drugs for mood disorders

Question 1

clinical triad of serotonin syndrome

Answer 1

cognitive/behavioral changes
autonomic instability
neuromuscular abnormalities

Question 2

key feature of serotonin syndrome that differentiates it from NMS

Answer 2

clonus

Question 3

TCA MOA

Answer 3

increase 5HT and NE

Question 4

TCAs are more effective than SSRIs for-

Answer 4

melancholic depression (anhedonia and lack of mood reactivity)

Question 5

TCA overdose

Answer 5

coma, convulsion, cardiotoxicity

Question 6

treatment of TCA overdose

Answer 6

sodium bicarbonate

Question 7

m/c cause of death from TCA overdose

Answer 7

cardiac arrhthymia

Question 8

TCA class ADRs (6)

Answer 8

anticholinergic
anti-alpha1
antihistamine- sedation, weight gain 
sexual dysfunction
decreased seizure threshold
cardiac arrhythmias

Question 9

type of TCA with more SE

Answer 9

tertiary (vs. secondary)

Question 10

tertiary TCAs (5)

Answer 10

amitriptyline
clomipramine
doxepin
imiprimine
trimiprimine

Question 11

secondary TCAs (3)

Answer 11

amoxapine
desimiprimine
nortriptyline

Question 12

TCA used for OCD

Answer 12

clomiprimine

Question 13

TCA used for enuresis

Answer 13

imiprimine

Question 14

TCA with least anticholinergic effects

Answer 14

desimiprimine

Question 15

TCA with leads a1 antagonism

Answer 15

nortriptyline

safest in elderly *

Question 16

SSRI MOA

Answer 16

increase 5HT

Question 17

most significant ADR of SSRIs

Answer 17

sexual dysfunction

Question 18

effect of SSRIs on CYP

Answer 18

most are inhibitors

exceptions- citalopram and escitalopram

Question 19

teratogenic effects of SSRIs

Answer 19

1st trimester- heart defects

after 20 weeks- PPHN, neonatal behavioral syndrome

Question 20

SSRI that can cause QT polongation

Answer 20

citalopram

Question 21

SNRI MOA

Answer 21

increase 5HT and NE

similar to TCA but less ADRs

Question 22

unique ADR of SNRI

Answer 22

hypertension

Question 23

uses of SNRIs

Answer 23

serious depression, fibromyalgia, neuropathic pain

Question 24

Atomoxetine (MOA, Use)

Answer 24

inhibits NE reuptake, used for ADHD

Question 25

bupropion MOA

Answer 25

increases DA and NE

Question 26

avoid bupropion in (2)

Answer 26

patients with seizure d/o, eating d/o due to increased seizure risk

Question 27

benefit of bupropion over SSRI

Answer 27

less sexual SE

Question 28

mirtazapine MOA

Answer 28

a2 antagonist (increases NE release)

Question 29

ADRs of mirtazapine (2)

Answer 29

sedation and weight gain

Question 30

mirtazapine is preferred in patients with depression +

Answer 30

anorexia

Question 31

ADR of nefazodone

Answer 31

hepatotoxicity

Question 32

ADRs of trazodone (2)

Answer 32

priapism, QTc prolongation

Question 33

MOA of MAO-Is

Answer 33

inhibit MAO to increase 5HT, NE, DA

Question 34

MAO-Is may be superior to SSRIs for treatment of

Answer 34

atypical depression (leaden paralysis, hyperphagia, weight gain, maintain mood reactivity)

Question 35

2 interactions of MAO-Is

Answer 35

tyramine= hypertensive crisis | other drugs that increase 5HT= serotonin syndrome

Question 36

MAO-iS

Answer 36

phenelazine tranylcypromine selegiline (MAO-B)

Question 37

when stopping MAO-I

Answer 37

wait 2 weeks before starting another class, allows for synthesis of new MAO

Question 38

MOA of lithium

Answer 38

alteration of Na transport in neurons = mood stabilization

Question 39

elimination of lithium

Answer 39

100% by kidneys

Question 40

ADRs of lithium

Answer 40

``` neurologic (tremor, ataxia, drowsiness) metallic taste hypothyroid nephrogenic DI weight gain leukocytosis ```

Question 41

teratogenicity of lithium

Answer 41

cat D- ebstein's anomaly (tricuspid)

Question 42

things that can precipitate lithium toxicity (3)

Answer 42

dehydration drugs (ACE-I, NSAIDs, thiazides) overdose

Question 43

mood stabilizer that is auto-inducer

Answer 43

carbamazepine

Question 44

mood stabilizer with worst teratogenic effects

Answer 44

valproic acid- neural tube defects, decreased IQ, behavioral problems, autism

Question 45

only mood stabilizer that is category C

Answer 45

lamotrigene