DISORDER NOT RESPONSIVE TO OTHER DRUGS
additive depression of CNS with other central depressants

Answer 2

imipramine

clomipramine, desipramine, amitriptyline, nortriptyline, doxepin, protriptyline, trimipramine

Question 3

DOC for OCD

Answer 3

clomipramine

Question 4

3 Cs of TCA overdose?

Answer 4

Coma
Convulsions
Cardiotoxicity

Question 5

toxic dose and lethal dose of TCA?

Answer 5

toxic dose = 7 mg/kg

lethal dose = 15 mg/kg

Question 6

treatment of TCA overdose

Answer 6

1. fluid resuscitation
2. activated charcoal
3. benzodiazepines
4. bicarbonate (for QRS duration > 100 msec or vntricular arrhythmias)

Question 7

SSRI
FIRST LINE FOR MDD
SE: erectile dysfunction, WITHDRAWAL SYNDROME
serotonin syndrome when used with MAOIs

Answer 7

fluoxetine
paroxetine, citalopram, escitalopram, sertraline, fluvoxamine, vilazodone

fluoxetine, paroxetine, and fluvoxamine are CYP450 INHIBITORS

Question 8

what drugs cause erectile dysfunction?

Answer 8

SSRIs
Opiates
Risperidone
Ethanol, Estrogen
Propranolol
Spironolactone
Finasteride
Hydrochlorothiazide

Question 9

features of serotonin syndrome?

Answer 9

Fever
Agitation
Tremor
Clonus
Hyperreflexia
Diaphoresis

Question 10

SNRI

SE: hypertension, hepatotoxicity, withdrawal syndrome

Answer 10

venlafaxine
duloxetine, desvenlafaxine, milnacipran

duloxetine and desvenlafaxine are CYP450 INHIBITORS

Question 11

serotonin antagonist
SE: orthostatic hypotension, priapism, hepatotoxicity
may cause arrhythmias in patients with pre-existing cardiac disease

Answer 11

trazodone (QT elongation, isolated PVCs)
nefazodone (CYP450 INHIBITOR)

trazodone has modest alpha and H1 receptor blockade

Question 12

what drugs cause priapism?

Answer 12

trazodone
papaverine
sildenafil
quetiapine
alprostadil
warfarin
bupropion

Question 13

tetracyclic anti-depressant
blocks D2 receptors
SE: AKATHISIA, PARKINSONISM, AMENORRHEA-GALACTORRHEA SYNDROME, seizures, cardiotoxicity

Answer 13

amoxapine (lowers seizure threshold)

maprotiline

Question 14

tetracyclic anti-depressant
antagonism of presynaptic alpha2-adrenoceptors
SE: weight gain, marked sedation

Answer 14

mirtazapine

1st alpha2 antagonist indicated for depression

Question 15

tetracyclic anti-depressant
increases dopamine and NE activity
SE: weight loss, seizures, priapism
lowers seizure threshold
CYP450 INHIBITOR

Answer 15

bupropion

ineffective alone
helps in smoking cessation

Question 16

MAOI
SE: insomnia, orthostatic hypotension, blurred vision
HYPERTENSIVE CRISIS occurs when taken with tyramine
SEROTONIN SYNDROME when taken with SSRIs

Answer 16

phenelzine

tranylcypromine, selegiline, isocarboxazid