Pharmacology: Depression

Question 1

What type of meds are used to treat Depression?

Answer 1

Antidepressive agents ONLY (at least focused on)

Question 2

Antidepressive Agents that are METABOLIZED by p450

Answer 2

• SSRI, SNRI, and TCAs

Question 3

Antidepressive Agents that are INHIBITED by p450

Answer 3

• MAO’s, 5HT Receptor Modulator, and Atypical antidepressants

Question 4

SSRI: Drug Names + MOA

Answer 4

• Fluoxetine, Paroxetine, and Citalopram (mostly Fluoxetine)
• Selective Serotonin Reuptake Inhibitor
• Most commonly prescribed! but 4-8 weeks to take affect

Question 5

Pregnant patient comes in complaining that she took medicine for her depression while she was pregnant during her 1st trimester and immediately stopped due to physician warning. However, her child still had cardiac malformations. Which drug did she take?

Answer 5

SSRIs = Teratogen (Cardiac malformation 1st trimester exposure)

Question 6

1st line therapy for Depression:

Answer 6

SSRI and SNRIs

Question 7

SNRI: Drug Name + MOA

Answer 7

• Venlafaxine and Duloxetine
• Selective Serotonin/Norepinephrine Reuptake Inhibitor

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Question 8

What kind of drugs have reduced sexual interest/function?

Answer 8

• Almost all drugs used for depression: SSRI, SNRI, TCAs, MAOs and Vilazodone (Atypical antidepressants). Especially SSRIs.
• It is rare for 5-HT receptor Modulator (Trazodone) and not mentioned for Buproprion (Atypical antidepressant)

Question 9

When taking SSRI’s/SNRI’s, TCA’s or St. John’s Wort, _________ is contraindicated.

Answer 9

MAO’s

Question 10

MAOs = Monoamine Oxidase Inhibitor: Drug Names + MOA

Answer 10

• Phenelzine and Selegine (red)

- Inhibits breakdown of DA, NE, and 5-HT

Question 11

Difference between the two MAOs

Answer 11

Phenelzine is nonselective while Selegine is selective irreversible at low doses but not selective at high doses.

Question 12

Which drug has a major metabolite? what is the effect of the metabolite?

Answer 12

• Trazodone (5HT Receptor Modulator)

- Metabolite is a potent 5-HT2 antagonist Antidepressant Effect.

Question 13

TCAs: Drug Names + MOA

Answer 13

• Amitriptyline, Nortriptyline, and Clomipramine
• Similar to SNRI: Inhibit reuptake of NE and 5HT but has nonspecific inhibition of other receptors (lot of Adverse Effects)

Question 14

Therapeutic Indication with Major Depression: Parkinson’s Disease

Answer 14

Selegine and Phenelzine (MAOs)

Question 15

Therapeutic Indication with Major Depression: Insomnia

Answer 15

Trazodone (5-HT Receptor Modulator)

Question 16

Therapeutic Indication with Major Depression: Smoking Cessation + specifically seasonal depression

Answer 16

Bupropion (Atypical antidepressants)

Question 17

Therapeutic Indication with Major Depression: Migraine Prophylaxis, OCD, etc.

Answer 17

TCAs (seemed to emphasize Amitriptyline for Migraine Prophylaxis)

Question 18

Therapeutic Indication with Major Depression: Urinary Incontinence (esp. in Europe)

Answer 18

Venlafaxine and Duloxetine (SNRIs)

Question 19

Adverse effects that are Anticolinergic + Discontinuation syndrome (cholinergic REBOUND) due to affecting _________ receptor

Answer 19

• Amitriptyline, Nortriptyline, and Clomipramine (TCAs)

- Muscarinic receptor

Question 20

Adverse Effects: Arrhythmogentic (Convulsion, Coma, and Cardiotoxicity) + Orthostatic Hypotension.

Answer 20

• Amitriptyline, Nortriptyline, and Clomipramine (TCAs)

Question 21

Why is there a delayed therapeutic response when using SSRIs, SNRIs, and TCAs?

Answer 21

Due to presynaptic autoreceptor. Even though these drugs increase the monoamines in the synaptic cleft, the presynaptic autoreceptor also become activated and prevent synthesis/exocytosis of monamines. But after a long period of time, there is desenzation of auto-receptor.

Question 22

Trazodone MOA

Answer 22

Selective inhibitor of SERT (Serotonin Transporter) on presynaptic membrane + metabolite is an antagnoist of 5-HT2A (blocks post synaptically)

• Also most blocker of presynaptic H1 receptor (alpha-adrenergic blocker)

Question 23

Vilazodone MOA

Answer 23

SERT inhibitor