Exam 2: Antidepressants & Anxiolytics

Question 1

SSRIs: indications

Answer 1

MDD
GAD
panic disorder
OCD
PMDD

Question 2

SSRIs: adverse effects

Answer 2

• sexual dysfunction
• N/V/D/constipation
• anxiety/jitteriness
• sedation/drowsiness
• switch to mania

Question 3

Fluoxetine: drug interaction

Answer 3

CYP2C19 inhibitor

Question 4

Paroxetine: drug interaction

Answer 4

CYP2D6 inhibitor

Question 5

Fluoxetine: special considerations

Answer 5

• most associated w/ jitteriness
• give in AM
• long T 1/2

Question 6

Paroxetine: special considerations

Answer 6

• most associated w/ constipation and sedation

- shortest T 1/2 (^ withdrawal)

Question 7

Citalopram: special considerations

Answer 7

• QTc prolongation

- dosage limits w/ CYP2C19 inhibitors

Question 8

Escitalopram: special considerations

Answer 8

-QTc prolongation

Question 9

Fluvoxamine: special considerations

Answer 9

best SSRI for OCD

Question 10

Sertraline: special considerations

Answer 10

bad nausea and diarrhea

Question 11

Vortioxetine: special considerations

Answer 11

bad nausea and diarrhea

Question 12

SSRIs

Answer 12

Fluoxetine
Paroxetine
Citalopram
Escitalopram
Fluvoxamine
Sertraline
Vortioxetine

Question 13

SNRIs: describe how MOA varies based on dosing

Answer 13

low doses: bind to 5HT transporters

high doses: bind to NE transporters

Question 14

SNRIs: indications

Answer 14

GAD
MDD
neuropathic pain

Question 15

SNRIs: adverse effects

Answer 15

• dizziness
• insomnia
• N/V/D/constipation
• Xerostomia
• Diaphoresis
• HTN
• Somnolence/fatigue
• Sexual dysfunction

Question 16

SNRIs: drug interactions

Answer 16

avoid use with:

-Sibutramine (5HT syndrome)

Question 17

Duloxetine: drug interactions

Answer 17

CYP2D6 inhibitor

Question 18

Velnafaxine: an SNRI w/ extra indications…

Answer 18

panic disorder

social anxiety disorder

Question 19

Duloxetine: an SNRI w/ extra indications…

Answer 19

neuropathic pain (first line)
diabetic neuropathy
fibromyalgia

Question 20

Milnacipran: an SNRI w/ an extra indication…

Answer 20

fibromyalgia

Question 21

SNRIs

Answer 21

Venlafaxine
Desvenlafaxine
Duloxetine
Milnacipran
Levomilnacipran

Question 22

TCAs: secondary amines

Answer 22

desipramine*
nortriptyline*
protriptyline
amoxipine

Question 23

TCAs: tertiary amines

Answer 23

amitriptyline*
clomipramine*
doxepin*
imipramine*
trimipramine

Question 24

TCAs: contraindications

Answer 24

elderly

suicidal pts

Question 25

TCAs: indications

Answer 25

- insomnia, neuropathy | - (low doses, still may be hard to tolerate b/c of adverse effects)

Question 26

TCAs: adverse effects

Answer 26

- switch to mania - CV* - anticholinergic* - antihistaminergic* (sedation, weight gain, confusion) - antiadrenergic (orthostasis, drowsiness dizziness)

Question 27

TCAs: drug interactions

Answer 27

avoid use with: - Antiarrythmics - Quinine - Ziprasidone - Metaclopramide

Question 28

TCAs: agents w/ less side effects

Answer 28

Desipramine | Nortriptyline

Question 29

Clomipramine: special consideration

Answer 29

best TCA for OCD

Question 30

Atypical antidepressants

Answer 30

buproprion mirtazapine trazodone

Question 31

Buproprion: MOA

Answer 31

associated w/ DA and NE

Question 32

Buproprion: indications

Answer 32

depression | smoking cessation

Question 33

Buproprion: special considerations

Answer 33

- least amount of sexual dysfunction SE - very stimulating (good if pt needs energy) - good for obese pts (weight loss)

Question 34

Buproprion: contraindications

Answer 34

seizure disorders

Question 35

Buproprion: drug interactions

Answer 35

``` avoid use with: -MAOIs -Tamoxifen increased effects if combined w/ EtOH strong CYP2D6 inhibitor ```

Question 36

Mirtazapine: MOA

Answer 36

central presynaptic a2-adrenergic antagonist: increased release of NE and 5HT

Question 37

Mirtazapine: indications

Answer 37

- depression | - off label: appetite stimulant, sleep aid

Question 38

Mirtazapine: drug interactions

Answer 38

avoid use with: - MAOIs - Sibutramine (5HT syndrome)

Question 39

Trazodone: MOA

Answer 39

inhibits reuptake of 5HT and alters presynaptic 5HT receptors

Question 40

Trazodone: indications

Answer 40

MDD, but mostly used as hypnotic agent

Question 41

Trazodone: drug interactions

Answer 41

- avoid use with sibutramine | - increased levels if combined w/ 3A4 inhibitors, alcohol, CNS depressants

Question 42

MAOIs

Answer 42

phenelzine tranylcypromine selegiline isocarboxazid

Question 43

MAOIs

Answer 43

isocarboxazid phenelzine selegiline tranylcypromine

Question 44

MAOIs: MOA

Answer 44

inhibit the degradation of 5HT by inhibiting deamination of monoamines>>> increased 5HT and NE in cytoplasm of presynaptic neurons

Question 45

MAOIs: adverse effects

Answer 45

-tyramine toxicity (b/c MAO metabolize tyramine)>>> hypertensive crisis

Question 46

Tyramine food sources

Answer 46

aged cheeses processed meats red wine (soy products, caffeine, chocolate)

Question 47

MAOIs: indications

Answer 47

not 1st line therapy, used in refractory depression

Question 48

MAOIs: drug interactions

Answer 48

A LOT (these combined w/ adverse effects, dietary restrictions make MAOIs last line)

Question 49

Anxiolytics

Answer 49

antidepressants benzos buspirone

Question 50

Benzos: MOA

Answer 50

- binds to GABA a receptors>>> activates Cl- ion channels | - potentiates GABA (inhibitory)

Question 51

Benzos: indications

Answer 51

acute anxiety acute alcohol withdrawal insomnia seizure disorders (used during seizure)

Question 52

Benzos: caution use in what pts?

Answer 52

elderly substance abuse disorder pregnancy

Question 53

Buspirone: MOA

Answer 53

partial agonist of 5-HT 1a

Question 54

Buspirone: indications

Answer 54

chronic anxiety (effect takes 2-6 weeks)