Antidepressants and Mood Stabilizers

Question 1

Serotonin-Selective Reuptake Inhibitor MOA - ___ inhibit the ___‐synaptic reuptake of serotonin (via ___)

Answer 1

Selectively inhibit the pre‐synaptic reuptake of serotonin (via SERT)
o results in enhanced, prolonged serotonergic neurotransmission to post‐synaptic receptors

Question 2

As a class, why do SSRI’s have fewer side effects than TCA’s?

Answer 2

As a class, much less impact on

• histamine receptors (CNS)
• muscarinic receptors (anticholingergic)
• adrenergic receptors (CV)

Question 3

Minor/infrequent side effects of SSRI’s (five areas).

What other class subset has this?

Answer 3

o Sexual dysfunction
o GI (N/V/dyspepsia)
o CNS (sedation or insomnia/agitation)
o Weight gain
o QT prolongation

Non-TCA SNRI’s have similar side effects.

Question 4

**What drug in the SSRI class has highest risk of drug-drug interaction?

Answer 4

**Fluoxetine (strong CYP450 inhibitor)

Question 5

What two drugs in the SSRI class has least risk of drug-drug interaction?

Answer 5

Citalopram and sertraline (mild CYP450 inhibitor)

Question 6

Sweating, hyperreflexia, akathisia/myoclonus, shivering/tremors - What state is this and what causes it?

Answer 6

Serotonin Syndrome.

Increased risk of this when given in combo with other serotonin-affecting (i.e. SSRI’s) agents.

Question 7

What drug class includes TCA’s?

Answer 7

SNRI’s

Question 8

Difference in MOA between tertiary and secondary amine TCA’s.

Answer 8

Tertiary - inhibit both NE/5‐HT relatively equally.

Secondary - inhibit NE more than 5‐HT.

Question 9

What three receptors do TCA-based SNRI’s impact?

Answer 9

alpha adrenergic - CV
muscarinic - anticholinergic
Histamine - CNS

Question 10

Symptoms indicating a toxic TCA overdose?

Answer 10

3 C’s (Tri C): Coma, Cardiotoxicity (Conduction abnormalities - CoD), Convulsions

Question 11

What is the “Quinidine-like” effect that results from toxic TCA overdose?

Answer 11

Class 1A Antiarrhythmic:

• Slows Conduction - In Ventricular cells: Slows phase 0 depolarization & conduction velocity
• Na channel blockade

Question 12

What Serotonin-Adrenergic Receptor Antagonists (SARA’s) has sleep assistance?

Answer 12

trazodone

Question 13

What Serotonin-Adrenergic Receptor Antagonists (SARA’s) selectively block pre‐synaptic 5‐HT2A and blockα1 post‐synaptic adrenergic receptors?

Answer 13

Trazodone and nefazodone

Question 14

What Serotonin-Adrenergic Receptor Antagonists (SARA’s) selectively blocks pre‐synapticα2 adrenergic
receptors & on serotonergic neurons?

Answer 14

mirtazapine

Question 15

Common SE of Serotonin-Adrenergic Receptor Antagonists (SARA’s)

Answer 15

o Constipation
o CNS (sedation) - H1 and/or alpha1
o Weight gain
o Dry mouth

Question 16

A depressed smoker who needs meds for both depression and smoking cessation.

Answer 16

Bupropion, which is a Noradrenergic-Dopamine Reuptake Inhibitors (NDRI) - inhibit the pre‐synaptic reuptake of serotonin norepinephrine (via NET) & dopamine (via DAT)

Question 17

MOA of Bupropion?

Answer 17

(An NDRI) Selectively inhibit the pre‐synaptic reuptake of
serotonin norepinephrine (via NET) & dopamine
(via DAT)

Question 18

Unique side effect of Noradrenergic-Dopamine Reuptake Inhibitors

Answer 18

agitation/insomnia - stimulating property

Question 19

What three amine neurotransmitters do do MAOI’s increase levels of?

Answer 19

NE, 5-HT, DA (they inhibit both MAO A and B)

Question 20

What is the only B-selective MAOI is NOT irreversible?

Answer 20

Selegiline (B-selective, non-selective at high doses)

Question 21

Cheese and wine :)

Answer 21

MAOI hypertensive crisis

Question 22

What is the biggest limiting factor of MAOI’s?

What MAOI would not have this effect?

Answer 22

Hypertensive crisis - because MAOI’s inhibit MAO-A, which is necessary for Tyramine metabolism.

Selegiline

Question 23

What drug can reduce risk of suicide in bipolar patients?

Answer 23

Lithium

Question 24

Three classic drug-drug interaction with lithium.

Answer 24

Any drug that increases Na excretion (NSAIDs, ACE inhibitor lisinopril, diuretic thiazides) will increase reabsorption of lithium.

Question 25

***What drug causes nephrogenic diabetes insipidus?

Answer 25

***Lithium (see polyuria/polydipsia).

Due to the renal impact Na/K/lithium.

Question 26

***What antiseizure/bipolar medication is a major CYP450 inducer?

Answer 26

***carbamazepine (esp drugs metab by CYP3A4)

used for actue and maintenance treatment

Question 27

Which mood stabilizer is used for acute bipolar with or w/o psychotic features?

Answer 27

divalproex

Question 28

***What anti-seizure/bipolar medication is a major CYP450 inhibitor?

Answer 28

lamotrigine (CYP2C9)

Question 29

When taking SSRI’s, TCA’s, SNRI’s, sympathomimetics, antihypertensives, or any 5-HT/NE affecting drugs, what is contraindicated in tx of depression/anxiety?

Answer 29

MAOI’s

Question 30

alpha1 blockage causes ___ symtpoms

Answer 30

postural hypotension