depression 2

Question 1

It a patient has depression and anxiety, what first line MDD me should not be used

Answer 1

anxiety

Question 2

bupropion inhibits what enzyme, interacting with what drugs

Answer 2

CYP 2D6 inhibitor; tamoxifen ritonavir

Question 3

what is the MOA of trazodon

Answer 3

5-HT reuptake antagonist; 5HT2A antagonist; enhances 5HT1A neurotransmission

Question 4

what are some side effects of trazodone

Answer 4

congestion
priapism
orthostatic hypotension
weight gain

Question 5

what are the therapeutic uses of trazodone? how long are their onsets?

Answer 5

major depression = up to 6 week onset

hypnotic = 1-3 hours for onset

Question 6

what drug works well with trazodone, increasing its concentration

Answer 6

fluoxetine

Question 7

trazodone lacks blocking properties of what?

Answer 7

cholinergic receptors and norepinephrine reuptake

Question 8

why is nefazodone rarely used

Answer 8

hepatotoxicity

Question 9

If a patient can’t tolerate an SSRI because of nausea, what is another good option?

Answer 9

mirtazapine

Question 10

what component of mirtazapines MOA leads to weight gain

Answer 10

5HT2C antagonism

Question 11

mirtazapines antagonism of what site decreases nausea

Answer 11

5HT3

Question 12

what is the unlabeled use for mirtazipine

Answer 12

PTSD

Question 13

True/ False:

the higher the dose of mirtazapine the more sedating

Answer 13

false; less sedating at high doses, more sedating at low doses

Question 14

what are the adverse effects of tricyclic antidepressants

Answer 14

1. dry mouth
2. blurred vision
3. constipation
4. urinary retention
5. confusion

Question 15

what is antagonized by tricyclics and what adverse effects do these cause

Answer 15

1. H1 histamine antagonism - sedation and weight gain

2. a1-adrenergic antagonism - orthostatic HTN and diaphoresis

Question 16

Why should suicidal ideation patients not get a 30 day supply of TCA’s

Answer 16

low therapeutic index; can be lethal in overdoses

Question 17

what are the 4 contraindications with TCAs

Answer 17

1. QTc greater than 450
2. concomitant use of MAOI in the past 14 days
3. patients who are pregnant or lactating
4. patients with narrow angle glaucoma

Question 18

what are the advantages of TCAs for depression

Answer 18

therapeutic levels can be drawn for adherence or toxicity