tetracyclic/unicyclics

Question 1

MOA: parent and metabolite are moderate inhibitors of NE and DA reuptake; resembles amphetamine in chemical structure and has CNS activating properties. Main effect is presynaptic release of catecholamines
Use: antidepressant, smoking cessation
Metab: CYP2B6
Adverse: agitation, insomnia, anorexia
Interactions: cyclophosphamide, desipramine ( this drug inhibits CYP2D6, raising levels), MAOIs

Answer 1

buproprion

Wellbutrin

Question 2

MOA: antagonist of presynaptic alpha2 autoreceptor, enhances release of NE & 5-HT; antagonist of H1 (sedative effect), 5-HT2 and 5-HT3 receptors
use: antidepressant
Adverse; significant sedative effect
Interactions: CNS depressants (alcohol, benzodiazepines); CYP450 metab drugs

Answer 2

mirtazapine

Remeron

Question 3

MOA: Potent NET inhibitor and less potent SERT inhibitor; anticholinergic property; moderate inhibitor of postsynaptic D2 receptor -> antipsychotic property
Use: antidepressant
Adverse: Parkinsonian syndrome from D2 inhibition
Interactions: fluoxetine; anticholinergics and antihistamines are additive

Answer 3

amoxapine

Question 4

MOA: potent NET inhibitor and less potent SERT inhibitor; anticholinergic property
Use: antidepressant
Adverse: TCA-like adverse effects from moderately high affinity for NET
Interactions: fluoxetine; anticholinergics and antihistamines are additive

Answer 4

maprotiline