OnlineMedEd: Psychiatry - Psych Pharm I

Question 1

The first antidepressants were aimed at increasing ____________. Later, drugs were developed that increased levels of ____________.

Answer 1

norepinephrine; serotonin

Historically, antidepressants went from MAOIs and TCAs to SSRIs.

Question 2

The increased levels of certain neurotransmitters can increase ______________.

Answer 2

plasticity

Question 3

What is the “rule of 6s” regarding antidepressants?

Answer 3

• Treat for at least six weeks to achieve maximum therapeutic effect.
• Treat for at least six months of response before considering discontinuing.
• Wait 6 weeks to wash out drug before starting another drug that interacts with serotonin.

Question 4

List the SSRIs.

Answer 4

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Citalopram (Celexa)
• Escitalopram (Lexepro)
• Paroxetine (Paxil)

All can cause decreased libido or delayed ejaculation.

Question 5

List the SNRIs.

Answer 5

• Venlafaxine (Effexor)
• Desvenlafaxine (Pristiq)
• Duloxetine (Cymbalta)

Question 6

The serotonin modulators –mirtazapine and trazodone –are poor antidepressants. In fact, trazodone is almost exclusively used for _____________.

Answer 6

insomnia

Question 7

These drugs are all tricyclic antidepressants: 
•Nortriptyline
•Amitriptyline 
•Desipramine
•Imipramine
• \_\_\_\_\_\_\_\_\_.

Answer 7

Doxepin

Question 8

TCAs are primarily used for ______________.

Answer 8

neuropathic pain and enuresis (because of the anticholinergic effects)

Question 9

In general, if a patient presents with acute mania, then you should __________________.

Answer 9

treat them with a mood stabilizer and an antipsychotic and maintain that as their chronic therapy

For instance, give them one of these combos:

• Lithium and quetiapine
• Valproic acid and quetiapine

Question 10

Which side effect of valproate did Sketchy leave out?

Answer 10

Agranulocytosis

Question 11

Choice of mood stabilizers used to be as follows:

1) . Lithium
2) . Valproate
3) . Carbamazepine or lamotrigine

What changed recently?

Answer 11

Now consider quetiapine as an adjunct to lithium or valproate or as a substitute if those agents can’t be used. Second, lamotrigine has been shown to be as effective as carbamazepine but since it has fewer side effects it should be used over carbamazepine.