Antidepressants

Question 1

Monoamine Oxidase Inhibitors (names)

Answer 1

Isocarboxazid
Phenelzine
Tranylcypromine
Selegiline

Question 2

MAOI MOA

Answer 2

Blocks the inhibitory effects of MAO so that there will be more 5HT, NE & DA in the synaptic cleft

Question 3

MAOI site of action

Answer 3

Mitochondria

Question 4

Hydrazine derivative MAOI

Answer 4

Phenelzine

Isocarboxazid

Question 5

Non-hydrazine derivative MAOI

Answer 5

Tranylcypromine

Selegiline

Question 6

Preference of MAO-A & MAO-B

Answer 6

MAO-A = NE & 5HT
MAO-B = DA & Tyramine

Question 7

MAOI AEs (9)

Answer 7

Drowsiness
Insomnia
Nausea
O. Hypotension
Weight gain
Muscle pain
Sexual dysfunction
Serotonin syndrome
Cheese reaction

Question 8

What drugs causes Serotonin syndrome?

How does this happen?

Answer 8

MAOI + any Serotonergic agent

Overstimulation of 5HT1A & 5HT2 receptors

Question 9

Symptoms of Serotonin Syndrome

Answer 9

Muscle rigidity
Hyperthermia
Myoclonus

Question 10

Serotonin syndrome management

Answer 10

“4S”

• Serotonergic agent discontinuation
• Supportive care
• Sedation w/ Benzos
• Serotonin antagonist = Cyproheptadine

Question 11

Cyproheptadine + Benzo is used for?

Answer 11

Serotonin syndrome management

Question 12

Cause of Cheese Reaction?

Answer 12

Excess tyramine buildup (MAO degrade tyramine in cheese, wine, etc)

Question 13

Symptoms of Cheese reaction

Answer 13

• Tachycardia
• Hypertension
• Arrhythmias
• Seizures
• Stroke

Question 14

MAOI Contraindications “2Ps”

Answer 14

“2Ps”

OTC cold preparations:

• pseudoephedrine
• phenylpropanolamine

Question 15

Cheese Reaction (Tyramine-induced HTN) Management

Answer 15

“2Ps”

• Phentolamine
• Prazosin

Question 16

Tricyclic Antidepressants (names)

Answer 16

“Pramine” & “Triptyline”

• Amitriptyline
• Clomipramine
• Desipramine
• Imipramine
• Nortriptyline

Question 17

TCAs MOA

Answer 17

Blocks SERT & NET (Inc. 5HT & NE in cleft)

Question 18

Selectivity of TCAs for SERT & NET

Answer 18

SERT: Clomipramine
NET: Desipramine & Nortriptyline

Question 19

TCAs Overdose Management

Answer 19

Sodium bicarbonate to reverse the conduction block

Question 20

Why are TCAs avoided in elderly?

Answer 20

Can cause:

• Orthostatic hypotension
• Reflex tachycardia

Question 21

Selective Serotonin Reuptake Inhibitors (SSRI) (names)

Answer 21

• Citalopram
• Escitalopram
• Fluoxetine
• Fluvoxamine
• Paroxetine
• Sertraline

Question 22

DOC for treating depression

Answer 22

SSRI

Question 23

SSRI MOA

Answer 23

Blocks SERT = No serotonin reuptake

Question 24

SSRI AEs

Answer 24

Gut = nausea, GI upset & diarrhea
Dec sexual function & interest
Weight gain
Serotonin syndrome when used w/ MAOI
Overdose = Seizures

Question 25

what are the best anti-depressants to start the pt. on?

Answer 25

Citalopram, setraline or Escitalopram | Low potential for interactions

Question 26

Serotonin & Norepinephrine Reuptake Inhibitors (SNRI) (names)

Answer 26

- Venlafaxine | - Duloxetine

Question 27

What drug should you switch the pt to if SSRIs provide no relief?

Answer 27

SNRIS - Venlafaxine & Duloxetine

Question 28

Norepinephrine & Dopamine Reuptake Inhibitors (NDRI) (names)

Answer 28

- Bupropion

Question 29

Overdose of Bupropion causes?

Answer 29

-Seizures (so contraindicated in pts. w/ seizure disorders)

Question 30

Noradrenergic & Specific Serotonergic Antidepressants (NASSA) (names)

Answer 30

- Mirtazapine

Question 31

NASSA (Mirtazapine) MOA

Answer 31

- Central presynaptic A2 antagonist - Inc NE & 5HT release - 5HT2 & 5HT3 Antagonist - H1 antagonist

Question 32

NASSA (Mirtazapine) AE

Answer 32

- Sedation & weight gain (H1)

Question 33

Antidepressant Discontinuation Syndrome symptoms

Answer 33

- Anxiety, irritability & tearfulness - Dizziness - Headache - Lethargy - Flu-like symptoms - Electric-shock sensations - Insomnia - Nausea, vomiting & diarrhea

Question 34

Drugs most likely to cause Antidepressant Discontinuation Syndrome

Answer 34

- Paroxetine - Venlafaxine Due to short half life

Question 35

Drug least likely to cause Antidepressant Discontinuation Syndrome

Answer 35

- Fluoxetine | Due to long half life

Question 36

Clinical uses of SSRIs

Answer 36

- Depression (DOC) - Anxiety (DOC) - GAD, SAD, PTSD, PD & OCD - Eating disorders - Bulimia - Premenstrual Dysphoric Disorder

Question 37

Clinical uses of Bupropion

Answer 37

- Depression | - Smoking cessation

Question 38

Clinical uses of TCAs & SNRIs

Answer 38

- Depression | - Chronic pain (neuropathic, etc.)

Question 39

DOC for Bipolar Disorder

Answer 39

- Lithium | NB: AD may worsen the symptoms of Bipolar so always rule out the disorder before using AD

Question 40

Lithium MOA

Answer 40

Inhibits Inositol polyphosphatase & monophosphatase --> No Inositol regeneration

Question 41

Adverse effects of Lithium

Answer 41

- Tremor, ataxia & aphasia - Sedation & seizures - Weight gain - Hypothyroidism - Nephrogenic DI - Edema - Dermatitis - Alopecia - Leukocytosis

Question 42

Management of Lithium-induced Nephrogenic DI

Answer 42

- Discontinue OR - Add Amiloride - Thiazides & NSAIDs

Question 43

Contraindications of Lithium

Answer 43

- Nursing mothers | - Cat D in pregnancy - Congenital cardiac anomalies

Question 44

Monitoring the bodily effects of Lithium

Answer 44

- Serum lithium conc. - Thyroid function - Renal function

Question 45

Drugs that reduce the Renal clearance of lithium

Answer 45

- Thiazides - NSAIDs - ACEI - ARBs

Question 46

Alternatives to Lithium

Answer 46

Antiepileptics - Valproate, Carbamazepine & Lamotrigine | Atypical AP - Olanzapine, Aripiprazole, Quetiapine & Risperidone

Question 47

Monitoring of Lithium-alternatives

Answer 47

- Valproate - Liver function & CBC | - Carbamazepine - CBC