Antidepressants

Question 1

Fluoxetine

Answer 1

SSRI (depression, atypical depression, anxiety). Longest half life (give to alleviate SSRI withdrawal symptoms). Tox: GI, sexual dysfunction, Serotonin Syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures)

Question 2

Paroxetine

Answer 2

SSRI (depression, atypical depression, anxiety). Tox: GI, sexual dysfunction, Serotonin Syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures)

Question 3

Sertraline

Answer 3

SSRI (depression, atypical depression, anxiety). Tox: GI, sexual dysfunction, Serotonin Syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures)

Question 4

Citalopram

Answer 4

SSRI (depression, atypical depression, anxiety). Tox: GI, sexual dysfunction, Serotonin Syndrome (hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures)

Question 5

Patient with depression has hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures

Answer 5

Serotonin Syndrome (SSRI, SNRI, MAOI, TCA)

Question 6

Serotonin Syndrome

Answer 6

Hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures

Question 7

Venlafaxine

Answer 7

SNRI (inhibits 5HT and NE reuptake)
*Also used for GAD and panic
Tox: HTN, stimulant effects, sedation, nausea

Question 8

Duloxetine

Answer 8

SNRI (inhibits 5HT and NE reuptake)
*Also used for Diabetic peripheral neuropathy
Tox: HTN, stimulant effects, sedation, nausea

Question 9

SSRIs

Answer 9

Fluorescence Paralyzes Senior Citizens

Fluoxetine, Paroxetine, Sertraline, Citalopram

Question 10

SNRIs

Answer 10

Venlafaxine, Duloxetine

Question 11

Amitriptyline

Answer 11

TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.
*Amitryptiline is tertiary TCA, therefore has more anticholinergic side effects thatn secondary (nortriptyline).

Question 12

Nortriptyline

Answer 12

TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.
*Nortriptyline is less anticholinergic SE than Amitryptiline, therefore good for elderly.

Question 13

Imipramine

Answer 13

TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
*Imipramine also used for bedwetting
Tox: Tri-C's (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.

Question 14

Desipramine

Answer 14

TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.
*Desipramine is less sedating and has higher seizure threshold.

Question 15

Clomipramine

Answer 15

TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
*Clomipramine also used for OCD
Tox: Tri-C's (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.

Question 16

Doxepin

Answer 16

TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.

Question 17

Amoxapine

Answer 17

TCA (blocks 5HT and NE reuptake)
Used for major depression, fibromyalgia
Tox: Tri-C’s (Convulsions, Coma, Cardiotoxicity): sedation, alpha1-blocking effects (postural hypotension), anticholinergic effects (tachycardia, urinary retention, dry mouth, AMS in elderly), respiratory depression, hyperpyrexia.
Treat cardiovascular tox with NaHCO3.

Question 18

TCAs

Answer 18

Amitriptyline, Nortriptyline, Imipramine, Desipramine, Clomipramine, Doxepin, Amoxapine.

*All end in -iptyline or -ipramine, except for Doxepin and Amoxapine

Question 19

TCA Toxicity

Answer 19

Tri-Cs: Convulsions, Coma, Cardiotoxicity (arrhythmias). Also, respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to anticholinergic SE (use Nortriptyline)
Treat cardiovascular tox with NaHCO3

Question 20

Tranylcypromine

Answer 20

MAOI (increases NE, 5HT, DA).
Used for atypical depression, anxiety, and hypochondriasis.
Tox: HTN crisis (with Tyramine ingestion), CNS stimulation.
DDI: Contraindicated with SSRIs, TCAs, St. John’s Wort, Meperidine, Dextromethorphan d/t Serotonin Syndrome.
Requires 2 week washout period before or after another anti-depressant.

Question 21

Phenelzine

Answer 21

MAOI (increases NE, 5HT, DA).
Used for atypical depression, anxiety, and hypochondriasis.
Tox: HTN crisis (with Tyramine ingestion), CNS stimulation.
DDI: Contraindicated with SSRIs, TCAs, St. John’s Wort, Meperidine, Dextromethorphan d/t Serotonin Syndrome.
Requires 2 week washout period before or after another anti-depressant.

Question 22

Isocarboxazid

Answer 22

MAOI (increases NE, 5HT, DA).
Used for atypical depression, anxiety, and hypochondriasis.
Tox: HTN crisis (with Tyramine ingestion), CNS stimulation.
DDI: Contraindicated with SSRIs, TCAs, St. John’s Wort, Meperidine, Dextromethorphan d/t Serotonin Syndrome.
Requires 2 week washout period before or after another anti-depressant.

Question 23

Selegiline

Answer 23

MAOI (increases NE, 5HT, DA).
*Selective MAO-B-I (and used for Parkinson’s)
Used for atypical depression, anxiety, and hypochondriasis.
Tox: HTN crisis (with Tyramine ingestion), CNS stimulation.
DDI: Contraindicated with SSRIs, TCAs, St. John’s Wort, Meperidine, Dextromethorphan d/t Serotonin Syndrome.
Requires 2 week washout period before or after another anti-depressant.

Question 24

MAOIs

Answer 24

MAO Takes Pride In Shanghai:

Tranylcypromine, Phenylzine, Isocarboxazid, Selegiline

Question 25

MAOI Toxicity

Answer 25

HTN crisis (with tyramine), CNS stimulation, Serotonin Syndrome (with SSRI, TCA, St. John’s Wort, Meperidine, Dextromethorphan)

Question 26

Bupropion

Answer 26

Antidepressant: Increases NE and DA via unknown mech
Used for depression, smoking cessation, or added to SSRI to alleviate sexual side effects.
Tox: Lowers seizure threshold, stimulant effects (tachycardia, insomnia), headache.

Question 27

Mirtazapine

Answer 27

Antidepressant: Alpha2-antagonist that increases NE and 5HT release, and potent 5HT-2 and 5HT-3 receptor antagonist.
Used for depressed old lady who is not eating or sleeping.
Tox: anti-histamine side effects of sedation, increased appetitie, weight gain, dry mouth

Question 28

Maprotiline

Answer 28

Antidepressant: Blocks NE reuptake
Tox: Sedations, Orthostatic hypotensions

Question 29

Trazodone

Answer 29

Antidepressant: Inhibits 5HT reuptake.
Used for insomnia, as high doses are needed for antidepressant effects. Often added to SSRI to alleviate sexual side effects.
Tox: Sedation, nausea, priapism, postural hypotension. “TrazoBONE”