Drugs - Misc Agents

Question 1

Which are the miscellaneous agents?

Answer 1

• Bupropion (Wellbutrin, Zyban)
• Alprazolam (Xanax)
• Mirtazapine (Remeron)

Question 2

What are the characteristics of bupropion?

Answer 2

• Parent drug is weak, but selective dopamine reuptake blocker
• stimulating so dose in the a.m.
• major metabolite is a potent norepinephrine reuptake inhibitor
• agitation
• high incidence of seizure (BAM-C) so the daily dose of 450 mg is given in divided doses of 150 mg each
• lower incidence of sexual dysfunction (along with nefazadone and mirtazapine)
• do not administer with MAOIs because of seizures
• less likely to produce weight gain
• contraindicated in patients with eating disorders
• effective agent for smoking cessation (Zyban) because we can dopamine reuptake blockade reduces craving

Question 3

What are the characteristics of alprazolam?

Answer 3

• Fits of rage reported
• not an antidepressant, but alleged to have some activity
• protracted withdrawal symptoms so it is more difficult to discontinue
• no effect on dopamine, norepinephrine, or serotonin reuptake

Question 4

What are the characteristics of mirtazapine?

Answer 4

• Potent H1 receptor blocker so significant sedation
• increased appetite and weight gain from H1 and 5HT2C block
• little sexual dysfunction because it blocks 5HT2A
• reduces anxiety because it blocks 5HT2A/2C and 5HT3
• MOA: Inhibits alpha-2 autoreceptors on norepinephrine neurons to allow increased firing and release of norepinephrine from these neurons. The net result of this agent is more norepinephrine and serotonin in the synaptic cleft without blocking reuptake