Pharmacotherapy of depression and bipolar disorder

Question 1

Drug interactions with antidepressants

Answer 1

MAO-Is, serotonin syndrome may result

Question 2

Prototype SSRIs

Answer 2

Fluoxetine (Prozac), Sertaline (Zoloft)

Question 3

MOA of SSRIs

Answer 3

blocks 5-HT reuptake, increased neurotransmitter in cleft

Question 4

Therapeutic use of SSRIs

Answer 4

MDD, anxiety

Question 5

Pharmacokinetics of SSRIs

Answer 5

First pass metabolism, active metabolites
well absorbed
requires 5-6 weeks to reach steady state
complete wash out in 5-6 weeks

Question 6

Side effects of SSRIs

Answer 6

initial anxiety
agitation
sexual dysfunction

Question 7

Toxicity of SSRIs

Answer 7

agitation, vomiting, seizure

pregnancy C-persistant pulmonary hypertension in newborns

Question 8

Drug interactions with SSRIs

Answer 8

Inhibits CYP 2D6- Tomoxifen for breast cancer

Drugs that prolong QT interval

Question 9

Advantages of sertraline

Answer 9

better tolerated, widely prescribed

Question 10

Prototyped SNRI

Answer 10

Duloxetine (cymbalta)

Question 11

MOA of SNRI

Answer 11

both seratonin and norepinephrine reuptake inhibited

Question 12

Therapeutic use of SNRI

Answer 12

MDD
anxiety
some types of chronic pain

Question 13

Pharmacokinetics of duloxetine

Answer 13

Well absorbed-food slows absorption
metabolixed by 2D6
half life 11-12 hrs

Question 14

Side effects of duloxetine

Answer 14

headache, somnolence, fatigue, insomnia
nausea, dry mouth, constipation, diarrhea
some chance of liver damage

Question 15

Drug interactions of duloxetine

Answer 15

Drugs using NET for their action- methyldopa, monoxidil
CYP 1A2 and 2D6 inhibitors
MAO inhibitors- seretonin syndrome

Question 16

Contraindications of duloxetine

Answer 16

MAO inhibitors

Narrow angle glaucoma

Question 17

Prototype TCA

Answer 17

Amitriptyline

Question 18

MOA of TCA

Answer 18

block 5HT and NE, many non-specific actions.

Question 19

Pharmacokinetics of amitriptyline

Answer 19

well absorbed, oral admin
metabolized by CYP 2D6
metabolized to active metabolites
half life 30 hrs

Question 20

Therapeutic use of amitriptyline

Answer 20

MDD

off label pain

Question 21

Muscarinic side effects of amitriptyline

Answer 21

tachycardia

Question 22

Alpha-1 adrenergic inhibition side effects of amitriptyline

Answer 22

orthostatic hypotension

Question 23

Antihistamine H1 antagonism side effects of amitriptyline

Answer 23

sedation, weight gain

Question 24

5HT2 side effects of amitriptyline

Answer 24

sexual dysfunction

Question 25

Toxicity of TCAs

Answer 25

acute poisoning life threatening,

seizures, severe cardiac toxicity

Question 26

Drug interactions with amitriptyline

Answer 26

serotonin syndrome
drugs that prolong Q-T interval
Can reverse antihypertensive effects

Question 27

MAOI prototype

Answer 27

phenelzine

Question 28

MOA of phenelzine

Answer 28

irreverrsible inhibiton of monamine oxidase MAO A and B, A is responsible for therapeutic effect

Question 29

Therapeutic use of MAOIs

Answer 29

Major depressive disorder, when others have failed

Question 30

Contraindications with TCAs

Answer 30

pre-exisiting cardiovascular effects

Question 31

Therapeutic use of lithium

Answer 31

bipolar disorder

Question 32

Pharmacokinetics of lithium

Answer 32

excretion is reduced when sodium is low

low therapeutic index

Question 33

Adverse effects of lithium

Answer 33

hand tremors, ataxia, seizures, arrhythmias, coma

Question 34

Adverse effects of MAOIs

Answer 34

orthostatic hypotension

sedation

Question 35

Food and drug interactions with MAOIs

Answer 35

tyramine
sympathomimetic amines
antidepressents
CNS depressants

Question 36

Toxicity of MAOIs

Answer 36

CNS stimulation, not lethal