Depression

Question 1

Imipramine/Desipramine MoA

Answer 1

Tricyclic antidepressants

Block reuptake of NA and 5HT into presynaptic neuron

Question 2

Imipramine/Desipramine AE

Answer 2

Have at least two of:
Muscarinic receptor blockade
H1 receptor blockade
Alpha1 adrenoreceptor blockade

Arrhythmia, weight gain, sexual dysfunction, insomnia, serotonin syndrome

Question 3

Imipramine/Desipramine indications

Answer 3

Panic disorder, agoraphobia, generalised anxiety disorder

Question 4

Serotonin syndrome

Answer 4

Sx:

Agitation, confusion, myoclonus, hyperreflexia, sweating, shivering, tremor, diarrhoea, fever, incoordination

Question 5

Fluoxetine MoA

Answer 5

Tricyclic antidepressant

Blocks alpha2 adrenoreceptors -> increased release of NA

Question 6

Fluoxetine AE

Answer 6

Strongly antagonises histamine receptors (sedation, weight gain, increased appetite), peripheral inhibition of alpha1 adrenoreceptors

Question 7

Fluoxetine indications

Answer 7

Panic disorder, agoraphobia, generalised anxiety disorder

Question 8

Venlafaxin MoA

Answer 8

Serotonin and NA reuptake inhibitor -> increases levels of synaptic monoamines

Question 9

Venlaxafin AE

Answer 9

Serotonin syndrome, nausea, sexual dysfunction, noradrenergic symptoms, Takotsubo cardiomyopathy, bleeding

Question 10

Moclobemide MoA

Answer 10

Reversible monoamine oxidase inhibitor -> increases synaptic NA and 5HT

Question 11

Moclobemide AE

Answer 11

Insomnia, nausea, dry mouth, constipation, headache

Question 12

Tranylcypromine MoA

Answer 12

Irreversible monoamine oxidase inhibitor -> increases levels of NA and 5HT
Effects wear off after synthesis of new enzymes (2-3 weeks)

Question 13

Tranylcypromine AE

Answer 13

Insomnia, postural hypotension, atropine-like side effects, sexual dysfunction, cheese reaction

Question 14

Cheese reaction

Answer 14

Hypertensive crisis

Caused by other foods containing tyramine which is metabolised by MAO-A

Question 15

Reboxetine MoA

Answer 15

NA reuptake inhibitor - selective to NA

Question 16

Reboxetine AE

Answer 16

Insomnia, dizziness, dry mouth, constipation, nausea, excessive sweating

Question 17

Nefazodone MoA

Answer 17

5HT antagonist and reuptake inhibitor (selective to 5HT; less potent than SSRIs and TCAs)

Question 18

Nefazodone AE

Answer 18

Severe liver damage, dry mouth, sleepiness, nausea, orthostatic hypotension, dizziness