Antidepressant Pharm

Question 1

Name the SSRIs

Answer 1

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

Question 2

SSRIs that are isomers and have similar SE/metabolism profiles

Answer 2

citalopram and escitalopram

Question 3

Block the presynaptic serotonin reuptake pump. Increases the time that serotonin is available in the synapse. Increases postsynaptic receptor occupancy

Answer 3

SSRIs

Question 4

SSRI that has an active metabolite

Answer 4

fluoxetine (Prozac)

Question 5

General elimination half life range for SSRIs

Answer 5

20-30 hours. Except fluoxetine (Prozac)- 4-16 days

Question 6

Which SSRIs inhibit liver enzymes less than other SSRIs? (ie good when you’re worried about drug-drug interactions)

Answer 6

Citalopram and escitalopram

Question 7

What happens when another drug is introduced that also works at same enzyme sites as first drug?

Answer 7

Stays in system longer, more chance of toxicty, overdose, greater side effects

Question 8

Why are SSRIs contraindicated if taking MAOis within 2 weeks?

Answer 8

risk of serotonin syndrome

Question 9

Top three side effects of SSRIs

Answer 9

sexual dysfunction, drowsiness, weight gain

Question 10

Sx include: dysphoria, dizziness, GI distress, fatigue, chills, myalgias. More common with fluvoxamine and paroxetine

Answer 10

serotonin withdrawal syndrome

Question 11

How long should someone be on SSRI for depression?

Answer 11

at least 1 yr after resolution of symptoms otherwise there may be recurrence

Question 12

Risk associated with citalopram

Answer 12

QT prolongation at doses over 40mg or at 20mg for >60yr/hepatic impairment/cimetidine

Question 13

Advantages of fluoxetine (Prozac)

Answer 13

capsule for weekly dosing and least problems with weight gain

Question 14

SSRIs CI with Tamoxifen

Answer 14

fluoxetine (Prozac), paroxetine (Paxil),

Question 15

SSRI with significant withdrawal symptoms

Answer 15

Paroxetine (Paxil)

Question 16

SSRI more likely to cause diarrhea than others

Answer 16

Sertaline (Zoloft)

Question 17

Name the SNRIs

Answer 17

Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Desvenlafaxine (Pristiq)

Question 18

use for treatment of depression if intolerable side effects or poor response to first line SSRI therapy

Answer 18

SNRIs

Question 19

inhibit the reuptake of norepinephrine and serotonin. leads to increased stimulation of the post-synaptic receptors

Answer 19

SNRIs

Question 20

Food decreases the rate of absorption but not the degree of absorption (ie less side effects)

Answer 20

SNRIs

Question 21

Most common side effects of SNRIs

Answer 21

nausea, dizziness, diaphoresis

Question 22

SNRI that most commonly causes nausea. Monitor for elevation of blood pressure

Answer 22

Desvenlafaxine (Pristiq)

Question 23

SNRI that is CI in uncontrolled angle closure glaucoma, severe renal or liver impairment. Indicated for diabetic neuropathy and fibromyalgia

Answer 23

Duloxetine (Cymbalta)

Question 24

SNRI with increased risk of upper GI bleed, slow taper off of it to avoid withdrawal symptoms, can cause QT prolongation

Answer 24

Venlafaxine (Effexor)

Question 25

Usually avoided in clinical practice for the treatment of depression due to anticholinergic side effects

Answer 25

TCAs

Question 26

Highly sedating so are often used for insomnia and for those with night time neuropathic pain or fibromyalgia

Answer 26

TCAs

Question 27

Inhibit reuptake of serotonin and norepinephrine. Also block muscarinic, histamine and alpha-adrenergic receptors

Answer 27

TCAs

Question 28

Group of medications whose cardiac SE include: Heart block, ventricular arrhythmias, sudden death

Answer 28

TCAs

Question 29

what patients do you need to screen for cardiac conduction system disease with an EKG before initiation of TCAs?

Answer 29

patients >40yrs

Question 30

Lower the seizure threshold, Increase in bone fractures, dangerous in overdose due to their broad spectrum

Answer 30

TCAs

Question 31

Block histamine receptors causing sedation, increased appetite, confusion, delirium

Answer 31

TCAs

Question 32

Block acetylcholine receptors causing blurred vision, constipation, dry mouth, urinary retention

Answer 32

TCAs

Question 33

Name the MAOi

Answer 33

Phenelzine (Nardil). Tranylcypromine (Parnate)

Question 34

Medication group most likely to cause serotonin syndrome. Need to avoid tyramine containing foods

Answer 34

MAOi

Question 35

Serotonin antagonist and reuptake inhibitors. Good for sleep at low doses. If tolerated – functions as an antidepressant at higher doses

Answer 35

Trazodone (Desyrel)

Question 36

Uses include: Major Depressive disorder, ADHD, Smoking cessation

Answer 36

Bupropion (Wellbutrin)

Question 37

Structurally related to amphetamine. Can cause anxiety. Lowers the seizure threshold. Avoid in bulemia

Answer 37

Bupropion

Question 38

No withdrawal syndrome upon discontinuation or sexual dsyfxn.

Answer 38

Bupropion

Question 39

Mildly stimulating so good for patients with fatigue, hypersomnia, or poor concentration

Answer 39

Bupropion

Question 40

Blocks adrenergic receptors leading to an increased release of norepinephrine and serotonin. Blocks serotonergic receptors and increases serotonin mediated neurotransmission

Answer 40

Mirtazapine (Remeron)

Question 41

Used off-label for insomnia. Used off-label for appetite stimulant. Good for patients with nausea

Answer 41

Mirtazapine

Question 42

classically associated with the simultaneous administration of two serotonergic agents. Majority present within 24 hrs.

Answer 42

serotonin syndrome

Question 43

Sx include: hyperthermia, agitation, tremor, clonus, dilated pupils, diaphoresis, DTR hyperreflexia, flushed skin

Answer 43

serotonin syndrome

Question 44

What does HARM stand for with serotonin syndrome?

Answer 44

hyperthermia, autonomic instability, rigidity, myoclonus

Question 45

Tx for serotonin syndrome

Answer 45

DC serotonin agents, sedate using benzos, O2, Fluids, avoid acetaminophen.

Question 46

At what temp of serotonin syndrome do you need to intubate and sedate immediately?

Answer 46

> 41.1C (105.98F)

Question 47

If benzos don't work, what is the antidotes for serotonin syndrome?

Answer 47

cyproheptadine