Bummer Drugs (MAO,TCA,SSRI)

Question 1

What enzyme degrades tyramine and why is this a problem?

Answer 1

MAO - people on MAOIs who eat cheese, soy, or wine can have lethal side effects of excess tyramine - excess catecholamines leading to HTN/stroke

Question 2

Which class of antidepressants are used for treatment of neuropathic pain and other pain disorders?

Answer 2

TCAs

Question 3

Name the 4 MAOIs

Answer 3

Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline
Rarely prescribed now

Question 4

What is the method of action of TCAs?What are common side effects and why?

Answer 4

Block SERT and NET, but also block alpha cholinergic, muscarinic, histamine, and 5-HT

Alpha block: orthostatic hypotension
Anti muscarinic: blurred vision, constipation, dry mouth
H1 block: sedation and weight gain
5-HT block: sexual dysfunction

Increased catecholamines can also cause cardiac overstimulation and can also slow cardiac conduction leading to arrhythmias

Question 5

Which class of antidepressant drug requires close monitoring of suicidal patients?

Answer 5

TCAs

Question 6

Which class of antidepressant can lead to conduction block and how do you treat it?

Answer 6

TCAs

With sodium bicarbonate

Question 7

Which two TCAs are known to have string anti muscarinic effects?

Answer 7

Amitriptyline and imipramine

Question 8

Which TCA has strong SERT effects but little NET effects?

Answer 8

Clomipramine

Question 9

Which TCA is strongly associated with sexual dysfunction? Why?

Answer 9

Clomipramine

Strong SERT effects cause sexual dysfunction

Question 10

Which TCA has strong NET effects?

Answer 10

Nortriptyline

Question 11

Which TCA is least sedating?

Answer 11

Desipramine

Question 12

What class of drug is the DoC for depression?

Answer 12

SSRIs

Selective serotonin reuptake inhibitors

Question 13

What class of antidepressants is the DoC for treatment of anxiety disorders?

Answer 13

SSRIs

Selective serotonin reuptake inhibitors

Question 14

What disorder can TCAs treat but not SSRIs?

Answer 14

Chronic pain

Question 15

Which class of antidepressants can treat enuresis? What is it? Why aren’t they commonly prescribed for this indication?

Answer 15

TCAs
Enuresis: involuntary urine voiding
Too many side effects

Question 16

What are the effects of overdose of SSRIs?

Answer 16

Can cause seizures RARELY fatal

Question 17

Name the 7 TCAs

Answer 17

Clomipramine
Imipramine
Nortriptyline
Amoxapine
Maprotiline
Amitriptyline
Desipramine

Question 18

Which SSRI inhibits 3 different CYPs and has a high potential for drug interactions?

Answer 18

Fluvoxamine

Question 19

Which two antidepressants treat PMS/PMDD? What class?

Answer 19

Fluoxetine and sertraline

SSRIs

Question 20

Which antidepressant treats bulimia? What class?

Answer 20

Fluoxetine

SSRI

Question 21

Which SSRI is strongly associated with weight gain?

Answer 21

Paroxetine

Question 22

What is the only SSRI associated with NE blocking effects?

Answer 22

Paroxetine

Question 23

Which three SSRIs have low potential for drug interactions?

Answer 23

Citalopram Escitalopram and Sertraline

Question 24

Blockage of reuptake of what two compounds can be effective in pain management?

Answer 24

NE and 5-HT

Question 25

What is the difference in effect in stimulating 5HT1A and 5HT2 receptors?

Answer 25

(+) 5HT1A: helps depression

(+) 5HT2: causes agitation, anxiety, and sexual dysfunction

Question 26

Which SSRIs inhibit CYP2D6 and have high potential for drug interactions?

Answer 26

Fluoxetine and paroxetine

Question 27

Patient presents with hyperthermia, muscle rigidity, and myoclonus. What is the name of this condition and what causes it?

Answer 27

Serotonin syndrome

Occurs when giving a MAOI + any serotonin reuptake inhibitor like SSRI, SNRI, TCA, or meperidine (opioid analgesic)

Question 28

Describe the Monoamine hypothesis of depression

Answer 28

Decreased levels of dopamine, serotonin, or NE can cause depression.
MAOIs treat it, but the drugs act immediately but the clinical effects are not seen for weeks (something else is going on)