Antidepressants

Question 1

PET scan of pt w/ major depressive disorder

Answer 1

decreased overall brain activity

Question 2

Neurotrophic hypothesis

Answer 2

deficits in nerve growth factors (BDNF) → structural changes & neuronal loss in the brain, especially hippocampus and frontal cortex

Question 3

Neuroendocrine hypothesis

Answer 3

dysregulation of the HPA axis→ altered glucocorticoid function

Question 4

Biogenic amine hypothesis

Answer 4

Abnormal neurotransmission of dopamine, NE, & serotonin

Question 5

Evidence of biogenic amine hypothesis

Answer 5

Reserpine –> depletes NE –> depression

Question 6

Antidepressant targets

Answer 6

Reuptake of serotonin, NE, and dopamine (neuronal plasticity after 2-3 weeks)

Question 7

TCA inhibit reuptake of ___ and block ____

Answer 7

NE and 5-HT;

alpha-adrenergic, histamine and muscarinic receptor

Question 8

SSRI inhibit reuptake of

Answer 8

5-HT

Question 9

SNRIs inhibit reuptake of

Answer 9

NE and 5-HT

Question 10

MAOIs inhibit the metabolism of

Answer 10

NE, DA, and 5-HT

Question 11

Reuptake inhibition is immediate, but effects are

Answer 11

Delayed due to the feedback inhibition; only long-term use will down-regulate auto-receptors –> increase 5-HT neuron firing

Question 12

antidepressant drug for chronic pain (TMJ)

Answer 12

TCA

Question 13

Tertiary amines TCA

Answer 13

Amitriptyline, imipramine

Question 14

Secondary amines TCA

Answer 14

Nortriptyline, Desipramine

Question 15

Difference between tertiary and secondary TCA

Answer 15

Teritary: 1. primarily inhibit 5-HT reuptake; 2. produces more seizure; 3. more sedating

Secondary amines: primarily block NE reuptake

Question 16

All antidepressants should be

Answer 16

Tapered gradually if possible

Question 17

TCA metabolized by

Answer 17

CYP2D6

Question 18

Histamine receptor blockade side effects

Answer 18

drowsiness, fatigue, sedation

Question 19

Cholinergic blockade side effect

Answer 19

Blurred vision, tachycardia, constipation, urinary retention, dry mouth, palpitations, impairment of memory and cognition

Question 20

Alpha 1 receptor blockade side effects

Answer 20

Cardiac depression and arrhythmia, postural hypotension, dizziness, reflex tachy

Question 21

SE: SIADH –> water intoxication and hyponatremia

Answer 21

TCA

Question 22

SE: Analgesia (from NE acting on alpha 2 receptors to decrease glutamate)

Answer 22

TCA

Question 23

Toxicity/Overdose: Tosades de pointes

Answer 23

TCA

Question 24

Torsades de pointes tx

Answer 24

Magnesium, isoproterenol and cardiac pacing

Question 25

Tx for arrhythmia +/- seizure from TCA overdose

Answer 25

Lidocaine, propranolol, phenytoin

Question 26

Tx of TCA overdose

Answer 26

Cardiac monitoring, supportive | Treat torsades de pointes, prevent seizure, restore acid/base balance

Question 27

Tx for acid/base balance from TCA overdose

Answer 27

Sodium bicarbonate and potassium chloride

Question 28

TCA drug interactions

Answer 28

MAOIs, SSRIs, sympathomimetic drugs (amphetamine), alcohol/CNS depressant, anticholinergic drugs

Question 29

TCA combined with MAOIs

Answer 29

Serotonin syndrome!

Question 30

DOC for OCD

Answer 30

Paroxetine

Question 31

DOC for social anxiety

Answer 31

Paroxetine

Question 32

SSRI that inhibit CYP450

Answer 32

Fluoxetine

Question 33

DOC for depression

Answer 33

Citalopram/ Escitalopram

Question 34

Least likely SSRI to interact w/ other drugs --> preferred in elder

Answer 34

Sertraline

Question 35

TCA metabolized by

Answer 35

CYP450s (2D6)

Question 36

SE: CNS stimulation (anxiety or insomnia) may occur with which SSRI

Answer 36

Fluoxetine, sertraline

Question 37

SSRI causes serotonin syndrome if combined w/

Answer 37

1. MAOI, 2. St john's wort, or 3. amphetamine

Question 38

SSRI and beta blocker combo

Answer 38

heart block and hypotension

Question 39

SSRI combined with codein

Answer 39

Fluoxetine inhibits conversion to the active compount

Question 40

SSRI combined with meperidine

Answer 40

Increases 5-HT; serotonin syndrome

Question 41

SSRI combined with tramadol

Answer 41

Increased risk of seizure

Question 42

SNRI drugs (2)

Answer 42

Venalfaxine, duloxetine

Question 43

MAO-A and B difference

Answer 43

MAO-A: metabolize NE, DA, and 5-HT in BOTH CNS and periphery MAO-B selectively metabolizes DA in CNS ONLY

Question 44

Drug of last choice for depression

Answer 44

Phenelzine

Question 45

Phenelzine increases which neurotransmitter

Answer 45

NE, 5HT, DA

Question 46

Selegiline increases which neurotransmitter

Answer 46

DA

Question 47

MAOI used in Parkinson's

Answer 47

Selegiline

Question 48

SE: Hypertensive crisis due to tyramine!!

Answer 48

Phenelzine

Question 49

Foods w/ tyramine

Answer 49

Red wine, beer, aged cheese, meats

Question 50

MAOI combined w/ what drugs causes severe HTN

Answer 50

OTC cold and cough meds (sympathomimetic amines - phenylephrine, ephedrine, amphetamine)

Question 51

MAOI combined w/ which drug groups can cause serotonin syndrome and lead to hyperprexia

Answer 51

Meperidine, dextromethorphan, TCAs, SSRI

Question 52

MAOI inhibits

Answer 52

CYP450 enzymes (2D6)

Question 53

Extended release for quitting smoking

Answer 53

Bupropion

Question 54

Do not give pt Bupropion who has

Answer 54

hx of seizures

Question 55

Reason why the gf is on Bupropion

Answer 55

sexual dysfunction side effects are rare

Question 56

Advantage in depressed pts w/ insomnia and anxiety

Answer 56

Mirtazapine

Question 57

Drug that eliminates side effects associated w/ SSRIs

Answer 57

Mirtazapine

Question 58

SSRIs common side effects

Answer 58

anxiety, insomnia, N, sexual dysfunction

Question 59

Non-stimulant tx for ADHD

Answer 59

Atomoxetine

Question 60

Atomextine SE

Answer 60

GI distress and insomnia

Question 61

Not a good antidepressant, used mostly as sleep aid

Answer 61

Trazodone

Question 62

SE: Priapism

Answer 62

Trazodone

Question 63

Pt on fluoxetine for his depression comes into the clinic complaining of pain, what pain med do you prescribe?

Answer 63

Acetaminophen or NSAID. NO OPIOID!!

Question 64

Other MAOI side effects

Answer 64

Orthostatic hypotension, wt gain, anticholinergic effects