anti depressants and mood stabilizers: Segars

Question 1

what antidepressant is indicated in nicotine withdrawal

Answer 1

-bupropion

Question 2

what antidepressant is indicated in Enuresis (bed wetting)?

Answer 2

-Imipramine

Question 3

What antidepressant is indicated in Diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain

Answer 3

Duloxetine

Question 4

what antidepressant is indicated in stress incontinence?

Answer 4

Duloxetine

Question 5

what are the different categories of antidepressants?

Answer 5

• Tricyclics (TCA’s): tertiary amines and secondary amines
• Heterocyclics or atypicals
• SSRIs
• SNRIs
• MAOIs

Question 6

what are the Tertiary amine TCAs

Answer 6

• Amitriptyline
• Clomipramine
• Doxepin
• Imipramine

Question 7

what are the secondary amine TCAs

Answer 7

• Amoxapine
• Desipramine
• Nortriptyline

Question 8

what are the Heterocyclic or atypicals

Answer 8

• Bupropion
• Mirtazapine
• Nefazodone
• Trazodone

Question 9

what are the SSRIs

Answer 9

• Citalopram
• Escitalopram
• Fluoxetine
• Paroxetine
• Sertraline
• Vilazodone
• Vortioxetine

Question 10

What are the SNRIs

Answer 10

• Desvenlafaxine
• Duloxetine
• Venlafaxine
• Levomilnacipran

Question 11

what are the MAOIs

Answer 11

• Isocarboxazid
• Phenelzine
• Selegiline
• Tranycypromine

Question 12

what receptor do SSRIs block

Answer 12

SERT

Question 13

Common Side effects of SSRIs

Answer 13

• CNS: sedations or insomnia/agitation/nervousness
• Sexual Dysfunction
• Weight gain or loss
• Acute withdrawal reactions (concern w/ all categories): flu-like symptoms

Question 14

Rare but serious side effects of SSRIs

Answer 14

• QT prolongations
• Hyponatremia
• Serotonin syndrome: sweating, HYPERREFLEXIA, akathisia/myoclonus, shivering/tremors
• Suicidality

Question 15

what SSRI has the stongest CYP450 inhibition?

What others are mild inhibitors

Answer 15

Fluoxetine

-Citalopram and Sertraline

Question 16

what 2 classes of antidepressants inhibit reuptake of serotonin via SERT AND norepinephrine via NET

Answer 16

• TCAs and SNRIs
• Tertiary TCA: equally
• Seconday: NE>5-HT

Question 17

what drug inhibits reuptake of serotonin, norepi, and Dopamine

Answer 17

Amoxapine

Question 18

what are the 3 receptor mediated groups of side effects for TCAs

Answer 18

• Cardiovascular (alpha)
• Anticholinergic (muscarinic)
• CNS (histamine)

Question 19

3 C’s for toxic ingestion of TCAs

Answer 19

• Coma
• Cardiotoxicity
• Convulsions

Question 20

explain the cardiotoxicity of TCAs

Answer 20

• quinidine like effect
• slows phase 0 by block Na channels
• long QRS

Question 21

Non TCA SNRIs have similar SEs to SSRI except less risk of what?

Answer 21

• sexual dysfunction

- except higher risk with venlafaxine

Question 22

what are the 2 agents that act like SSRIs and also selectively block POST-synaptic a1 receptors on NE neurons and post-synaptic 5-HT receptors

Answer 22

• Trazodone

- Nefazodone

Question 23

What agent selective blocks PRE-synaptic a2 receptors on NE and 5HT neurons

Answer 23

• Mirtazapine

- No SERT/NET activity

Question 24

What inhibits pre synaptic reuptake of NE via NET and dopamine via DAT (NDRI)

Answer 24

Bupropion

Question 25

what is the dose dependent side effect of Bupropion

Answer 25

Seizures

Question 26

all the MAOIs are non selective except which one

Answer 26

Selegiline . . B selective | -become non selective at high doses

Question 27

how is the antidepressant Selegiline administered

Answer 27

patch

Question 28

whats the high yield drug interaction with MAOIs

Answer 28

- interact with 5HT and NE affecting drugs | - need a 2 week wash out period (fluoxetine; 5 weeks)

Question 29

what is the major concern with MAOIs

Answer 29

hypertensive crisis

Question 30

Describe the 5 R's to antidepressant efficacy

Answer 30

- Response: >50% reduction in symptoms. not well but better . . Partial Response is >25% but <50% - Remission: Symptom free (very low to no symptoms0 - Recovery: 2-6 months of ongoing Remission . . not cured - Relapse: return of symptoms after Remission but before Recovery - Recurrence: Return of symptoms after Recovery

Question 31

MOA of Lithium

Answer 31

-inhibits Ca-dependent and depolarization provoked release of NE and DA

Question 32

Side effects of Lithium

Answer 32

- polyuria (polydipsia) | - clinical picture of nephrogenic diabetes insipidus

Question 33

Structure of Lithium

Answer 33

- monovalent ion - handled by kidneys similar to Na/K - competes with Na for reabsorption

Question 34

Drug interactions with Lithium and other drugs that impact Na/K

Answer 34

- Diuretics (especially thiazides, hydrochlorothiazide) - ACEIs: especially Lisinopril - NSAIDs

Question 35

why is lithium difficult to monitor

Answer 35

narrow therapeutic agent | -.6-1.0 mEq/mL

Question 36

what mood stabilizer is a major CYP450 inhibitor

Answer 36

Carbamazepine