Pharmacology - Antidepressants - Oliver Brown

Question 1

T/F: Most antidepressant drugs block the reuptake of both NE and 5HT to varying degrees.

Answer 1

True

Question 2

Give the class: Tranylcypromine

Answer 2

MAOI

Question 3

Give the class: Fluoxetine

Answer 3

SSRI

Question 4

Give the class: Citalopram

Answer 4

SSRI

Question 5

Give the class: Duloxetine

Answer 5

SNRI

serotonin-norepi reuptake inhibitor

Question 6

Give the class: Venlafaxine

Answer 6

SNRI

Question 7

Give the mechanism:
Tranylcypromine
Phenelzine

Answer 7

Irreversibly inhibit both MAO-A and MAO-B

MAOI

Question 8

Give the side effects: Tranylcypromine

Answer 8

Hypertensive crisis (with tyramine-rich foods); serotonin syndrome (MAOI + SSRI)

Anticholinergic, orthostatic hypotension, sexual dysfunction, weight gain, sedation, insomnia, dizziness

Question 9

What is Tranylcypromine used for:

Answer 9

Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism

Question 10

Give the mechanism: 
Fluoxetine
Sertraline
Citalopram
Escitalopram
Paroxetine

Answer 10

Inhibit reuptake of 5-HT (and NE to lesser extent)

SSRI

Question 11

Give the indication: 
Fluoxetine
Sertraline
Citalopram
Escitalopram
Paroxetine

Answer 11

Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism; pre-menstrual dystrophic disorder

Question 12

Give the side effects: 
Fluoxetine
Sertraline
Citalopram
Escitalopram
Paroxetine

Answer 12

Serotonin syndrom (with MAOIs)

Fewer than tricyclics; mostly nausea, decreased sexual function

Question 13

What is unique about Fluoxetine and Paroxetine as SSRIs?

Answer 13

They are Potent P450 inhibitors; form active metabolite (norfluoxetine)
Specifically CYP2D, CYP2C, CYP2A

Question 14

Give the class: Venlafaxine (Effexor)

Answer 14

SNRI

Question 15

Give the mechanism:
Duloxetine (Cymbalta)
Venlafaxine (Effexor)

Answer 15

Inhibits reuptake of 5-HT and NE

Question 16

Give the indication:
Duloxetine (Cymbalta)
Venlafaxine (Effexor)

Answer 16

Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism

Question 17

Give the class: Buproprion

Answer 17

Atypical antidepressant

Question 18

Give the class: Mirtazapine

Answer 18

Atypical antidepressant

Question 19

Give the mechanism: Mirtazapine

Answer 19

5HT2a antagonist; also inhibits 5HT reuptake

Question 20

Give the indication: Buprioprion

Answer 20

Depression, weight loss, smoking cessation (my answer)

Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism; maintain nicotine abstinence in quitting smokers (their answer)

Question 21

Give the indication: Mirtazapine

Answer 21

Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism

Question 22

Give the important side effect of Buproprion

Answer 22

It lowers the seizure threshold

Question 23

Give the class:
Trazodone
Nefazodone

Answer 23

5HT2A antagonist
also inhibits serotonin reuptake
use for depression esp when coupled with insomnia
Side effects include drowsiness (major)

Question 24

What are some miscellaneous antidepressant treatments?

Answer 24

Lithium salts
St. John's Wort
ECT
TMS (transcranial magnetic stimulation) - like ECT but w/o the siezure
NRIs
Ketamine

Question 25

Give the class: Phenelzine

Answer 25

MAOI

Question 26

MAO-A oxidizes mainly:

Answer 26

NE, 5HT, tyramine

Question 27

MAO-B oxidizes mainly:

Answer 27

DA, phenylethylamine

Question 28

What is serotonin syndrome?

Answer 28

When a pt is on MAOI and SSRI (or other drugs) potentially lethal Hyperthermia, Muscle rigidity, Myoclonus, Rapid changes in mental status and vital signs

Question 29

``` Give the class: Desipramine Imipramine Amitriptyline Nortriptyline ```

Answer 29

Tricyclics

Question 30

``` Give the mechanism: Desipramine Imipramine Amitriptyline Nortriptyline ```

Answer 30

Block reuptake of NE or 5-HT at varying potencies and selectivity; also variably block muscarinic, a-adrenergic, dopamine, and histamine receptors

Question 31

``` Give the indication: Desipramine Imipramine Amitriptyline Nortriptyline ```

Answer 31

Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism

Question 32

What is the added unique indication of Amitriptyline?

Answer 32

prevention of tension headaches, migraines Depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism;

Question 33

``` Give the side effects: Desipramine Imipramine Amitriptyline Nortriptyline ```

Answer 33

Sympathomimetic (cardiac arrhythmias and conduction defects, especially at OD) Antimuscarinic, orthostatic hypotension, sedation (additive with alcohol), seizures

Question 34

Are the tricyclics used often to treat depression?

Answer 34

No | Not very safe; rarely used anymore

Question 35

Overdose of tricylcics may cause what serious adverse effect?

Answer 35

cardiac arrhythmias | conduction defects

Question 36

Main complaints patients give when taking SSRIs are:

Answer 36

Nausea | Sexual dysfunction

Question 37

What is the only atypical antidepressant that is selective for dopamine uptake transporter?

Answer 37

Buproprion

Question 38

Give the mechanism: Ketamine

Answer 38

NMDA receptor antagonist | produces rapid antidepressant response - rapidly increases synaptogenesis in mice

Question 39

What is enuresis?

Answer 39

Institutionalized elderly patients who have incontinence | An indication for antidepressant use

Question 40

T/F: SSRIs are more effective antidepressants than tricyclics.

Answer 40

False | They have the same efficacy but are better tolerated.

Question 41

What anticonvulsants are used to treat bipolar depression?

Answer 41

Carbamazepine | Valproate

Question 42

What class of drugs are indicated for severe bipolar disorder?

Answer 42

The antipsychotics: Olanzapine (Zyprexa) Risperidone (Risperdal) Aripiprazole (Abilify)

Question 43

Give the side effects: Lithium

Answer 43

Drowsiness, weight gain, tremor, polydipsia, polyuria Neurotoxicity, Cardiac toxicity, renal dysfunction with elevated levels

Question 44

Give the mechanism: Lithium

Answer 44

Lithium causes depletion of inositol phosphate second messengers (IP3 and DAG depleted)

Question 45

What is the bioamine hypothesis of depression?

Answer 45

Too little CNS NE and or 5HT (amount or activity)