psychopharm4

Question 1

fluoxetine

Answer 1

prozac; longest half life, so no need to taper; safe in pregnancy and children; more common sleep changes and anxiety; can elevate levels of neuroleptics leading to incr side effects

Question 2

sertraline

Answer 2

zoloft; highest risk for GI disturbances; very few drug interactions; more common sleep changes

Question 3

paroxetine

Answer 3

paxil; several drug interactions because it is higly protein bound; more anticholinergic effects; short half life leading to withdrawal phenomenon if not taken consistently

Question 4

fluvoxamine

Answer 4

Luvox; currently approved only for OCD; n/v more common; lots of drug interactions

Question 5

citalopram

Answer 5

celexa; fewest drug-drug interactions; possibly fewer sexual side effects

Question 6

escitolopram

Answer 6

lexapro; levo-enantiomer of citalopram; similar efficacy; more expensive than citalopram

Question 7

side effects of SSRIs

Answer 7

sexual dysfunction; GI disturbance (nausea and diarrhea); insomnia (also vivid dreams); headache; anorexia, weightloss; restlessness (on initiation and termination); seizures

Question 8

examples of SNRIs

Answer 8

velafaxine and duloxetine; side effects similar to SSRIs

Question 9

venlafaxine

Answer 9

effexor; used for depression, anxiety disorders, and may have some use in ADHD

Question 10

venlafaxine (effexor) should not be used in what patients

Answer 10

those with untreated or labile BP because it can increase BP

Question 11

what is desvenlafaxine

Answer 11

Pristiq; it is the active metabolite of venlafaxine and it is expensive

Question 12

duloxetine

Answer 12

Cymbalta; often used for people with depression and neuropathic pain or in fibromyalgia; more dry mouth and constipation related to norepi effects; more liver side effects

Question 13

how does bupoprion work?

Answer 13

wellbutrin; norepi-dopamine reuptake inhib

Question 14

benefits of buproprion

Answer 14

lack of sexual side effects; some efficacy in treatment of adult ADHD; side effects include incr risk of seizures and psychotsis at high doses and incr anxiety in some

Question 15

buproprion is contraindic in which patients

Answer 15

patients with seizures or active eating disorder and in those currently on MAOI

Question 16

trazadone

Answer 16

seratonin antag and reuptake inhib; useful in refractory major depression, major depression with anxiety, and insomnia; no sexual side effects, no effect on REM sleep

Question 17

side effects of trazadone

Answer 17

nausea, dizziness, orthostatic hypotension, cardiac arrythmias, sedation, and priapism

Question 18

nefazodone

Answer 18

similar to trazadone; seratonin-norepi-dopamine reuptake inhib; black box warning for rare but serious liver failure

Question 19

mirtazapine

Answer 19

remeron; alpha 2 adrenergic receptor antag; treatment for refractory major depression, esp in patients who need to gain weight

Question 20

side effects of mirtazapine (remeron)

Answer 20

sedation, weight gain, dizziness, somnolence, tremor, dry mouth, constip and rare agranulocytosis; no sex side effects and few drug interactions

Question 21

how do TCAs work

Answer 21

inhibit reuptake of norepi and seratonin; incr availability of monoamines in the synapse

Question 22

TCA side effects

Answer 22

greater than SSRIs and lethal in overdose

Question 23

two types of TCAs

Answer 23

tertiary amines and secondary amines

Question 24

tertiary amines

Answer 24

type of TCA; highly anticholinergic, more sedating, greater lethality in overdose

Question 25

example of tertiary amine

Answer 25

amitryptline, imipramine, clomipramine, doxepin