Anti-Depressants

Question 1

Tricyclic: Tertiary Amines

Answer 1

Doxepine
Imipramine
Trimipramine
Amitriptyline
Clomipramine

*Low therapeutic index (lethal dose is close to therapeutic dose)

Question 2

Tricyclic: Secondary Amines

Answer 2

Nortriptyline
Desipramine
Protriptyline

*Low therapeutic index (lethal dose is close to therapeutic dose)

Question 3

Tetracyclic

Answer 3

Amoxapine

*Low therapeutic index (lethal dose is close to therapeutic dose)

Question 4

MAOI: Classical

Answer 4

Phenelzine

Tranylcypromine

Question 5

MAOI: Selective

Answer 5

Selegeline

Question 6

SSRI

Answer 6

Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)

Question 7

Atypical

Answer 7

Bupropion
Trazadone
Mirtazapine

Question 8

SNRI

Answer 8

Venlafaxine
Duloxetine

*work most rapidly

Question 9

NRI

Answer 9

Reboxitine

Question 10

Tricyclic: General side effects/Problems

Answer 10

Anticholinergic
Antihistaminic
Anti-alpha1
Sexual side effects
Overdose and lethality (most associated w/ completed suicide)

Question 11

SSRI: General Side Effects/Problems

Answer 11

Weight gain
sexual side effects (40%)
GI problems
Drug interactions
effects on sleep
Serotonin syndrome
Withdrawal/Serotonin discontinuation syndrome

Question 12

Serotonin Syndrome

Answer 12

Build up of serotonin
agitation, confusion, dilated pupils, muscle twitching/loss of muscle coordination, diarrhea, heavy sweating, headache, shivering, goose bumps
high fever, seizure, unconsciousness, irregular heartbeat
Mimics NMS, but missing rigidity and antipsychotics

Question 13

Serotonin Discontinuation syndrome

Answer 13

usually with high dosage, short acting SSRIs

poor sleep, jittery, nervous, flu-like

Question 14

Doxepine

Answer 14

Tricyclic Tertiary Amine
antidepressant
blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors
Most anti-cholinergic of the TCAs

Question 15

Imipramine

Answer 15

Tricyclic Tertiary Amine
antidepressant, treats bedwetting
blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors
Fatal in overdose
up to a month to take effect
Reliable blood levels

Question 16

Trimipramine

Answer 16

Tricyclic Tertiary Amine
antidepressant
blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors

Question 17

Amitriptyline

Answer 17

Tricyclic Tertiary Amine
antidepressant
blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors
Very sedating
commonly used
helpful w/ neurologic/non-specific pain

Question 18

Clomipramine

Answer 18

Tricyclic Tertiary Amine
antidepressant
blocks re-uptake of all NTs (NE, 5HT, DA). Blocks postsynaptic M1, A1, H1 receptors
Most SSRI-like of TCAs

Question 19

Nortriptyline

Answer 19

Tricyclic Secondary Amine
Antidepressant
Blocks re-uptake of all NTs (NE, 5HT, DA)
Blocks postsynaptic M1, A1, H1 receptors
Least anti-cholinergic of TCAs
Therapeutic window (not useful below or above a certain dose)
Least problem with hypotension (least anti-alpha 1)
Good for elderly
Reliable blood levels

Question 20

Desipramine

Answer 20

Tricyclic Secondary Amine
Antidepressant
Blocks re-uptake of all NTs (NE, 5HT, DA)
Blocks postsynaptic M1, A1, H1 receptors
Least anticholinergic
least anti-alpha 1
reliable blood levels

Question 21

Protriptyline

Answer 21

Tricyclic Secondary Amine
Antidepressant
Blocks re-uptake of all NTs (NE, 5HT, DA)
Blocks postsynaptic M1, A1, H1 receptors

