Antidepressants

Question 1

MOA of which drug?

• selectively inhibits CNS uptake of serotonin –> leading to increased serotinin CNS activity

Answer 1

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Citalopram
• Escitalopram
• Paroxetine
• Fluoxetine
• Sertraline
• Fluvoxamine

Question 2

What is the 1st line med for depression?

Answer 2

SSRI

Question 3

What is the 1st line med for anxiety?

Answer 3

SSRI

Question 4

Why are SSRIs preferred?

Answer 4

• easy dosing
• less SE
• low toxicity in cases of overdose** bc/ they don’t affect norepinephrine, acetylcholine, histamine, or dopamine
• Preferred in children over other classes

Question 5

SE of which drug?

• GI upset
• Sexual dysfunction
• HA
• changes in energy level (fatigue/restelssness)
• Anxiety
• insomnia
• weight changes
• SIADH

Answer 5

SSRI

Question 6

Which SSRI should be avoided in patients with long QT syndrome?

Answer 6

Citalopram

Question 7

What medication if combined with SSRI can cause serotonin syndrome?

Answer 7

MAOI (monoamine oxidase inhibitors)

Question 8

What are sxs of serotonin syndrome?

Answer 8

• acute AMS
• seizures
• coma, death
• restlessness
• diaphoresis
• tremor
• hyperthermia
• N/V/abd pain
• mydriasis
• tachycardia

Question 9

Opioid intoxication causes eyes to do what?

Answer 9

Pupil constriction (miosis)

*Narcotics are miotics*

Question 10

Opioid withdrawal causes the eyes to do what?

Answer 10

Mydriasis (dilation)

Question 11

Stimulants like cocaine and meth intoxications cause the eyes to do what?

Answer 11

Mydriasis (dilated)

Question 12

What is MOA of SNRI?

Answer 12

Inhibits neuronal serotonin, norepinphrine, & dopamine reuptake.

Question 13

What are the indications for SNRI?

(Venlafaxine, Desvenlafaxine, Duloxetine)

Answer 13

• May be used as 1st line agents (like SSRIs), particularly in patients with significant fatigue or pain syndromes in association w/ depression.
• 2nd line agents in pts with no response to SSRIs

Question 14

What are SE of SNRIs? (3)

Answer 14

• Hyponatremia
• Noradrenergic symptoms (↓ cognition, fatigue)
• HTN
• Dizziness

Question 15

CI/Cautions of SNRIs

Answer 15

• MAOI use
• Renal/Hepatic impairment
• Seizures
• **avoid arupt discontinuation**
• Caution in pts w/ HTN
• Serotonin Syndrome if used with St. John’s Wort

Question 16

Which 3 scenarios of DDI of antidepressants cause adverse effects?

Answer 16

• SSRI + MAOI = serotonin syndrome
• SNRI + St. John’s Wort = Serotonin Syndrome
• MAOI + TCA = delirium & HTN

Question 17

MOA of which drug?

• Inhibits reuptake of serotonin & norepinephrine

Answer 17

Tricyclic Antidepressants (TCAs)

Question 18

4 indications for use of TCAs

Answer 18

• depression
• insomnia
• diabetic neuropathic pain
• post-herpetic neuralgia

Question 19

What are TCAs not favorable to use?

Answer 19

• SE profile
• Severe toxicity w/ overdose**

Question 20

SE of which drug?

• Non-depressed pts –> sleepiness
• Depressed pts –> elevated mood
• Anticholinergic effects
• Sedation
• Weight gain
• *Prolonged QT interval

Answer 20

TCA

• Amitriptyline
• Clomipramine
• Doxepin
• Imipramine
• Nortriptyline

Question 21

What is the BEST indicator of overdose of TCA?

Answer 21

Prolonged QT interval

Question 22

Besides prolonged QT interval, what are other signs of TCA overdose?

Answer 22

Na channel blocker effects

• Sinus tachy
• Wide complex tachycardia**
• neurologic sxs
• ARDS
• SIADH

Question 23

What may be useful for cardiotoxicity associated with TCA overdose?

Answer 23

Sodium Bicarb

Question 24

3 CI/cautions of TCA use

Answer 24

• MAOI use
• Recent MI
• Seizure hx

Question 25

MOA of which drug? * enhances central noradrenergic & serotonergic activity

Answer 25

Tetracyclic Compounds * Mirtazapine

Question 26

Which drug? * Used for depression * Less sexual dysfunction SE * May be used with Trazadone

Answer 26

Tetracyclic Compounds * Mirtazapine

Question 27

What are common SE of Tetracyclic Compounds (Mirtazapine)?

Answer 27

* Sedation\* * dry mouth * constipation * weight gain * agranulocytosis

Question 28

What is the one contrindication to Mirtazapine (tetracyclic compound?)

Answer 28

Use of MAOI

Question 29

MOA of which drug? * Inhibits the neuronal uptake of dopamine & norepinephrine

Answer 29

Bupropion Hydrochloride (Wellbutrin)

Question 30

What antidepressant is used for smoking cessation?

Answer 30

**Bupropion Hydrochloride** * Wellbutrin is marketed for depression * Zyban is marketed for smoking cessation

Question 31

What are SE of Bupropion

Answer 31

* Seizures * Agitation * Anxiety * Restlessness * Weight loss * HTN * HA

Question 32

Which antidepressant has less GI distress and less sexual dysfunction compared to SSRI?

Answer 32

Bupropion

Question 33

**CI/Cautions of which drug?** * Seizure disorder\* * Eating disorders (anorexia/bulimia) * MAOI use * Pts undergoing ETOH / drug detoxification * Avoid abrupt withdrawal

Answer 33

Bupropion

Question 34

MOA of which drug? * blocks breakdown of neurotransmitters (Dopamine, serotonin, epinephrine, norepinephrine) by inhibiting monoamine oxidase

Answer 34

MAOI

Question 35

What are the names of the 3 "non-selective" MAOI

Answer 35

* Phenelzine * Tranycypramine * Isocarboxazid

Question 36

What is the name of the "selective" MAOI?

Answer 36

Selegiline

Question 37

What is the indication of MAOI?

Answer 37

* Refractory depression * Many types of anxiety & affective disorders

Question 38

SE of which drug? * Hypertensive crisis (must avoid Tyramine containing foods) * insomnia * anxiety * orthostatic hypotension * weight gain * sexual dysfunction

Answer 38

MAOI

Question 39

How does MAOI cause HTN crisis?

Answer 39

MAOI prevents breakdown of tyramine, leading to HTN

Question 40

What is this? * acute AMS * restlessness * diaphoresis * tremor * hyperthermia * seizures * coma/death

Answer 40

Serotonin Syndrome

Question 41

Which drug? * Serotonin antagonist & reuptake inhibitor * Antidepressant * Anti-anxiety * Hypnotic effects * SE: sedation, cardiac arrhythmias, priapism (rare SE)

Answer 41

Trazodone