Pharm- Antidepressants

Question 1

name the categories of antidepressants

Answer 1

MAOIs: tranylcypromine

TCAs: imipramine, desipramine, amitriptyline, nortriptyline

SSRIs: fluoxetine, sertraline, paroxetine, venlafaxine, duloxetine

Miscellaneous antidepressants: trazodone, bupropion, mirtazapine

Bipolar: lithium, valproic acid, carbamazepine, lamotrigine

Question 2

what do unipolar and bipolar depression refer to?

Answer 2

unipolar is dysthymic/MDD

bipolar is bipolar DO

Question 3

what’s the monoamine theory?

Answer 3

that antidepressants correct deficiencies of 5HT and NE

supporting evidence is that many antidepressants alter these NT levels

contradicting evidence is that some anti-d’s don’t change these levels, and it takes 2-6 weeks for effect to kick in

Question 4

neurogenesis hypothesis?

Answer 4

depression results from impaired neurogenesis in the hippocampus, and anti-d’s fix this

supporting evidence: the time it takes for anti-d’s to take effect, cortisol is an inhibitor of hippocampal regen, radiation on hippocampus in rodents decreased effectiveness of anti-d’s

contradicting evidence: most evidence is correlative

Question 5

SSRIs

Answer 5

• • fluoxetine [Prozac®]
• • sertraline [Zoloft®]
• • paroxetine [Paxil®]

selective 5HT reuptake inhibition

used acutely for anxiety, chronically for depression

also used for panic do, anxiety do, OCD

adverse effects: headaches, sexual dysfunction, GI upset

overuse/withdrawal: high therapeutic index, but mild sympoms if abrupt withdrawal (so taper off)

interactions: they inhibit CYP450, dangerous when using with warfarin, TCAs, lithium

Question 6

SNRIs

Answer 6

serotonin/NE reuptake inhibitors

venlafaxine (effexor) and duloxetine (cymbalta)

used for stress and anxiety

similar to SSRIs

Question 7

Miscellaneous drugs

Answer 7

trazodone, bupropion, mirtazapine

bupropion is unique in NE and DA reuptake inhibition, low side effects; also used for nicotine addiction and ADHD; overdose causes seizures

mirtazapine is an alpha2 antagonist (causes increase in NE and 5HT transmission) and an antihistamine (causes strong sedation)

trazodone also causes sedation

Question 8

TCAs

Answer 8

imipramine, amitryptiline, desipramine, nortryptiline

the first 2 are tertiary amines and block both NE and 5HT reuptake, the latter 2 ar secondary amines and only block NE

also used for panic do, anxiety, OCD, ADHD

inital side effects are sedation and dysphoria, dry mouth, confusion, weight gain, leads to serious problems with patient compliance

low therapeutic index: OD causes coma, convulsions, cardiac arrythmias; highly metabolized by CYP450

Question 9

MAOIs

Answer 9

• tranylcypromine [Parnate®]
• phenelzine [Nardil®]
• selegiline

irreversibly block MAO

side effects of hypertension, agitation, euphoria, insomnia

avoid using it with sympathomimetics, wine and cheese, amphetamines, bupropion

use with SSRIs causes serotonin syndrome

Question 10

serotonin syndrome

Answer 10

from high serotonin levels

potentially fatal: tachycardia, coma, hypomania, hallucinations

from MAOIs and SSRIs, SSRIs and linezolid (an antibiotix with MAOI properties), ecstasy and MAOI

Question 11

treatment of acute manic episode

Answer 11

olanzapine

Question 12

treatment for bipolar?

Answer 12

olanzapine for mania, olanzapine and fluoxetine for hypomania (the olanzapine is to prevent rebound mania), lithium for mood stabilization

Question 13

lithium

Answer 13

very narrow therapeutic index

blood levels can increase due to decreased excretion (ACE inhibitors, thiazides, furosemide,

Question 14

antiseizure drugs

Answer 14

valproate, carbamazepine