Psychopharmacologic Therapy

Question 1

What are SSRIs used to treat?

Answer 1

mild to moderate depression
Panic disorder
OCD
PTSD
Social phobia
Bipolar illness

Question 2

What SSRI’s only block serotonin reuptake?

What SSRI’s block both serotonin and NE

Answer 2

Serotonin only: Prozac, Zoloft, Paxil, Luvox, Lexapro

Serotonin and NE: Wellbutrin, Desyrel, Serzone, Effexor, Cymbalta

Question 3

Anesthetic considerations for SSRI’s?

Answer 3

Inhibits cytochrome P450 system, anti platelet activity, Serotonin syndrome-medication induced

Question 4

Mechanism of action of TCAs?

Answer 4

Blocks reuptake of serotonin or NE at presynaptic terminal

Question 5

TCA tertiary amines?

Answer 5

Inhibit serotonin and NE
Amitriptyline (Elavil)
Imipramine (Tofranil)
Clomipramine (Anafranil)

Question 6

TCA Secondary amines?

Answer 6

Inhibit NE reuptake only
Desipramine (norpramin)
Nortriptyline (pamelor)

Question 7

TCAs pharmacokinetics

Answer 7

Highly lipid soluble, highly protein bound, long E1/2T 10-80 hours, liver metabolism, active metabolites, elderly can take up to a week to rid body.

Question 8

TCAs drug interactions and anesthetic considerations

Answer 8

Sympathomimetics, inhaled anesthetics (increase MAC), decrease opioid and barbiturate dose, anticholinergics (anticholinergic toxicity), antihypertensives, use Glyco>atropine; use physostigmine for anticholinergic crisis.

Question 9

TCA side effects

Answer 9

anticholinergic, orthostatic hypotension, lower seizure threshold, MAO inhibitors can cause CNS toxicity with TCAs. cardiotoxcitity.