Depressants

Question 1

Monoamine Oxidase Inhibitors?
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone
Sertraline

Answer 1

Phenelzine

Question 2

Tricyclic Antidepressants?
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone
Sertraline

Answer 2

Amitriptyline

Clomipramine

Question 3

Selective Serotonin Reuptake Inhibitors?
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone
Sertraline

Answer 3

Fluoxetine
Sertraline
Paroxetine

Question 4

Serotonin/Norepinephrine Reuptake Inhibitors?
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 4

Venlafaxine

Duloxetine

Question 5

Atypical Antidepressants?
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 5

Bupropion
Trazodone
Mirtazapine

Question 6

Treats 
Depression due to hazards, 
2nd/3rd line option off label: OCD, bulimia, ADHD, anxiety
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 6

Monoamine Oxidase Inhibitors- Phenelzine

Question 7

MECHANISM OF ACTION
inhibition of monoamine oxidase (MAO) non-selective- results in (increased or decreased?) catecholamines!
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 7

Monoamine Oxidase Inhibitors- Phenelzine

increased

Question 8

Adverse Reaction- 
Increased Norepinephrine- which is (more or less)dangerous than Serotonin Syndrome
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 8

Monoamine Oxidase Inhibitors- Phenelzine

More

Question 9

Hypertensive Crisis- Drug interaction and food (low or high) in Tyramine can increase norepinephrine. 
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 9

Monoamine Oxidase Inhibitors- Phenelzine

High

Question 10

Which are examples of Tyramine Food?
Cheese
Alcohol- Beer and Wine
Fresh, frozen, and canned meats (salami, pepperoni, fish, etc.)
Cured/Aged/smoked meats (salami, pepperoni, fish, etc.)
Fermented foods (sauerkraut, kimchi)
Unfermented food Fermented foods (sauerkraut, kimchi)
Fava beans
Avocado
Caffeine!!

Answer 10

Cheese
Alcohol- Beer and Wine
Cured/Aged/smoked meats (salami, pepperoni, fish, etc.)
Fermented foods (sauerkraut, kimchi)
Fava beans
Avocado
Caffeine

Question 11

Drug Interactions
Patients should not take any drugs unless it is approved by the same prescriber.
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 11

Monoamine Oxidase Inhibitors- Phenelzine

Question 12

Adverse Reactions Serotonin
Serotonin (Increased) Syndrome:
This is a dangerous build up of serotonin, however not nearly as dangerous as hypertensive crises.
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 12

Monoamine Oxidase Inhibitors- Phenelzine

Question 13

Adverse RE
S/S Shivers- Shivering, Hyperreflexia, Increased Temp, Vital Signs, Encephalopathy, Restlessness, Sweating.
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 13

Monoamine Oxidase Inhibitors- Phenelzine

Question 14

Monoamine Oxidase Inhibitors- Phenelzine -S/S Shivers
S- 
H-
I- 
V-
E-
R-
S-

Answer 14

Shivering
Hyperreflexia
Increased Temp
Vital Signs, 
Encephalopathy, 
Restlessness, 
Sweating.

Question 15

Adverse RE
S/S Smart- Sweating, Myoclonus, Autonomic instability, Rigidity, Temperature Increase, Seizures. 
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 15

Monoamine Oxidase Inhibitors- Phenelzine

Question 16

Monoamine Oxidase Inhibitors- Phenelzine -S/S Smart
S--
M-
A-
R-
T-
S-

Answer 16

Sweating
Myoclonus
Autonomic instability
Rigidity
Temperature Increase
Seizures.

Question 17

Monoamine Oxidase Inhibitors- Phenelzine
Onset:
Fast Onset- within ? hours, Resolves by ? the exacerbating medication/s.

Answer 17

24

stopping

Question 18

Avoid because they increase serotonin!
Serotonin Drugs
Antidepressants
Opioid (Tramadol, Meperidine)
Other medication (dextromethorphan, linezolid), 
St. John's Wort!

Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 18

Monoamine Oxidase Inhibitors- Phenelzine

Question 19

CNS Stimulation:
S/S: anxiety, insomnia, agitation, hypomania, mania
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 19

Monoamine Oxidase Inhibitors- Phenelzine

Question 20

Monoamine Oxidase Inhibitors- Phenelzine

Washout period: When switching from MAO-I you must want ? week/? days to use another antidepressant.

Answer 20

2

14

Question 21

2nd/3rd line option off label: OCD, bulimia, ADHD, anxiety
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 21

Monoamine Oxidase Inhibitors- Phenelzine

Question 22

Treat:
Depression◦off label common : Neuropathic pain, insomnia
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 22

Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine

Question 23

Treat:
Depression, Bipolar Disorder, Obsessive Compulsive Disorder (OCD), bulimia nervosa, Social Anxiety.
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Sertraline
Bupropion
Clomipramine
Trazodone

Answer 23

Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine

Question 24

Treat:
	Depression, Diabetic Neuropathy, GAD, Obsessive Compulsive Disorder (OCD). 
Amitriptyline
Fluoxetine
Paroxetine
Phenelzine
Mirtazapine
Venlafaxine
Duloxetine
Bupropion
Clomipramine
Trazodone

Answer 24

D. Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 25

``` Treat: Depression, SAD (seasonal affective disorder), Smoking cessation, Weight loss, sexual dysfunction Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 25

E. Atypical: Bupropion

Question 26

