Pharmacology of Mood Disorders-French

Question 1

Amitriptyline SE

Answer 1

Tricyclic antidepressants - 2nd line due to SE

Sedation

Antimuscarinic : blurred vision, constipation, dry mouth, urinary hesitancy, fuzy thinking, aggravation of glaucoma, paralytic ileum, urinary retention, delirium

Cardiovascular: sudden death, orthostatic hypotension (alpha 1 blocade), EKG abnormalities

Neurologic: seizures with overdose, tremor, paresthesias

Question 2

Fluoxetine, Paroxetine, escitalopram SE

Answer 2

SSRI

Acute: nausea- diarrhea, activation insomnia, restlessness, dry mouth

Delayed onset: weight gain, sexual dysfunction, cognitive blunting

low likelihood of fatalities in overdose

Question 3

withdrawal ssri

Answer 3

flu like symptoms worse with shorter half life

paroxetine> fluoxetine

Question 4

Venalfaxine SE

Answer 4

SNRI

hypertension, Anxiety

nausea, somnolence, sweating, dizziness, sexual

more rapid appearance of withdrawal symptoms than SSRI

Question 5

Buproprion SE

Answer 5

NDRI

Anxiety, potential for seizures at high dose

dizziness, dry moth, tremor, insomnia, aggravation of psychosis

Question 6

Trazodone SE

Answer 6

drowsiness
overdose= minor problems

black box warning: liver failure with nefazodone

dizziness, nausea, agitation

Question 7

Phenelzine SE

Answer 7

MAOI

postural hypotension from chronic increase in false transmitter octopamine

Overdose: Seizures, shock, hyperthermia

milder anticholinergic, sedation, CNS stimulation, liver damage

Question 8

MAOI Drug Interactions

Answer 8

Hypertensive Crisis with acute increase in NE displacement

meperidine, decongestants
foods high in tyramine (beer, wine, cheese)

Question 9

SSRI + MAOI Drug Interaction

Answer 9

serotonin syndrome: hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status and vital signs

can also occur with meperidine (opiate analgesic) and dextromethorphan (cough suppressant)

Question 10

Saint John’s Wort Drug Interactions

Answer 10

induce p450 drug metabolizing enzymes: 1A2, 2C9, 3A4

reduced levels of warfarin, cyclosporine, digoxin, and theophylline

Question 11

serotonin syndrome in elderly taking what medications?

Answer 11

SSRIs and St. John’s Wort

Question 12

SSRI Drug Interactions

Answer 12

inhibit P450 drug metabolizing enzymes: fluoxetine, paroxetine: CYP2D6

less with sertraline and citalopram

Question 13

Summary Amitriptyline

Answer 13

TCAD

Sedative Action +++
Antimuscarinic Action +++

SERT Block +++
NE block++

Question 14

Summary Escitalopram, fluoxetine, paroxetine

Answer 14

SSRI

SERT Block: +++

Question 15

Summary Venalfaxine

Answer 15

SNRI

SERT Block +++
NET Block ++

Question 16

Summary buproprion

Answer 16

NDRI

NET Block ++
DAT Block ++

Question 17

Summary Trazodone

Answer 17

NDRI

Sedative Action +++
SERT block +

Question 18

Lithium Drug Interaction

Answer 18

diuretics decrease renal clearance up to 25% leading to increased lithium plasma levels

NSAID analgesic agents- also increased lithium plasma levels

Question 19

Lithium Toxicity

Answer 19

narrow therapeutic index

moderate toxicity: confusion, sedation, lethargy, twitching

Severe toxicity: seizures, stupor, coma

Question 20

Lithium SE

Answer 20

Fine tremor, GI upset, muscle weakness

Decrease thyroid function (3-30%), possibly weight gain

Polyuria, polydipsia (anti ADH)

Question 21

Lithium and second messenger systems

Answer 21

interfere with recycling of membrane phosphoinosites in phosphatidylinositol 2nd messenger system

Gq protein, IP3, DAG

Question 22

Lithium and gene regulation

Answer 22

growth factors and neuronal plasticity by interaction with downstream signaling cascades

inhibit glycogen synthase kinase and protein kinase C