anti-depressants

Question 1

Tranylcypromine and moclobemide share some characteristics, including:

a. headaches as a side effect
b. selectivity for MAOA
c. irreversible inhibition of MAO
d. raising levels of 5HT

Answer 1

d. raising levels of 5HT

tranylcypromine: irreversible MAO inhibitor
moclobemide: reversible MAO inhibitor

Question 1

Which of the following is associated with the greatest risk of cardiovascular complications?

a. Nefazadone
b. Moclobemide
c. Fluoxetine
d. Desipramine

Answer 1

d. desipramine (TCA)

nefazadone (serotonin antagonist and reuptake inhibitor)
moclobemide (reversible monoamine oxidase inhibitor)
fluoxetine (selective serotonin reuptake inhibitor)

Question 2

Fluoxetine:

a. Has anxiety as an initial acute side effect
b. Blocks both 5-HT and noradrenaline uptake
c. Acts as an antagonist at alpha-1-adrenoceptors, muscarinic and histamine receptors
d. Is able to improve mood within a 2 day period

Answer 2

a. Has anxiety as an initial acute side effect (SSRI)

b. TCAs, SARIs
c. TCAs

Question 3

Why are Selective Serotonin Reuptake Inhibitors (SSRIs) preferred over Tricyclic antidepressants (TCAs) in the present practice?

a. Increased efficacy and decreased toxicity
b. Multiple target mediated action
c. Improved bioavailability

Answer 3

a. Increased efficacy and decreased toxicity

Question 4

what is desipramine?

Answer 4

tricyclic anti-depressants

Question 5

what is fluoxetine?

Answer 5

SSRI

Question 6

which antidepressant can provoke manic episodes in bipolar patients?

Answer 6

SSRIs

Question 7

why do SSRIs not result in cardiac problems?

Answer 7

only target 5HT transporter –> no effect on NA receptor

Question 8

what is Tranylcypromine?

Answer 8

irreversible monoamine oxidase inhibitors (MAOIs)

Question 9

what drug is associated with serotonin syndrome?

Answer 9

SSRIs (fluoxetine)

Question 10

MAO(A) breaks down ___ and ___
MAO(B) breaks down ____

Answer 10

5HT and NA
dopamine

Question 11

what is the cheese reaction?
associated with which drug?

Answer 11

irreversible MAOIs (tranylcypromine)
inhibit MAO in gut and liver –> prevent breakdown of tyramine –> displace large quantities of NA from nerve terminals –> release of NA from all sympathetic nerves in periphery –> hypertensive crisis

Question 12

what is moclobemide?

Answer 12

reversible MAOI

Question 13

why is there no cheese reaction in reversible MAOIs?

Answer 13

drug selectively targets MAO(A) enzyme

Question 14

what is nefazodone?

Answer 14

serotonin antagonist and reuptake inhibitor (SARI)

Question 15

what class of drug shares 5HT and NA reuptake blockade of classical TCAs without α1-adrenoceptor, muscarinic receptor and H1 receptor blockade?
name an example

Answer 15

Serotonin and noradrenaline reuptake inhibitors (SNRIs)
example: venlafaxine

Question 16

give an example of a SNRI?

Answer 16

Venlafaxine

Question 17

what is lithium indicated in?

Answer 17

bipolar disorder to stabilise mood

Question 18

what drugs are considered if bipolar patient no longer responds to lithium?

Answer 18

anti-epileptics (eg. valproate)

Question 19

what is Reboxetine?

Answer 19

NA reuptake inhibitor

Question 20

what is Mianserin?

Answer 20

α2-adrenoceptor antagonist

Question 21

what are the causes of depression?
1. Deficiency of _____transmitters
2. Abnormal upregulation of _____ receptors

Answer 21

1. monoamine (NA/5HT)
2. monoamine

Question 22

what is amitriptyline?

Answer 22

tricyclic antidepressant

Question 23

The beneficial effect of antidepressant drugs occurs when:

a. levels of 5-HT rise
b. levels of NA stabilise
c. receptors are blocked
d. receptors become downregulated

Answer 23

d. receptors become downregulated

Question 24

Desipramine:

a. enhances the synthesis of noradrealine
b. can block D2 receptors
c. is an irreversible inhibitor of MAO
d. raises noradrenaline levels in the brain

Answer 24

d. raises noradrenaline levels in the brain

Question 25

Tranylcypromine causes the following side effects. Which one is not caused by moclobemide?

a. insomnia
b. postural hypotension
c. nausea

Answer 25

b. postural hypotension

Question 26

Lithium is the only drug that is used to treat mania. The mechanism of action is unclear. Which is not a side effect?

a. tremor
b. diabetes insipidus
c. GIT disturbances
d. nephritis
e. oedema

Answer 26

c. GIT disturbances