depression

Question 1

categories of antidepressants

Answer 1

Monoamine oxidase inhibitors(MAOIs)
Tricyclic antidepressants(TCAs)
Serotonin reuptake inhibitors(SSRIs)
serotonin & Norepinephrine reuptake inhibitors(SNRIs)
norepinephrine & dopamine reuptake inhibitors(NDRIs)

Question 2

MAOIs

Answer 2

MAO is essential in the GI breakdown of tyramine- foods containing should be avoided by anyone on MAOIs- could result in toxic catecholamine lvls
-HTN emergencies & fatal accelerated HTN have occured from dietary intake of tyramine &/or interaction with other narcotics

Question 3

example MAOIs

Answer 3

tranylcypromine/ parmate
phenelzine/ nardil
isocarcarboxazid/ marplan
selegiline/ eldepryl

Question 4

TCAs

Answer 4

MOA is unclear- dec reuptake of on monamine neurotransmitters & downreg of postsynaptic receptors
tx OCD, enuresis, panic attacks, chroninc pain, migraine HA as well as depression
-chief SE are anti-cholinergic ssx- dry mouth(effect on muscarinic receptors), constipation, urinary hesitancy, orthostatic hypotension, sedation
**OD in as little as 10x the daily dose- high toxicity- prolonged QT interval- torsade de points

Question 5

amitriptyline/ elavil

Answer 5

TCA
for major depresison, bipolar DO, Migraine & tension HA, chronic pain
MOA- CNS modulation of serotonin & NE, inc lvls of both
PO, IM- taken QH to minimize dizziness & drowsiness
SE- dizziness, drowsiness, ANTICHOLINERGIC efffects- dry mouth, constipation, urinary hesitancy, blurred vision.
- withdrawl like ssx with abrupt stopping of tx- N/V, HA, lethargy- flu-like ssx- discontinuation syndrome

Question 6

SSRIs

Answer 6

MC prescribed category
MOA- blockade of serotonin reuptake at presynaptic terminal= inc lvl of serotonin available for transmission
inc serotonin lvls are measured within hrs of 1st dose- but clinical effects may take wks-mos to occur
wide range of potential SE- but still considered best risk:benefit ratio of all antidepressant drugs

Question 7

fluoxetine/ prozac

Answer 7

SSRI
for major depressive DO, OCD, bulimia, panic DO
MOA- dec serotonin reupatake at presynaptic cleft allows for inc seroton lvls in the synapse & available for post-synaptic recpetor sites
PO QD- half life 48-72hrs- 2wks to achieve full therapeutic effects
SE- serotonin syndrome- fever, agitation, diarrhea, elevated BP. sexual dysfunx is very common- lack of interest, impotency, anorgasmia

Question 8

Duloxetine/ cymbalta

Answer 8

serotonin & norepinephrine reuptake inhibitor(SNRI)
for major depressive DO, general anxiety DO, painful peripheral neruopathy & fibromyalgia
SE- HA, somnolence, fatigue, nausea, xerostomia, insomnia, erectile dysfxn- black box warnng about suicide

Question 9

bupropion/ wellbutrin

Answer 9

norepinephrine & dopamine reuptake inhibitor(NDRI) & nicotine antagonist
for major depression, bipolar, ADD, aids in smoking cessation(marketed as zyban)
MOA- blockade of NE & dopamine inc the pool of these amines in the synaptic cleft
SE- dry mouth, HA, insomina, tremors, restlessness, agitation, anxiety, sweating, dizziness

Question 10

bupropion/ Zyban

Answer 10

NDRI
marketed for smoking cessation
takes 5-7 days to reach effective blood levels- start before quit date
150mg QD for 3 days, then 150mg BID
duration of tx is 12wks- approved for up to 12mos to prevent relapse if cessation happens in 12 wks

Question 11

levomefolic acid/ deplin

Answer 11

MTHF (methyltetrahydrofolate)
first medical food
2 dosages- .5mg & 1mg- L-methylfolate- script only
for management of suboptimal folate lvls in depressed pts