Antidepressants

Question 1

Tricyclic antidepressant example

Answer 1

Clomipramine

Question 2

TCA mechanism of action

Answer 2

Block NA and 5-HT reuptake
Metabolites active but different selectivity
Increased functional availability of monoamines
Not direct MOA! BETABLOCKERS NOT EFFECTIVE
Probably subsequent downregulation of receptors but beta blockers not antidepressants

Question 3

Antidepressants therapeutic delay

Answer 3

More than 2 weeks

Question 4

TCA effects

Answer 4

Mood effects only in depressed patients
Fall in BP (alpha blockade)
Atropinic effects
Sedation which benefits sleep as it is disturbed

Question 5

Negative effects of TCAs

Answer 5

Cardiotoxicity
Rise in rate
At therapeutic doses
Not just related to increased NA -quinidine like sodium channel block
Beta blockers do not reduce cardiotoxicity

Question 6

TCA effects in acute overdose

Answer 6

Excitement
Delirium 
Convulsions
Coma 
Respiratory depression
Takes days to recover

Question 7

TCA interactions

Answer 7

Antihypertensives that require uptake system
Thyroid hormones potentiate
Summation with MAOIs
Potentiation of CNS antidepressants because of effects on metabolism and sedation

Question 8

SSRI example

Answer 8

Fluoxetine

Question 9

SSRI VS TCA

Answer 9

Lower atropinic effects 
Lower cardiovascular effects
Lower acute toxicity
Lower sedation
BUT
Nausea
Anorexia
Aggression
Sexual dysfunction

Question 10

SSRI X MAOIS

Answer 10

Serotonin syndrome-
Tremors
CVS collapse
Hyperthermia
All from 5-HT1A stimulation

Question 11

SSRI MOA

Answer 11

Block serotonin reuptake

Question 12

MAOI MOA

Answer 12

Regulates releasable pool of na and serotonin
Effects probably a result of MAOI A inhibition
Increases 5ht and na in brain and peripheral organs, plasma and cells
Increases spontaneous leakage

Question 13

Types of MAOIs

Answer 13

MAOI A- important for serotonin
Without it humans are violent and retarded
MAOI B- important for na, da

Question 14

MAOI example

Answer 14

Phenelzine -not selective

Clorygene -selective for A

Question 15

MAOI effect

Answer 15

Mood elevation in normal and depressed peeps

Can lead to mood swings

Question 16

MAOI side effects

Answer 16

Mood swings agitation hypomania
Atropinic effects
Hepatotoxicity
Hypertensive crisis
-interaction with TCAs, precursors of amines and tyramine in food
Abnormal syndrome with pethidine
-hyperpyrexia, restlessness, coma, hypotension
-result of formation of abnormal metabolite due to inhibition of mao

Question 17

MAOI interaction with tyramine

Answer 17

Tyramine normally digested by gut and released as amines by liver
Tyramine a product of tyrosine
High level of these amines cos of maoi and they displace na from storage vesicles