``` Treat: Used for sleep and weight gain/appetite stimulant Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 26

ATYPICALS: Mirtazapine

Question 27

``` Treat: Used for sleep only! Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 27

ATYPICALS: Trazodone

Question 28

``` MIRT= Man, I’m Really Tired? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 28

ATYPICALS: Mirtazapine

Question 29

``` Adverse side Effect: UNIQUE SIDE EFFECT: PRIAPISM Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 29

ATYPICALS: Trazodone

Question 30

``` MECHANISM OF ACTION Block neuronal reuptake of NE and 5-HT, therefore increasing their concentrations at synapses. Also potential to block cholinergic, histaminergic, and α1 receptors. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 30

B. Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine

Question 31

``` MECHANISM OF ACTION: Selectively block neuronal reuptake of serotonin Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 31

C. Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine

Question 32

``` MECHANISM OF ACTION: Potent inhibitors of neuronal serotonin and norepinephrine reuptake (and weak inhibitors of dopamine reuptake*) Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 32

D. Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 33

``` Adverse RE Which has Serotonin syndrome Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 33

Monoamine Oxidase Inhibitors- Phenelzine Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 34

``` AD E Cardiac Toxicity: EKG Before treatment! fatal if a patient were to overdose and take their whole Rx bottle Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 34

Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine

Question 35

``` lower seizure threshold, Anticholinergic properties, paradoxical sweating. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 35

Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine

Question 36

``` hyperhidrosis”, Histamine blocking- sedation (use it for sleep!), weight gain. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 36

Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine

Question 37

``` Prevents the uptake on platelets results in More Bleeding! Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 37

Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine

Question 38

``` Adverse Side Effects Serotonin Syndrome (2-72 hours after treatment) Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 38

Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 39

``` INCREASED NOREPINEPHRINE Weight Gain, Increased anxiety, Insomnia, Hypertension- Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 39

Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 40

``` Which deal with weight gain? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 40

Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 41

``` Which deals with weight lost? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 41

E. Atypical: Bupropion

Question 42

``` ADVERSE EFFECTS Hallucinations, delusions, vivid dreams- especially for smoking cessation, increased seizure risk, anticholinergic like- constipation, dry mouth, weight loss Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 42

Atypical: Bupropion

Question 43

``` Withdrawal Syndrome Dizziness, headache, anxiety, tremor, etc ? is believed to have least due to long half-life Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 43

Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine fluoxetine

Question 44

``` MNEMONIC SSRI/SNRI S- S- R- I- ```

Answer 44

``` MNEMONIC SSRI/SNRI Sexual Dysfunction/Sodium loss Serotonin Syndrome/Sick Stomach/ Size Increase(CHRONIC T(Therapy)) Restlessness Insomnia ```

Question 45

``` Don’t forget the Sodium Loss/Hyponatremia, this can be seen in geriatrics for? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 45

Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 46

``` Which drug have a 14 day washout period and vis versa? Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 46

Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine Phenelzine

Question 47

``` St. John’s Wort (Inducer) Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 47

Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine

Question 48

``` DRUG-DRUG INTERACTIONS Other drugs that increase serotonin levels GI Bleed risk- NSAIDS, anticoagulants Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 48

Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 49

``` Tri Depresents Mnemonic- TCA T- C- A- ```

Answer 49

T-think Think how the drug works- Increase serotonin and Norepinephrine C- Cardiac◦ Watch out for the heart, also alpha-1 blockade- orthostatic hypotension/dizziness A- Anti- A lot◦ Antidepressant (suicidal Ideation)◦Anticholinergic (delirium, seizures)◦Antihistamine (sleepiness, weight gain)

Question 50

``` Monitor for weight gain Monitor for history of GI Bleeds◦Watch out with NSAIDS + Anticoagulants Patients should be educated to report any sexual functions problems to their provider Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 50

Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 51

``` Patients should be monitored for hypertension Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 51

Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 52

``` Monitor for weight loss Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 52

E. Atypical: Bupropion

Question 53

``` take in the morning to avoid insomnia issues Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 53

E. Atypical: Bupropion Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 54

``` Take with food to avoid sick stomach. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 54

E. Atypical: Bupropion Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine

Question 55

``` Understand Hypertensive Crisis Symptoms ( High Tyramine- Drug interaction- St. John's Wort. Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 55

Monoamine Oxidase Inhibitors- Phenelzine

Question 56

``` CNS stimulation Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 56

Monoamine Oxidase Inhibitors- Phenelzine

Question 57

``` Suicidal Ideation Orthostatic hypotension SLOW to work!- Several weeks Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 57

Monoamine Oxidase Inhibitors- Phenelzine Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine Selective Serotonin Reuptake Inhibitors- fluoxetine, sertraline, paroxetine Serotonin/Norepinephrine Reuptake Inhibitors- venlafaxine+ duloxetine E. Atypical: Bupropion

Question 58

``` Monitor baseline EKG for patients Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 58

Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine

Question 59

``` TAKE AT BEDTIME! THEY CAUSE DROWSINESS Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 59

Tricyclic Antidepressants (TCA’s): Amitriptyline, Clomipramine

Question 60

``` inistration: Takes minimum 1 month to maximum of 3 months to see benefit (if no response after 1 month, try alternative agent) Amitriptyline Fluoxetine Paroxetine Phenelzine Mirtazapine Venlafaxine Duloxetine Bupropion Clomipramine Trazodone ```

Answer 60

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