Question 22

Amoxapine

Answer 22

Tetracyclic
antidepressant, antipsychotic
Blocks re-uptake of all NTs (NE, 5HT, DA)
Blocks postsynaptic M1, A1, H1 receptors
Also blocks postsynaptic D2 receptor
Risk of EPS, TD, NMS
May cause gynecomastia
Low therapeutic index (lethal dose is close to therapeutic dose)

Question 23

Phenelzine

Answer 23

Classical MAO Inhibitor
Antidepressant
Irreversible inhibition of MAO-A and MAO-B(A is for serotonin, B is for dopamine)
Can block Alpha-1 receptors
Hypotension (Alpha-1 block)
anticholinergic
Weight gain
Avoid meals w/ tyramine
Serotonin syndrome
Hypertensive crisis (BP >200)
sexual dysfunction

Question 24

Tranylcypromine

Answer 24

Classical MAO Inhibitor
Antidepressant
Irreversible inhibition of MAO-A and MAO-B(A is for serotonin, B is for dopamine)
Can block Alpha-1 receptors
Hypotension (Alpha-1 block)
anticholinergic
Weight gain
Avoid meals w/ tyramine
Serotonin syndrome
Hypertensive crisis (BP >200)
sexual dysfunction

Question 25

Selegiline

Answer 25

Selective MAO Inhibitor Antidepressant Selective inhibition for MAO-B (degrades dopamine) Does not run the risk of serotonin syndrome or hypertensive crisis, unless there is a drug-drug interaction that causes loss of selectivity for MAO-B (some contraceptives)

Question 26

Fluvoxamine (Luvox)

Answer 26

1/2 life = 17 hours (shortest of SSRIs) Antidepressant, first med approved for OCD Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) Worst Rx-Rx interactions Headaches and migraines

Question 27

Paroxetine (Paxil)

Answer 27

``` 1/2 life = 21 hours Antidepressant Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) Some sedation (anti-H1) significant weight gain most anticholinergic increased risk of EPS with Antipsychotics not lethal in overdose ```

Question 28

Sertraline (Zoloft)

Answer 28

``` Antidepressant Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) GI problems not much drug interaction ```

Question 29

Citalopram (Celexa)

Answer 29

``` Antidepressant Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) least amount of drug interactions little/no weight gain ```

Question 30

Escitalopram (Lexapro)

Answer 30

Antidepressant Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) Most potent portion of citalopram molecule

Question 31

Fluoxetine (Prozac)

Answer 31

``` 1/2 life > 70 hours Antidepressant Blocks re-uptake of serotonin blocks phase one metabolism of other drugs (leads to toxicity) no weight gain (some weight loss) Most activating (give in the morning) May boost anxiety May prevent 5HT discontinuation syndrome ```

Question 32

Bupropion

Answer 32

``` Atypical Antidepressant, anxiolytic, aid to smoking cessation, ADHD Blocks re-uptake of NE and dopamine RIsk of psychosis risk of seizures in people with eating disorders some drug interactions no weight gain no sexual side effects ```

Question 33

Trazodone

Answer 33

``` Atypical Antidepressant, hypnotic Blocks re-uptake of NE and dopamine major anti-histaminic heavily sedating priapism not addictive ```

Question 34

Mirtazapine

Answer 34

``` Atypical Antidepressant heavily anti-histaminic (sedation and weight gain) No sexual side effects slight risk of agranulocytosis (0.3%) ```

Question 35

Venlafaxine

Answer 35

SNRI antidepressant blocks re-uptake of NE (mostly), 5HT and DA Hypertension (6-13%) because of NE re-uptake blockage short 1/2 life serotonin discontinuation syndrome

Question 36

Duloxetine

Answer 36

``` SNRI Antidepressant Blocks re-uptake of NE and 5HT little weight gain short 1/2 life ```

Question 37

Reboxitine

Answer 37

Antidepressant | blocks re-uptake of NE

Question 38

Tricyclics With Reliable Blood Levels

Answer 38

Desipramine Imipramine Nortriptyline