032315 antidepressants

Question 1

monoamine theory of depression

Answer 1

depression results from deficient monoamine (NE and/or 5HT) transmission in the CNS

the delay in onset of effects fails to support the traditional monoamine hypothesis

restated (new) monoamine hypothesis is that depression is due to bioegnic amine receptor or transmission imbalance

Question 2

neurons containing NE are located where

Answer 2

locus coeruleus

Question 3

neurons containing serotonin are located where

Answer 3

raphe nucleus

Question 4

TCAs MOA

Answer 4

block reuptake of NE and 5HT

Question 5

SSRI MOA

Answer 5

block reuptake of 5HT

Question 6

mirtazapine MOA

Answer 6

atypical antidepressant

blocks serotonin and NE presynaptic alpha2 receptors

Question 7

MAO inhibitors’ MOA

Answer 7

prevents breakdown of NE, 5HT

Question 8

where is MAO located

Answer 8

mitochondria, liver, lung

Question 9

what percent of pts w major depression respond to anti-depressants

Answer 9

67%

Question 10

tx of major depression–order of use

Answer 10

SSRIs
SNRIs
atypical drugs
TCAs
MAO inhibitors

Question 11

SSRIs-list them

Answer 11

fluoxetine
sertraline
paroxetine
citalopram
escitalopram

Question 12

acute toxicity of SSRIs

Answer 12

less than TCAs and MAOinhibitors

• nausea, insomnia, sexual dysfxn
• suicidal thinking risk increased in children and adolescents
• SSRI withdrawal: shock-like sensations, dizziness, anxiety, etc

Question 13

serotonin reaction

Answer 13

occurs when SSRIs are given with MAOIs

hyperthermia, muscle rigidity, cardiovascular collapse

Question 14

neuroleptic malignant syndrome

Answer 14

SSRIs and SNRIs, are associated with when given w anti-psychotics

Question 15

uses for SSRIs

Answer 15

• major depression
• OCD (drug of choice)
• panic disorder, social anxiety disorder, PTSD (more effec than anti-anxiety agents)
• generalized anxiety disorder (drug of choice)
• PMS
• hot flashes

Question 16

side effect profile of SNRI

Answer 16

more SSRI-like than TCA-like (TCA can bind to lots of other receptors like those for dopamine, etc, leading to more side effects)

Question 17

use of SNRIs

Answer 17

major depression, anxiety, fibromyalgia, etc

Question 18

bupropion MOA

Answer 18

weakly blocks NE and dopamine uptake

Question 19

use of bupropion

Answer 19

major depression, nicotine withdrawal, seasonal affective disorder

Question 20

side effects of bupropion

Answer 20

NO weight gain or sexual dysfxn

Question 21

mirtazapine MOA

Answer 21

blocks presynaptic alpha2 receptors

Question 22

side effects of mirtazapine

Answer 22

increases appetite (AIDs pts)

Question 23

trazodone MOA

Answer 23

weak SSRI-like effect

Question 24

side effects of trazodone

Answer 24

priapism, sedating

Question 25

use of trazodone

Answer 25

major depression, insomnia

Question 26

vortioxetine MOA

Answer 26

SSRI-like action in addition to 5HT1A agonist and 5HT3 antagonist

Question 27

side effects of TCAs

Answer 27

decreases REM, increases stage 4 sleep ANTICHOLINERGIC effects: dry mouth, blurry vision, urinary retention sedation orthostatic hypotension cardiac side effects (due to anticholinergic and increased NE)-palpitations, tachycardia, arrhythmias, longer QRS intervals, EKG changes

Question 28

drug interactions of TCAs

Answer 28

guanethidine sympathomimetic drugs absoprtion and metabolism of other drugs

Question 29

uses of TCAs

Answer 29

MDD enuresis in childhood chronic pain OCD

Question 30

side effects of MAOIs

Answer 30

lowers blood pres, orthosatic hypotension acute toxicity: agitation, hallucinations, hyperpyrexia, convulsions, BP changes

Question 31

tyramine

Answer 31

if not broken down, can cause release of NE, resulting in hypertensive crisis

Question 32

foods that can interact w MAOIs

Answer 32

``` avocados soybean figs smoked meats fermented sausage dried fish cheese ```

Question 33

uses of MAOIs

Answer 33

MDD (not first line) | narcolepsy

Question 34

what if antidepressant drugs alone aren't effective?

Answer 34

add antipsychotic drugs physiological tx-ECT, transcranial magnetic stimulation, deep brain stimulation

Question 35

St John's wort

Answer 35

MAOI activity