Antidepressants

Question 1

SSRIs

Answer 1

• fluoxetine, paroxetine, sertaline, citalopram, escitalopram, fluvoxamine
• MDD, anxiety disorder, OCD, PTSD, PMDD, bulimia
• inihibit 5-HT reuptake selectively
• side effects: nausea, HA, anxiety, agitation, insomnia, impotence, extrapyramidal effects, seizures w overdose, serotonin syndrome with MAOI
• paroxetine and fluoxetine are inhibitors of CYP2D6
• fluvoxamine is inhibitor of CYP3A4

Question 2

SNRIs

Answer 2

• venlafaxine, duloxetine
• indicated for MDD, chronic pain, fibromyalgia, menopausal symptoms
• inhibits reuptake for serotonin and NE
• adverse effects: nausea, HA, anxiety, agitation, insomnia, extrapyramidal, seizures w overdose, serotonin syndrome with MAOI, anticholinergic, sedation, hypertension (with venlafaxine)
• venlafaxine is metabolized by CYP2D6

Question 3

TCAs

Answer 3

• imipramine, amitryptaline, clomipramine, desipramine, nortriptyline
• indicated for MDD, chronic pain, OCD (clomipramine)
• similar MOA as SNRIs, but tend to interact with variety of other receptors, so more side-effects
• all of the side effects + orthostatic hypotension, muscarinic block, arrhythmias and seizures with OD

Question 4

MAOIs

Answer 4

• phenelzine, tranylcypromine
• indication for MDD unresponsive to other drugs
• inhibits monoamine oxidase (phenel is irreversible)
• adverse effects: hypertensice rxns in response to indirectly acting sympathomimetics, hyperthermia, CNS stimulation (agitation, convulsions), hypertensive crisis with tyramine-containing foods, serotonin syndrome with SSRIs, orthostatic hypotension

Question 5

5-HT2 antagonists

Answer 5

• nefazodone, trazodone
• indicated for MDD and hypnosis (trazodone)
• trazodone is a prodrug and nef can cause heptaotox
• other adverse effects include sedation and orthostatic hypotension

Question 6

Heterocyclics

Answer 6

• bupropion, mirtazapine
• indicated for MDD, bup is for smoking cessation, and mirt is for sedation
• bup enhances both NE and DA neurotransmission
• mirt is antagonist at multiple serotonin receptos and antagonist of presynaptic alpha 2 autoreceptor which enhances release of NE and 5-HT
• bup lowers seizure threshold
• mirt causes sedation

Question 7

Lithium

Answer 7

• indicated for BPD
• completely absorded 6-8 hr
• no protein binding
• excreted entirely in urine
• t1/2 of 20 hr
• diuretics decrease renal clearance by 1/4, and NSAIDs interfere as well
• adverse effects: tremor (controlled with -olols), reversibly decreases thyroid fxn, reversible polydipsia and polyuria. Extracellular hyperkalemia and intracellular hypokalemia
• DON’T GIVE TO PTS WITH DEHYDRATION OR NA DEPLETION OR CVD OR RENAL IMPAIRMENT OR DURING LACTATION