Anti-Depressants

Question 1

Citalopram drug class

Answer 1

SSRI

Question 2

Citalopram clinical pearl

Answer 2

QTc prolongation for doses greater than 40mg/day

Question 3

Citalopram cyp interactions

Answer 3

CYP 2C19 substrate

Question 4

Escitalopram drug class

Answer 4

SSRI

Question 5

Fluoxetine drug class

Answer 5

SSRI

Question 6

Fluoxetine clinical pearl

Answer 6

long half life
No need to taper down
Weight loss, insomnia, fatigue

Question 7

Fluoxetine CYP

Answer 7

2C19 and 3A4 inhibitor

Question 8

Fluvoxamine drug class

Answer 8

SSRI

Question 9

Fluvoxamine clinical pearl

Answer 9

approved for OCD

Question 10

Fluvoxamine CYP

Answer 10

1A2

Question 11

Paroxetine drug class

Answer 11

SSRI

Question 12

Paroxetine clinical pearl

Answer 12

must taper due to anticholinergic effects
weight gain, sedation
Pregnancy category D

Question 13

Paroxetine CYP

Answer 13

2D6

Question 14

Sertraline drug class

Answer 14

SSRI

Question 15

SSRI general adverse effects

Answer 15

increased bleeding risk, anxiety/agitation, GI UPSET, sexual dysfunction, hyponatremia/SIADH, decreased bone mineral density, akathisia

Question 16

Desvenlafaxine drug class

Answer 16

SNRI

Question 17

Desvenlafaxine clinical pearls

Answer 17

Dose limited side effect: nausea

renal dosing

Question 18

Desvenlafaxine CYP

Answer 18

no cyp interactions

Question 19

Duloxetine drug class

Answer 19

SNRI

Question 20

Duloxetine clinical pearl

Answer 20

slowly titrate dose to avoid nausea

HEPATOTOXICITY- MUST GET LFT’S AT INITIATION

Question 21

Duloxetine CYP

Answer 21

1A2 substrate

2D6 inhibitor and substrate

Question 22

Levomilnacipran drug class

Answer 22

SNRI

Question 23

Levomilnacipran clinical pearl

Answer 23

Must adjust dose in renal impairment or strong CYP

Question 24

Levomilnacipran CYP

Answer 24

3A4 substrate

Question 25

Milnacipran drug class

Answer 25

SNRI

Question 26

Milnacipran clinical pearl

Answer 26

indicated for fibromyalgia | renal dosing

Question 27

Venlafaxine drug class

Answer 27

SNRI

Question 28

Venlafaxine clinical pearl

Answer 28

Dose must be >150mg/day to have NE effects

Question 29

Venlafaxine CYP

Answer 29

substrate of 2D6 and 3A4 (major)

Question 30

SNRI general adverse effects

Answer 30

Variable amounts of sedation, increased bleeding risk, anxiety/agitation (when starting), GI upset, sexual dysfunction, blood pressure elevation, hyponatremia, decreased bone mineral density, nausea, akathisia

Question 31

Amitriptyline drug class

Answer 31

TCA

Question 32

Desipramine drug class

Answer 32

TCA

Question 33

Doxepin drug class

Answer 33

TCA

Question 34

Imipramine drug class

Answer 34

TCA

Question 35

Nortriptyline drug class

Answer 35

TCA

Question 36

Amitriptyline clinical pearl

Answer 36

used at lower doses for neuropathic pain

Question 37

Doxepin clinical pearl

Answer 37

commonly used for insomnia

Question 38

Nortriptyline clinical pearl

Answer 38

Used in smoking cessation

Question 39

TCA adverse effects

Answer 39

CNS: sedation, increased seizures, confusion Anticholinergic: blurred vision, urinary retention, constipation CV: orthostatic hypotension, tachycardia Others: weight gain, sexual dysfunction OVERDOSE CAN CAUSE ARRHYTHMIAS

Question 40

Isocarboxazid drug class

Answer 40

MAOI

Question 41

Phenelzine drug class

Answer 41

MAOI

Question 42

Selegiline drug class

Answer 42

MAOI

Question 43

Tranylcypromine drug class

Answer 43

MAOI

Question 44

MAOI clinical pearls

Answer 44

Must have 2 week washout period between antidepressants (5 weeks if fluoxetine) Tyramine diet Can cause serotonin syndrome and hypertensive crisis

Question 45

MAOI contraindications

Answer 45

pheochromocytoma, hepatic/renal dysfunction, cerebrovascular disease, excessive caffeine use, elective surgery, concomitant sympathomimetics (cocaine, amphetamines, etc.), CV disease, use with SSRI

Question 46

Bupropion MOA

Answer 46

Dopamine/NE reuptake inhibitor (does not affect serotonin)

Question 47

Bupropion contrainidications

Answer 47

active seizure disorder or eating disorder (stimulating effects suppress appetite)

Question 48

Bupropion CYP

Answer 48

2D6 inhibitor

Question 49

Mirtazepine MOA

Answer 49

Presynaptic alpha-2 blocker as well as 5HT2, 5HT3, and H2 receptor blockage

Question 50

Mirtazepine adverse effects

Answer 50

increased sedation and appetite in doses smaller than 15mg/day warning for agranulocytosis and increased cholesterol NO CLINICALLY SIGNIFICANT INTERACTIONS

Question 51

Trazodone MOA

Answer 51

Selectively inhibits neuronal reuptake of serotonin and acts as an antagonist at 5HT1, 5HT2, H1, and alpha-1

Question 52

Trazodone clinical pearls

Answer 52

sedation (pts may not be able to tolerate high effective doses), can see lower doses of trazodone being used in combination with other antidepressants despite SSRI component PRIAPISM

Question 53

Vilazodone MOA

Answer 53

SSRI and possibly contributes to 5HT1a agonism (possibly making it work faster?)

Question 54

Vilazodone clinical pearls

Answer 54

take with food, titrate up to 40mg | Major CYP 3A4 interactions

Question 55

Vortioxetine MOA

Answer 55

SSRI and 5HT1A agonist, 5HT3 antagonist

Question 56

Vortioxetine clinical pearls

Answer 56

take with meals | Strong CYP 2D6 substrate

Question 57

Imipramine use

Answer 57

children with ADHD or nocturnal enuresis