Antidepressants

Question 1

Antidepressant selection is based upone what three things?

Answer 1

past history of response
side effect
coexisting medical conditions

Question 2

What kind of drug are TCAs?

Answer 2

antidressants

Question 3

What kind of drug are MAOIs?

Answer 3

antidepressants

Question 4

SSRI

Answer 4

selective serotonin reuptake inhibitors

Question 5

SNRIs

Answer 5

serotonin/norepinephrine reuptake inhibitors

Question 6

What EKG change may you see while taking TCAs?

Answer 6

QT elongation

Question 7

What are some examples of antihistaminic side effects?

Answer 7

sedation and weight gain

Question 8

What are some examples of anticholinergi side effects?

Answer 8

dry mouth, dry eyes, constipation

Question 9

What are some examples of antiadrenergic side effects?

Answer 9

orthostatic hypotension, sedation, sexual dysfunction

Question 10

What are the active metabolites of tertiary TCAs?

Answer 10

desipramine

nortriptyline

Question 11

Tertiary TCAs act primarily on ______________ receptor

Answer 11

serotonin

Question 12

What are secondary TCAs?

Answer 12

often the metabolites of tertiary TCAs

Question 13

What kind of drug is desipramine?

Answer 13

secondary TCAs

Question 14

What kind of drug is notrtriptyline?

Answer 14

secondary TCAs

Question 15

What kind of side effects may you see with TCAs?

Answer 15

antihistaminic
anticholinergic
antiadrenergic

Question 16

MAOIs block the inactivation of what amines?

Answer 16

norepinephrine
dopamine
serotonin

Question 17

MAOIs ________________ the synaptic levels of certain amines

Answer 17

increase

Question 18

What are the AE of MAOIs?

Answer 18

orthostatic hypotension
weight gain
dry mouth
sedation
sexual dysfunction
sleep disturbance

Question 19

What should you avoid while taking MAOIs?

Answer 19

tyramine

Question 20

What is serotonin syndrome?

Answer 20

it can develop if MAOIs are taking with meds that increase serotonin or have sympathomimetic action

Question 21

What are the Sx of serotonin syndrome?

Answer 21

abdominal pain, diarrhea, sweats, tachycardia, HTN myoclonus, irritability, delirium

Question 22

What can serotonin syndrome lead to?

Answer 22

hyperpyrexia
cardiovascular shock
death

Question 23

How can you avoid serotonin syndrome?

Answer 23

wait 2 weeks before switching from an SSRI to an MAOI

Question 24

What drug needs to have a 5 week waiting period when switching drugs d/t the long half life?

Answer 24

fluoxetine

Question 25

What is the MOA of SSRIs?

Answer 25

block presynaptic serotonin reuptake

Question 26

What is the MC AE of SSRIs?

