Antidepressants

Question 1

5-HT uptake inhibitors (SSRIs)

Answer 1

Fluoxetine
Paroxetine
Sertraline
Citalopram

Question 2

Can occur with any drug that increases 5-HT

Hyperthermia, confusion, myoclonus, CV collapse, flushing, diarrhea, seizures

Answer 2

Serotonin syndrome

Treatment with cyproheptadine

Question 3

What do you have to watch out for when prescribing antidepressants for children and adolescents?

Answer 3

Suicide

Question 4

Symptoms of SSRI withdrawal

Answer 4

Dizziness
Light-headedness
Vertigo
Shock-like sensations
Paresthesia 
Symptoms begin 1-7 days after stopping an SSRI

Question 5

Approved uses for SSRI

Answer 5

Major depression
OCD
Panic disorder
Social anxiety disorder
PTSD
Generalized anxiety disorder
PMS 
Hot flashes associated with menopause

Question 6

First SSRI on market

Long half-life active metabolite - 7 days or more

Answer 6

Fluoxetine

Question 7

Similar to fluoxetine with less effects on drug metabolism
Shorter half-life
OCD, PTSD, panic attacks

Answer 7

Sertraline

Question 8

Approved for hot flashes associated with menopause

Answer 8

Paroxetine

Question 9

Drugs that block both 5-HT and NE reuptake

SE more like SSRI-like than TCA-like

Answer 9

SNRI

Question 10

SNRI
Approved for major depressive disorder and anxiety
Also approved for neuropathic pain syndromes, fibromyalgia, back pain and osteoarthritis pain

Answer 10

Duloxetine

Question 11

SNRI for MDD and anxiety

Answer 11

Venlafaxine

Question 12

Atypical antidepressants

Answer 12

Buproprion
Mirtazapine
Trazodone

Question 13

Block reuptake of NE and 5-HT
Elevation of mood in depressed after about 2-3 weeks
Decreases REM and increases stage 4 sleep
Prominent anticholinergic effects (dry mouth, blurred vision, urinary retention)

Answer 13

TCAs

Question 14

Cardiac SE of TCAs

Answer 14

Due to anticholinergic effects and increased NE concentrations
Palpitations, tachycardia and arrhythmias
EKG changes

Question 15

Symptoms of TCA overdose

Answer 15

Hyperpyrexia, changes in BP, seizures, coma, cardiac conduction defects
Treatment is symptomatic

Question 16

Drug interactions with TCAs

Answer 16

Guanethidine - blocks uptake
Sympathomimetic drugs
Effects absorption and metabolism of other drugs

Question 17

Therapeutic uses of TCAs

Answer 17

MDD
Enuresis in childhood - imipramine
Chronic pain - amitriptyline
OCD - clomipramine and SSRIs

Question 18

MAO inhibitors
Antidepressant action takes about 2 weeks
Corrects sleep disorders in depressed patients
Used for MDD and narcolepsy

Answer 18

Phenelzine

Tranylcypromine

Question 19

SE of MAOIs

Answer 19

Lowers BP, can produces orthostatic hypotension

Acute toxicity can produce agitation, hallucinations, hyperpyrexia, convulsions and change in BP

Question 20

What are some physiological treatments of depression if antidepressant medications are not effective?

Answer 20

Electroconvulsive therapy
Transcranial magnetic stimulation
Deep brain stimulation

Question 21

Hypericum perforatum
Contains hypericin
Has MAOI activity

Answer 21

St. John’s Wort

Question 22

Drug interactions of St. John’s Wort

Answer 22

Increases 3A4 expression – BCP, protease inhibitors, cyclosporine