Exam 1: Depression

Question 1

Class: Tricyclic antidepressants
Drugs:

Answer 1

• imipramine (Tofranil)
• amitriptyline
• nortriptyline (Pamelor)
• doxepin (Sinequan)

Question 2

Class: Tricyclic antidepressants
MOA:

Answer 2

• structure similar to antipsychotics

- Blocks reuptake of NEp + Serotonin

Question 3

Class: Tricyclic antidepressants

Side effects:

Answer 3

• Sedation
• ↓ BP
• Anticholinergics
• Cardiac Toxicity
• dysrhythmias

Question 4

Class: Tricyclic antidepressants

Toxicity/AE:

Answer 4

• *5x daily dose = lethal

- 1-wk supply per Rx

Question 5

Class: Monoamine oxidase inhibitors (MAOI)
Drugs:

Answer 5

• isocarboxazid (Marplan)
• phenelzine (Nardil)
• tranylcypromine (Parnate)

Question 6

Class: Monoamine oxidase inhibitors (MAOI)
MOA:

Answer 6

• Irreversible blockage of MAO-A → Inactivates NE, serotonine, and DA
• PHENELZINE:
  • Blocks MAOa + MAOb
  • Metabolism not understood

Question 7

Class: Monoamine oxidase inhibitors (MAOI)
Indications:

Answer 7

• 2nd / 3rd choice

Question 8

Class: Monoamine oxidase inhibitors (MAOI)

Side effects:

Answer 8

↑ SE
**Potent hypotensive effect

PHENELZINE:
↑ Weight gain
↑ Sedation
↑ Sexual dysfunction **sometimes hepatotoxicity

Question 9

Class: Monoamine oxidase inhibitors (MAOI)
Interactions:

Answer 9

Cheese: ↑tyramine →MAOI + GI tract → HTN crisis
• Yeast extracts
• Aged, cured fish 
• Imported beers 
• Chianti wine
• Figs
• Bananas
• Bean curd
• Soybean paste
• Meats (sausage, liver, salami, pepperoni, bologna)
• Chocolate
• Fava beans
• Ginseng
• Caffeine

Question 10

Class: Selective serotonin reuptake inhibitors (SSRI)
Drugs:

Answer 10

• fluoxetine (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)
• fluvoxamine (Luvox)
• citalopram (Celexa)
• escitlopram (Lexapro)

Question 11

Class: Selective serotonin reuptake inhibitors (SSRI)
MOA:

Answer 11

• Selective inhibition of serotonin reuptake @ synapse → ↑Serotonin effect

Question 12

Class: Selective serotonin reuptake inhibitors (SSRI)
Indications:

Answer 12

**MOST COMMON
**1st line drug
↓SE than TCA’s

Question 13

Class: Selective serotonin reuptake inhibitors (SSRI)

Side effects:

Answer 13

• 70% sexual dysfuction
• SI
• ↑weight
• Nervousness
• Insomnia
• Anxiety
• Withdrawal syndrome

**Serotonin Syndrome → 
• ∆ mental status
• Tremor, hyperreflexia, myoclonus
• Autonomic instability 
○ Fever
○ Mydriasis 
○↓↑ BP
○ ↑HR

Question 14

Class: Serotonin-norepinephrine reuptake inhibitors
Drugs:

Answer 14

• venlafaxine (Effexor)
• desvenlafaxine (Pristiq)
• duloxetine (Cymbalta)

Question 15

Class: Serotonin-norepinephrine reuptake inhibitors
MOA:

Answer 15

• Blocks reuptake of BOTH serotonine & NE

Question 16

Class: Serotonin-norepinephrine reuptake inhibitors
Indications:

Answer 16

• good for pts with ↓ response / intolerability to SSRI’s

Question 17

Class: Serotonin-norepinephrine reuptake inhibitors

Side effects:

Answer 17

• N/V
• Dizziness
• Diaphoresis
• Similar to SSRI:
• 70% sexual dysfuction
• SI
• ↑weight
• Nervousness
• Insomnia
• Anxiety
• Withdrawal syndrome

**Serotonin Syndrome → 
• ∆ mental status
• Tremor, hyperreflexia, myoclonus
• Autonomic instability 
○ Fever
○ Mydriasis 
○↓↑ BP
○ ↑HR

Question 18

Class: Atypical antidepressants
Drug:

Answer 18

bupropion (Wellbutrin)

Question 19

Class: Atypical antidepressants
Drug: bupropion (Wellbutrin)
MOA:

Answer 19

• Similar to Ampthetamines
  • Stimulant
  • ↓ appetite

Question 20

Class: Atypical antidepressants
Drug: bupropion (Wellbutrin)
Indications:

Answer 20

**also used for smoking cessation (Zyban)

Question 21

Class: Atypical antidepressants
Drug: bupropion (Wellbutrin)
Side effects:

Answer 21

**no sexual SE
↓weight
- SEIZURES

Question 22

Class: Atypical antidepressants
Drug: bupropion (Wellbutrin)
Route/dosing:

Answer 22

**Response 1-3 wks