Chapter 3 CNS - other antidepressants

Question 1

Maparotiline (ludiomil)

Answer 1

• mechanism unclear, blocks reuptake of NE

indication
* equal in potency to tricyclic antidepressants

effects
* fewer anticholinergic effects
* Blood dyscrasias may affect blood components, bone marrow, lymph tissue, or blood vessels.

PO - metabolized in liver and excreted in the bile

it’s a hepatic enzyme inducing and inhibiting agent

TETRACYCLIC STRUCTURE

Question 2

Mirtazapine (remeron)

Answer 2

• unknown mechanism
• Mirtazapine inhibits the central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine.

indication:
* depression
* anxiety associated with depression

effects
* low anticholinergic effects
* orthostatic hypotension
* sedation
* aganulocytosis

PO, metabolized by liver mainly

tetracyclic structure

Question 3

Alprazolam (xanax)

Answer 3

• benzo w/ anxiolytic activity
• mechanism for antidepressant effects unknown

indication
* adjuct to tricyclic antidepressants for depression and panic attacks

Amitriptyline.
Amoxapine.
Desipramine (Norpramin)
Doxepin.
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Protriptyline.
Trimipramine.

effects
* sedation, lethargy
* no anticholinergic effects

PO, more rapid onset than tricyclic antidepressants

high dependence & abuse potential + severe withdrawal sx

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few interactions; additive with other CNS depressants

Question 4

bupropion (wellbutrin)

Answer 4

• unknown mechanism
• inhibit the reuptake of norepinephrine and dopamine weakly. The effects on norepinephrine and dopamine appear to lead to its clinical manifestations

indication:
* depression
* smoking cessation

effects
* seizures
* hepatotoxicity
* agitation
* anticholinergic effects
* tremor
* n/v
* headaches

PO — active metabolites may accumulate, worse w/ liver or kidney dysfunction

• bupropion induces p450 enzyme altering drug metabolism