Answer 26

``` GI upset sexual dysfunction anxiety restlessness nervousness insomnia, fatigue, sedation, dizziness ```

Question 27

What is discontinuation syndrome?

Answer 27

happens w/SSRIs | agitation, nausea, disequilibrium, dysphoria

Question 28

______________ has a short half life with no active metabolite, which means no build up (good if hypomania develops)

Answer 28

paroxetine

Question 29

What are two pro's of paroxetine?

Answer 29

short half life | sedating properties

Question 30

Paroxetine has significant _______________ inhibition

Answer 30

CYP2D6

Question 31

What are some AE of paroxetine?

Answer 31

weight gain anticholinergic effects discontinuation syndrome

Question 32

Sertraline has very weak _______ interactions

Answer 32

P450

Question 33

What length half life does sertraline have?

Answer 33

short half life | lower build up of metabolites

Question 34

Which has more sedating properties, sertraline or paroxetine?

Answer 34

paroxetine

Question 35

A ___________ stomach is required for the absorption of sertraline

Answer 35

full

Question 36

Fluoxetine has a __________ half life

Answer 36

Long decreased risk of discontinuation syndrome increased risk of metabolite buildup

Question 37

What is a possible initial AE of fluoxetine?

Answer 37

increased anxiety and insomnia

Question 38

Fluoxetime is more likely to induce __________ than other SSRIs

Answer 38

mania

Question 39

In what type of patient should you use fluoxetine cautiously? why?

Answer 39

hepatic illness. b/c it has a long half life and there is a risk of metabolite buildup

Question 40

What are two pros of citalopram?

Answer 40

low inhibition of p450 | intermediate 1/2 life

Question 41

What is it a good thing that citalopram has a low inhibition of p450?

Answer 41

less drug/drug interaction

Question 42

What EKG change may you see with citalopram?

Answer 42

QT elongation | dose dependant, doses greater than 40 not recommended

Question 43

What is the MOA behind citaloprams sedating properties?

Answer 43

mild antagonism at H1 histamine receptor

Question 44

Citalopram has __________ GI AE than sertraline

Answer 44

less

Question 45

Escitalopram has a ________ inhibition of p450 enzems

Answer 45

low

Question 46

escitalopram is _________ effective than citalopram in acute response and remission

Answer 46

more

Question 47

Which SSRI has the shortest half life?

Answer 47

fluvoxamine

Question 48

What is a unique pro of fluvoxamine?

Answer 48

analgesic properties

Question 49

Fluvoxamine is a strong inhibitor of ___________ and __________

Answer 49

CYP1A2 | CYP2C19

Question 50

Inhibit both serotonin and noradrenergic reuptake like the TCAs but without the antihistamine, antiadrenergic or anticholinergic side effects

Answer 50

SNRIs

Question 51

What are SNRIs used to treat

Answer 51

depression, anxiety and neuropathic path

Question 52

______________ has almost no activity against P450

Answer 52

venlafaxine

Question 53

Why are desvenlafaxine and venlafaxine good for geriatric populations?

Answer 53

short half life and fast renal clearance avoids build up

Question 54

Venlafaxine can cause an increase in ___________ BP

Answer 54

diastolic

Question 55

What drug can cause significant nausea, especially with the IR tablet?

Answer 55

venlafaxine

Question 56

Tapering of venlafaxine is recommended after ________ of administration

Answer 56

2 weeks

Question 57

What is a con AE of desvenlafaxine?

Answer 57

dose related increase in total CHOL LDL and TG

Question 58

There is some data that suggests _________ may have some efficacy for the physical symptoms of depression

Answer 58

duloxetine

Question 59

Duloxetine is a _____________ and _____________ inhibitor

Answer 59

CYP2D6 | CYP1A2

Question 60

You cannot break the capsule of this drug as its active ingredient is not stable within the stomach

Answer 60

duloxetine

Question 61

This drug is a 5HT2 and 5HT3 receptor antagonists

Answer 61

mirtazapine

Question 62

Mirtazapine is _____________ at low doses

Answer 62

very sedative

Question 63

MOA of buproprion

Answer 63

reuptake inhibition of dopamine and norepinephrine

Question 64

This drug is a second line ADHD agent

Answer 64

buproprion

Question 65

You do NOT want to give this drug to a person suffering from anorexia/bulemia d/t risk of seizure

Answer 65

buproprion

Question 66

This drug has some abuse potential because it can iduce psychotic sx at high doses

Answer 66

buproprion

Question 67

For a treatment naive patient, you want to start with what kind of drug?

Answer 67

SSRI | citalopram, fluoxetine, sertraline

Question 68

Paxil and mirtazapine are poor first line choices because of thier ________ and____________ effects

Answer 68

sedation | weight gain

Question 69

What drug is contraindicated in a pt with HTN issues

Answer 69

venlafaxine

Question 70

What drug may help with neuropathic pain?

Answer 70

TCAs

Question 71

_____________ has an indication for neuropathic pain, dpression and anxiety

Answer 71

duloxetine