Antidepressants

Question 0

Lexapro

Answer 0

Escitalopram
SSRI
Initial: 10mg Maintenance: 10-20mg

Question 1

Celexa

Answer 1

Citalopram
SSRI
Initial: 20mg Maintenance: 20-40mg (20mg of celexa=10mg of lexapro)
QT prolongation. Avoid in hepatic impairment and FQs(other QT prolonging drugs)

Question 2

Zoloft

Answer 2

Sertraline
SSRI
Initial: 50mg Maintenance: 50-200mg
Improves energy, increases DA: activating

Question 3

Prozac

Answer 3

Fluoxetine
SSRI
Initial: 20mg Maintenance: 20-80mg
Strong CYP2D6 inhibitor

Question 4

Paxil, Brisdelle, Pexeva

Answer 4

Paroxetine
SSRI
Initial: IR=20mg CR=25mg Maintenance: IR=20-50mg CR=25-62.5
Strong CYP2D6 inhibitor
Pregnancy category D
Sedation, sexual dysfxn, anticholinergic SEs , weight gain, withdrawal SEs

Question 5

Luvox

Answer 5

Fluvoxamine
SSRI
Initial: 50mg Maintenance: 50-300mg
Strong CYP1A2 inhibitor

Question 6

Effexor

Answer 6

Venalfaxine
SNRI
Prodrug
Initial: IR-75mg, XR-75mg
Maintenance: IR 75-375mg/day, XR 75-225mg/day
Acts like SSRI at low doses. Higher doses will start the block NET
SEs: GI upset, increase blood pressure, sweating and weight loss
Withdrawal syndrome bc of short half life

Question 7

Pristiq, Khedezla

Answer 7

Desvenlafaxine
SNRI
Initial: 50mg Maintenance: 50-400mg/day
Active metabolite of Effexor. Initial dose will block SERT and NET
Empty capsule may be present in stool

Question 8

Cymbalta

Answer 8

Duloxetine
SNRI
Initial: 30mg Maintenance: 30-120mg/day
Approved for fibromyalgia and neuropathic pain
Avoid use in alcoholics or hepatic impairment bc of hepatotoxicity risks

Question 9

Savella

Answer 9

Milnacipran
SNRI
Initial: 12.5 mg on day 1 than titrate per PI
Maintenance: 50-100mg BID
Avoid use in alcoholics or hepatic impairment bc of hepatotoxicity risk
SEs: headache, constipation, nausea, HTN

Question 10

Fetzima

Answer 10

Levomilnacipran
SNRI
Initial: 20 mg daily for 2-4 days increase to 40mg
Maintenance: 40-120mg/day take doses at same time qd
SEs: diaphoresis, constipation and nausea

Question 11

Remeron

Answer 11

Mirtazapine
Atypical (Seretonin receptor modulator)
Initial: 15mg QHS. Maintenance: 15-45mg/day
Increases lipids
Adjunct to treat: anxiety, insomnia, sexual dysfunction, GI SEs
Using with clonidine can cause rebound HTN

Question 12

Wellbutrin, Aplenzin, Forfivo

Answer 12

Bupropion
Atypical (NE, DA re uptake inhibitor)
Strong CYP2D6 inhibitor
Contraindicated in: epilepsy, eating disorders, abrupt discontinuation of alcohol or sedatives
Use as adjunct therapy to treat; lack of weight gain, sexual dysfxn, sedation
*lowers seizure threshold

Question 13

Desyrel, Oletro

Answer 13

Trazodone
Atypical (Seretonin receptor modulator)
3A4 metabolism to iminoquinone/reactive species leads to hepatotoxicity
SEs: priapism, orthostasis, sedation, dry mouth, nausea
Take on empty stomach. Used as adjunct therapy bc high doses as mono therapy lead to increased SEs
IR:300-600 mg/day
XR: 150-375 mg/day

Question 14

Serzone

Answer 14

Nefazodone
Atypical
BLACK BOX WARNING: life threatening hepatic failure

Question 15

Viibryd

Answer 15

Vilazodone
Atypical
Initial: 10mg. Maintenance: 40mg
Take with food

Question 16

Buspar

Answer 16

Buspirone

Atypical

Question 17

Brintellix

Answer 17

Vortioxetine
Atypical
Initial: 10mg. Maintenance: 5-20mg
SE: nausea

Question 18

Sinequan, Silenor

Answer 18

Doxepin
TCA-tertiary amine
Initial: 25mg QHS. Maintenance:100-300mg/day

Question 19

Anafranil

Answer 19

Clomipramine
TCA-tertiary amine
Initial: 25mg QD. Maintenance:100-200mg/day

Question 20

Elavil

Answer 20

Amitriptyline
TCA-tertiary amine
Initial: 25mg QHS. Maintenance:100-300mg/day

Question 21

Tofranil

Answer 21

Imipramine
TCA-tertiary amine
Initial: 75mg QHS. Maintenance:75-300mg/day

Question 22

Norpramin

Answer 22

Desipramine
TCA- secondary amine
Initial: 25mg QHS. Maintenance:50-150mg/day

Question 23

Pamelor

Answer 23

Nortriptyline
TCA-secondary amine
Initial: 25mg QHS. Maintenance:100-300mg/day

Question 24

Emsam

Answer 24

Selegiline patch MAOI Initial 6mg/24hours. Maintenance:6-12mg/24hours Selectively inhibits MAO-B in the gut so not dietary restrictions required

Question 25

Nardil

Answer 25

Phenelzine MAOI Initial:15mg/day. Maintenance: 30-90 mg/day

Question 26

Parnate

Answer 26

Tranylcypromine MAOI Initial:10 mg/day. Maintenance:30-60 mg/day in 2-4 divided doses

Question 27

Marplan

Answer 27

Isocarboxazid MAOI Initial:10mg BID Maintenance: 10-60 mg/ day in 2-4 divided doses

Question 28

Common side effects of SSRIs

Answer 28

Nausea, diarrhea, vomiting, sleep disturbances,headache and sexual dysfunction

Question 29

Bupropion IR dose

Answer 29

Initial: 100mg BID Maintenance: 150mg TID

Question 30

Bupropion SR dose

Answer 30

Initial: 150 mg in AM Maintenance: 150-200 mg BID

Question 31

Bupropion XL dose

Answer 31

Initial: 150mg daily Maintenance: 150-300mg/day

Question 32

Common side effects of SNRIs

Answer 32

``` GI, nausea,vomiting, constipation Insomnia/activation Sexual dysfunction Increased HR, BP Dilated pupils Dry mouth Excessive sweating ```

Question 33

TCA tertiary side effects

Answer 33

``` Sedation, anticholinergic, weight gain, conduction abnormalities SERT inhibition > NET Imipramine (Tofranil) Amitriptyline (Elavil) Clomipramine (Anafranil) Doxepin (Silenor) ```

Question 34

TCA secondary amine

Answer 34

Less side effects | Norpramin (desipramine), Pamelor (nortriptyline)

Question 35

MAOIs common side effects

Answer 35

``` Orthostasis Sedation Insomnia Headache Weight gain Sexual dysfunction Peripheral edema Constipation Hypertensive crisis from MAO-A inhibition in gut and tyramine.mavoid eating tyramine containing foods 14 days after MAOI D/C Seretonin syndrome ```

Question 36

Discontinuation syndrome

Answer 36

Avoid by tapering antidepressant dose by no more than 25%/week Onset is 1-3 days upon abrupt discontinuation Don't need to taper MAOIs upon d/c