Antidepressants

Question 1

What is the mechanism of an SSRI?

Answer 1

Inhibits 5-HT (serotonin) re-uptake selectively.

Question 2

What is the mechanism of an SNRI?

Answer 2

Inhibits re-uptake of both 5-HT and NE selectively.

Question 3

What is the mechanism of a tricyclic antidepressant?

Answer 3

Inhibits re-uptake of both 5-HT and NE but acts on other receptors as well (ACh M / alpha 1 adrenergics / H1 receptors).

Question 4

What is the mechanism of buproprion?

Answer 4

Inhibits re-uptake of NE and DA.

Question 5

What is buproprion often used for?

Answer 5

Smoking cessation

Question 6

What is the mechanims of MAOIs?

Answer 6

Inhibition of monoamine oxidase that breaks down neurotransmitters.

Question 7

Are there selective advantages of choosing one antidepressant over another with respect to efficacy?

Answer 7

No. They are all about equal in efficacy.

Question 8

What amino acid is serotonin and norepinephrine synthesized from respectively?

Answer 8

Tryptophan and Tyrosine

Question 9

What is the mechanism of amphetamines effect on monoamines?

Answer 9

Amphetamine is a substrate for NE re-uptake transporter. Inside the cell amphetamine inhibits the vesicular monamine transporter and NE builds up in the cytoplasm. This build up causes reversal / leak of NE into the synaptic cleft.

Question 10

MAO-A degrades which neurotransmitters?

Answer 10

5-HT, NE, tyramine

Question 11

MAO-B degrades which neurotransmitter?

Answer 11

dopamine

Question 12

Your patient is undergoing chemotherapy and they complain of extreme nausea. What medication could you prescribe and what receptor would it act on?

Answer 12

Odansetron antagonizes the 5-HT3 (serotonin) receptor in the nausea / vomitting centers of the brain.

Question 13

How is trazadone a unique drug in the class of antidepressants?

Answer 13

Trazadone is a prodrug that is converted to a serotonin receptor antagonist (5-HT2A)

Question 14

What is the mechanism of action for Vilazodone?

Answer 14

Acts as both an SSRI + serotonin antagonist at the 5-HT1A receptor in hippocampus.

Question 15

What is the mechanism of imipramine? What category of anti-depressant is imipramine?

Answer 15

Imipramine is selective for the serotonin re-uptake transporter while its metabolite is selective for the NE re-uptake transporter. Tricyclic

Question 16

How does mirtazapine work?

Answer 16

Antagonist at serotonin receptor. Also is an antagonist for NE receptor on the pre-synaptic cell. Because its an antagonist at the cell it enhances release of NE and 5-HT.

Question 17

How does phenalzine work and what class of drug is it?

Answer 17

Hydrazide that binds irreversibly with the enzyme MAO.MAOI

Question 18

How does Tranylcypromine work and what class of drug is it?

Answer 18

Does not bind MAO irreversibly but does have a long effect. MAOI

Question 19

What are the side effects of Trazadone?

Answer 19

sedation, GI disturbance, orthostatic hypotension (5-HT antagonist)

Question 20

What are the side effects of Mirtazapine?

Answer 20

significant sedation, increased appetite and weight gain

Question 21

What are the side effects of buproprion?

Answer 21

agitation, insomnia, anorexia

Question 22

What are the MAO-I side effects?

Answer 22

orthostatic hypotension, weight gain, sexual disturbances

Question 23

Your patient is taking an MAO-I and you want to counsel her on dietary restrictions she’ll have to adhere to. What do you want to warn her about?

Answer 23

Tyramine containing foods (red wine, smoked meats, smoked cheese) can lead to a hypertensive crisis because of uncontrolled catecholamine release.

Question 24

Your patient is taking an MAO-I and a lowly intern prescribes the patient an SSRI or SNRI. What adverse effect might be seen if and MAO-I is taken with an SSRI or SNRI?

Answer 24

Serotonin syndrome!

Question 25

Your patient is placed on an SSRI and asks you if its okay to take St. Johns Wort for the depression, sumatriptan for her migranes, and tramadol for her chronic pain. Why would you tell your patient this is dangerous?

Answer 25

This can cause SEROTONIN SYNDROME which can lead to an altered mental status, myoclonus, tremors, tachycardia, fever, agitation, HTN, ataxia, sweating, and GI symptoms.

Question 26

Your patient is a 15 year old with new onset major depressive disorder. Which SSRI is the only FDA approved SSRI for children and adolescents?

Answer 26

Fluoxetine

Question 27

Your patient has major depressive disorder and you want to treat her with an SSRI. You find out that she is also pregnant. Which SSRI is known to have a risk for adverse effects in pregnancy?

Answer 27

Paroxetine

Question 28

Which antidepressant is the most dangerous when it comes to overdosing?

Answer 28

TCA; prescribed on a no-refill basis

Question 29

Overdosing on buproprion can lead to ...

Answer 29

Seizures

Question 30

Overdosing on mertazapine can lead to ...

Answer 30

sedation, disorientation, tachycardia

Question 31

What is the main mechanism by which antidepressants are cleared from the body?

Answer 31

Metabolism by liver enzymes

Question 32

What are the 4 first-line drugs of choice for antidepressants?

Answer 32

SSRI, SNRI, buproprion, mirtazapine

Question 33

What is the clinical use of lithium?

Answer 33

Mood stabilizer for bipolar disorder.

Question 34

What are the side effects of lithium?

Answer 34

Tremor, sedation, edema, heart block (inhibits K+ entry to myocytes), hypothyroidism, polyuria, teratogenesis.