Lecture 17

Question 1

1. Which of the following antidepressants is classified as a Norepinephrine/Dopamine Reuptake Inhibitor (NDRI)?

Answer 1

1. Which of the following antidepressants is classified as a Norepinephrine/Dopamine Reuptake Inhibitor (NDRI)?

Question 2

Which antidepressant is most likely to cause significant weight gain?

Answer 2

Mirtazapine

Question 3

Which is a common adverse effect associated with SSRIs like Paroxetine?

Answer 3

Constipation
CNS at low dose
Anticholinergics effects

Question 4

What is a major risk when MAOIs are combined with tyramine-rich foods?

Answer 4

Hypertensive crisis

Question 5

Which of the following drugs has a high risk of causing sexual dysfunction, including decreased libido and anorgasmia?

Answer 5

Paroxetine ( SSRI)

Question 6

Which antidepressant is associated with the risk of Torsades de Pointes (TdP) due to QTc prolongation?

Answer 6

Citalopram, escitalopram , and TCA

Question 7

When switching from an SSRI to an MAOI, what is the recommended washout period for Fluoxetine due to its long half-life?

Answer 7

5 weeks

Question 8

Which of the following combinations is most likely to result in serotonin syndrome?
A. SSRI + SNRI
B. MAOI + Tricyclic Antidepressant (TCA)
C. NDRI + TCA
D. NaSSA + SSRI

Answer 8

B. MAOI + Tricyclic Antidepressant (TCA)

Question 8

What are mild symptoms of Serotonin syndrome ?

Answer 8

HTN/tachycardia, dilated pupils, sweating/shivering, tremor/myoclonus/hyperreflexia, usually afebrile

Question 9

What are the evidence behind suicide and AD ?

Answer 9

reduced suicidal ideas risks in 25-64, actions in >65 yo

2x risk of suicidal attempts in adolescents
But maybe because AD is only used in adolescents as the last line Tx

Pts with moderate to severe depression on SSRI → reduction of risk of suicide

Question 10

Which AD has more risk of BIT bleeding and why ?

Answer 10

SSRIs decrease 5-HT uptake by platelets, which reduces clotting and can
also increase GI acid production
* Increased risk with concomitant NSAIDs, anticoagulants/antiplatelets

Question 11

Which of AD has the most risk of priapism ?

Answer 11

Trazodone

Question 12

rank the AD with most to least weigh gain SE and the effect ?

Answer 12

TCAs > SSRI (esp. paroxetine) > SNRI,
H1 blockade

Question 13

What the potent inhibitor of CYP in AD ?

Answer 13

Paroxetine, Fluoxetine, Bupropion

• Fluvoxamine

Question 14

What is an potent inducer of CYP and PgP if a pt is taking AD medications ?

Answer 14

St. John’s Wort

Question 15

What are the effects of Pgp inducers vs inhibitors ?

Answer 15

Inhibitors of P-gp may increase brain concentrations of drugs that are
substrates of P-gp (decr drug out of brain, across BBB)

• Inducers of P-gp may decrease brain concentrations of drugs that are
  substrates of P-gp (incr drug out of brain, across BBB)

Question 16

What are the lab monitoring to consider with pt on AD ?

Answer 16

Metabolic profile
* Hepatic (ex: LFTs)
* Renal (ex: SCr)

• Therapy specific SEs
• CBC (ex: bleeding risk)
• Electrolytes (ex: Na+ imbalance)

Question 17

Trazodone is a ______ ?

Answer 17

Serotonin Antagonists/Reuptake Inhibitors (SARIs)

Question 18

Name MAOIs ?

Answer 18

phenelzine, tranylcypromine)

Question 19

Amitriptyline is a _____ ?

Answer 19

TCA

Question 20

Name a Noradrenergic/Specific Serotonergic Agents ?

Answer 20

Mirtazipine

Question 21

name SSRI ?

Answer 21

e.g., Escitalopram (Lexapro). Fluoxetine (Prozac). Paroxetine (Paxil). Sertraline (Zoloft

Question 22

What are Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) ?

Answer 22

e.g., Venlafaxine, Desvenlafaxine, Duloxetine