519-520: Psych Drugs 2

Question 1

Name 4 SSRI’s

Answer 1

Fluoxetine
Paroxetine
Sertaline
Citalopram

“Flashbacks paralyze senior citiznes”

Question 2

What are the clinical uses for SSRIs?

Answer 2

Depression
GAD
Panic disorder
OCD
Bulimia
Social Phobias
PTSD

Question 3

How long does it take for antidepressants to take effect?

Answer 3

4-8 weeks

Question 4

Are SSRIs or TCAs more toxic?

Answer 4

TCAs

Question 5

What are the toxicities of SSRIs?

Answer 5

GI distress
Sexual dysfunction (anorgasmia, ↓ libido)
Serotonin syndrome

Question 6

What drugs can cause serotonin syndrome?

Answer 6

Any drug that ↑ SSRIs (e.g. MAO inhibitors, SNRIs, TCAs)

Question 7

What are the symptoms of serotonin syndrome?

Answer 7

seizures
myoclonus
confusion

hyperthermia
flushing
cardiovascular collapse

diarrhea

Question 8

What do you treat serotonin syndrome?

Answer 8

Cyproheptadine (5-HT2 receptor antagonist)

Question 9

List 2 SNRIs

Answer 9

Venlafaxine, duloxetine

Question 10

Mechanism of SNRIs:

Answer 10

Inhibit 5-HT and NE reuptake

Question 11

Clinical use of SNRIs:

Answer 11

Depression
GAD and panic disorder - venlafaxine
Diabetic peripheral neuropathy - duloxetine

Question 12

Toxicity of SNRIs:

Answer 12

Stimulant effects
Nausea
Relaxxation (sedation)
Increased BP - most common

Question 13

List as many TCAs as you can:

Answer 13

-triptyline: amitriptyline, nortriptyline
-imprame: imipramine, desipramine, clomipramine
doxepin, amoxapine

Question 14

Mechanism of TCAs:

Answer 14

Block reuptake of NE and 5-HT

Question 15

Clinical use of TCAs:

Answer 15

Major depression
OCD (clomipramine)
Fibromyalgia

Question 16

Toxicities of TCAs:

Answer 16

Anticholinergic: tachycardia, urinary retention, dry mouth; confusion and hallucinations in elderly
α1-blocking effects (e.g. postural HTN)
Respiratory depression
Hyperprexia
Sedation

Tri-C’s: convulsions, coma, cardiotoxicity (arrhythmias)

Question 17

Name the MAO inhibitors

Answer 17

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (selective MAO-B inhibitor)

(MAO Takes Pride In Shanghai)

Question 18

MAO inhibitor effects on levels of amine transmitters:

Answer 18

↑ levels of NE, 5-HT, dopamine

Question 19

Clinical use of MAO inhibitors:

Answer 19

Atypical depression
Anxiety
Hypochondriasis

Question 20

Toxicities of MAO inhibitors:

Answer 20

Hypertensive crisis (esp. w/ tyramine ingestion)
CNS stimulation
Contraindicated with SSRIs, TCAs, St. John’s wort, meperidine, and dextromethorphan (to prevent serotonin syndrome)

Question 21

What is the difference in side effect profiles between second and third generation TCAs?

Answer 21

third generation TCAs (amitriptyline) have more anticholinergic effects than second (nortriptyline)

Question 22

List three atypical antidepressants

Answer 22

Bupropion, mirtazapine, trazodone

Question 23

What are the clinical uses for bupropion?

Answer 23

Depression, smoking cessation

Question 24

What neurotransmitters are involved in the actions of bupropion?

Answer 24

↑ NE and dopamine (unknown mechanism)

Question 25

What are the toxicities of bupropion?

Answer 25

stimulant effects (tachycardia, insomnia) headache seizure in bulimic paitents

Question 26

Regarding its side effect profile, what is an advantage to the use of bupropion for treating depression?

Answer 26

no sexual side effects

Question 27

What receptor does mirtazapine act on, and what neurotransmitters are involved?

Answer 27

α2-antagonist (↑ release of NE and 5-HT)

Question 28

Toxicity of mirtazapine

Answer 28

Sedation ↑ appetite Weight gain Dry mouth

Question 29

Which antidepressant might you consider using for a depressed patient with insomnia?

Answer 29

mirtazapine

Question 30

Which antidepressant might you consider using for a depressed patient with anorexia, or an elderly patient who is in danger of wasting away?

Answer 30

mirtazapine - it causes weight gain

Question 31

What is the mechanism of trazodone?

Answer 31

Primarily blocks 5-HT and α1-adrenergic receptors

Question 32

What are the clinical applications for trazodone?

Answer 32

Insomnia is the primary use b/c high doses are needed for antidepressant effects

Question 33

What are the toxicities of trazodone?

Answer 33

sedation nausea priapism ("trazobone") postural hypotension