SSRIs

Question 1

SSRIs MOA

Answer 1

inhibits re-uptake 5HTs

5HT1-depression, 5HT2-sexual dysf, 5HT3-GI effect

Question 2

SSRIs Side Effects

Answer 2

Anticholinergic (Paxil, preg. D)
Hyponatremia
Headache, Sedating (Luvox), Activating (Prozac)
GI effect (N/V)

Question 3

Celexa

Answer 3

Citalopram: MDD
Max: 40mg/d or 20mg/d for pt > 60 yrs (risk of QT prolong)
Avoid > 20mg/d w/ 2C19 inhibitor (omeprazole, cimetidine, OC)

Question 4

Lexapro

Answer 4

Escitolapram: MDD, GA
Dose: 10mg/d up to 20 mg/d

Question 5

Prozac, Sarafem

Answer 5

Fluoxetine: MDD, OCD, Bulimia nervosa (Sarafem) PDD
Dose: 10 mg/d, max: 80 mg/d
Prozac 90 mg ER wkly
DDI: d/c MAOIs 14 d prior starting prozac or washout 5 wks on prozac before MAOIs

Question 6

Sarafem

Answer 6

Fluoxetine: premenstrual dysphoric disorder
Dose: 20mg/d can be BID, max: 80mg/d

Question 7

Luvox

Answer 7

Fluvoxamine: OCD
Dose: 50 mg, max: 300mg/d QHS
DDI: CYP1A2 (cimetidine), 2D6 inhibitor (strong)

Question 8

Paxil

Answer 8

Paroxetine: MDD, OCD, Panic Disorder, SAD, PTSD
Dose: 10-60mg/d qAM
Preg: D (cardiac defect)

Question 9

Zolof

Answer 9

Sertraline: MDD, OCD, PTSD, Panic Disorder (PD)
Dose: 25mg/d, MAX: 200 mg/d (important)

Question 10

Viibryd

Answer 10

Vilazodone: MDD (adult only)
Dose: start kit, 10mg/d x7, then 20mg/d x7, maintenance: 40mg/d w/ FOOD
ADR: diarrhea n/v (common)
DDI: 3A4 substrate

Question 11

Effexor

Answer 11

Venlafaxine: MDD, GAD (XR only) 
Effexor ER (daily "ghost tablet" in stool 
ADR: HTN (higher dose), HA, sexual dysf

Question 12

Pristiq

Answer 12

Desvenlafaxine: like Effexor XR
Dose: 50mg/d, Max: 400m/d, CrCl <30: 50mg QOD

Question 13

Cymbalta

Answer 13

Duloxetine: MDD, GAD, DPN, fibromyalgia, chronic musc., osteoarthritis pain
Dose: 30mg, usual: 60 mg (QD/BID), max: 120mg/d
DDI: CYP1A2, 2D6 inhibitors
Avoid CrCl <30, Monitor: BP

Question 14

Savella

Answer 14

Milnacipran (SNRI): fibromyalgia (only, like Lyrica, Cymbalta)
Dose: 12.5-50mg BID
ADR: increase BP & pulse, seizure

Question 15

Zyban, Wellbutrin

Answer 15

Bupropion: NE & Dopamine agonist for MDD
Nictonie withdrawal (Zyban-150 mg SR) 
Wellbutrin XL-prevent depression in SAD 
Max: 300 mg/d (seizure risk, important) 
Cautions: bulimia (electrolytes imbalance), alcoholics, seizures

Question 16

Oleptro, Desyrel

Answer 16

Trazodone: serotonin & alpha-adrenergic blocker
MDD (oleptro ER), sleep disorder (IR)
ADR: priapism, GI effects, antichol..effect

Question 17

Serzone

Answer 17

Nefazodone: serotonin, alpha-adrenergic blocker: MDD
Dose: 100-600mg/d
ADR: sedation, GI effects

Question 18

Remeron

Answer 18

Mirtazapine: increase NE & 5HT3
MDD, increase appetite good for frail elderly w/ depression
Dose: 15mg, Max: 45mg/d, & ODT
ADR: somnolence, appetite increase, wt gain, cholesterol & TG increase

Question 19

Anafranil

Answer 19

Clomipramine: (blocks NE & 5HT) OCD (only)

Question 20

Sinequan

Answer 20

Doxepin: MDD & anxiety

Question 21

Tofranil

Answer 21

Imipramine: MDD & bed wetting (DDAVP)

Question 22

Norpramine

Answer 22

Desipramine: MDD & ADHD

Question 23

Pamelor, Aventyl

Answer 23

Nortriptyline: MDD

Question 24

TCA side effects

Answer 24

Anticholinergic, orthostatic hypotension, arrthymia & tachy

Question 25

MAOIs: MAO, SE, DDI

Answer 25

Txt: MDD, SE: insomnia, orthostatic hypotention, wt gain, sexual dysf.
DDI: dextromethorphan, meperidine, TCA’s, SSRI, sympathomimetic, tyramine containing food (hypertensive crisis

Question 26

Emsam

Answer 26

Selegiline: MAOI: MDD
Patches 6,9,12 mg q24hr (higher than PK, 5mg qd)
Avoid tyramine-containing food

Question 27

Abilify

Answer 27

Aripriprazole: SGA, add on for MDD

2-15mg/d

Question 28

Symbyax

Answer 28

Olanzapine/fluoxetine: treatment-resistant depression (TRD)
Dose: qhs
Useful for bipolar, schizo w/ depression