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1

Name the 2 SNRI’s & 2 Mixed-Actions

SNRI: Venlafaxine (Effexor), Duloxetine (Cymbalta)

Mixed action: Bupropion (Wellbutrin), Mirtazapine (Remeron)

2

What are the s/e of Effexor (Venlafaxine)?

May cause NEW diastolic HTN (not okay in HTN pts)
-also sexual s/e & w/d symptoms with as little as 1-3 missed doses

3

What are the s/e of Cymbalta (Duloxetine)?

Elevates liver enzymes (check LFT’s!)
-also sexual s/e.

*good choice in pts with neuropathy*

4

What are the s/e of Bupropion (Wellbutrin)?

May lower SEIZURE threshold (not for EtOH or BN/AN)
May WORSEN pts with ANXIETY d/o
-HOWEVER NO sexual s/e, may cause weight loss.

5

What are the s/e of Remeron (Mirtazapine)?

Highly sedating. Note to take at bedtime. Inc appetite.
-used frequently in anxiety d/o in OEF/OIF Veterans
-Like Bupropion, NO SEXUAL s/e but OK in anxiety

6

Name the tricyclic antidepressants.

Tertiary: Amitriptyline, Imipramine
Secondary: Imipramine, Desipramine,
?: Nortriptyline, Clomipramine, Doxepin

7

Name two antidepressants without sexual side effects.

Mirtazapine (Remeron) & Bupropion (Wellbutrin)

8

Which one of the SSRIS is worst for discontinuation syndrome?

Paroxetine (Paxil), then Luvox (b/c of shortest t ½)

9

Which one of the SSRIS may cause weight gain?

Paroxetine

10

Irritability, unstable gait, rebound anxiety and shock-like
Or electric-like shocks are all symptoms of what syndrome?

SSRI discontinuation syndrome

11

SSRI discontinuation syndrome best avoided by

fluoxetine (Prozac) & Citalopram (Celexa)

12

What are the “three C’s” of TCA overdose?

Coma, Convulsions and Cardiotoxicity

13

What is a side-effect to Trazodone?

“Trazodone raises the bone” (Priapism)

14

What can happen with MAOI +Tyramine excess?

HTN crisis (increased catecholaminergic activity)➔stroke, aneurysm

15

Which MAOI binds reversibly and which irreversibly?

Reversible: Moclobemide
Irreversibles: Phenelzine, Tranylcypromine, Selegiline

16

What are the 6 signs of Neuroleptic Malignant Syndrome?

FALTER from antipsychotics
F=Fever (usually over 40C),
A=autonomic instability L=leukocytosis,
T=tremor,
E=elevated CPK,
R=rigid mm

17

What HTN med can be given for nightmares in PTSD?

Prazosin (alpha-blocker)

18

What is a non-stimulant option for treatment of ADHD?

Strattera (Atomoxetine)
-has slower onset, but less abuse potential
-is also used for narcolepsy

19

At what age can you give amphetamines for ADHD?

No Amphetamines until 3 years old

20

At what age can you give methylphenidate for ADHD?

6 yo

21

Why can’t stimulants be given to ADHD children if they have hx of HTN, psychosis or seizures?

Release of NE (catecholamines)=worsened HTN

Release of DA (dopamine)=worsened psychosis
Increased activity & excitation=worsened seizures

-cardiac problems are an issue (no stimulants!)