Antidepressants

Question 1

What are the 3 big classes of side effects of TCAs?

Answer 1

Antihistaminic
Anticholinergic
Antiadrenergic

Question 2

What antihistaminic side effects are there of TCAs?

Answer 2

Sedation

Weight gain

Question 3

What anticholinergic SEs are there?

Answer 3

Dry mouth
Dry eyes
Constipation

Question 4

What antiadrenergic SE are there?

Answer 4

Orthostatic hypotension

Sexual dysfunction

Question 5

How do TCAs work?

Answer 5

Side chains that bind to serotonin receptors

Question 6

What are examples of TCAs?

Answer 6

Amitrytiline
Clomipramine
Imipramine
Doxepin

Question 7

Heart SE of TCAs?

Answer 7

QT prolongation

Question 8

What are secondary TCAs?

Answer 8

Metabolites of TCAs

Primarily block noradrenaline

Question 9

How do monoamine oxidase inhibtors work?

Answer 9

Bind irreversibly to monoamine oxidase

Prevent inactivation of amines

Question 10

What amines are stopped from being deactivated by MAOIs?

Answer 10

Dopamine
Serotonin
Norepinephrine

Question 11

What happens with these non-inactivated amines?

Answer 11

They don’t get broken down in the gut and get absorbed to increase levels

Question 12

Side effects of MAOIs?

Answer 12

Orthostatic hypotension
Sexual dysfunction
Sleep disturbance
Sedation

HYPERTENSIVE CRISIS
SEROTONIN SYNDROME

Question 13

What causes a hypertensive crisis with MAOIs?

Answer 13

When consumed with tyrosine rich foods

Question 14

Why does tyrosine cause a hypertensive crisis with MAOIs?

Answer 14

Is also an amine that is sympathomimetic

Question 15

What must be done when switching an SSRI to a MAOI because of serotonin syndrome?

Answer 15

Must wait 2 - 3 weeks depending on SSRI halflife

Question 16

Example of a MAOI?

Answer 16

Phenelzine

Question 17

Name 6 SSRIs?

Answer 17

Sertraline
Fluoxetine
Paroxetine
Citalopram
Escitalopram
Fluvoxamine

Question 18

Pros of sertraline?

Answer 18

Weak P450 interactions
Short half life
Less sedating

Question 19

Cons sertraline?

Answer 19

GI adverse SE

Question 20

Pros paroxetine?

Answer 20

Short half life

No build up if mania occurs

Question 21

Cons paroxetine?

Answer 21

CYP2D6 inhibition
Sedation
Weight gain

Question 22

Pros fluoxetine?

Answer 22

Long half life
Increases energy
Good to use to wean off SSRIs and prevent discontinuation syndrome

Question 23

What is good about a longer half life in SSRIs?

Answer 23

Less chance of discontinuation syndrome

Question 24

Cons fluoxetine?

Answer 24

Increased chance of metabolite build up

P450 interactions

MORE LIKELY TO CAUSE MANIA!

Question 25

Pro citalopram?

Answer 25

Low P450 interaction | Longer half life than fluoxetine

Question 26

Cons citalopram?

Answer 26

LONG QT Sedation GI effects

Question 27

Pros fluvoxamine?

Answer 27

Analgesic properties

Question 28

Cons fluvoxamine?

Answer 28

Short half life Headache Strong inhibitor of CYPs

Question 29

4 SNRIs?

Answer 29

Venlafaxine Duloxetine Mirtazipine Bupropion

Question 30

How do SNRIs work?

Answer 30

Inhibit reuptake of serotonin and noradrenaline

Question 31

Pros venlafaxine?

Answer 31

No P450 activity Good renal clearance - Better for geriatrics

Question 32

Cons venlafaxine?

Answer 32

Increased BP Bad discontinuation syndrome QT prolongation

Question 33

Pros duloxetine?

Answer 33

Good for physical symptoms of depression | Smaller BP increase than venlafaxine

Question 34

Cons duloxetine?

Answer 34

CYP inhibitor | Study indicated high drop out rate

Question 35

Pros mirtazipine?

Answer 35

Good augmentation with SSRI Hypnotic Less sexual SE

Question 36

Cons mirtazipine?

Answer 36

Hella weight gain Increased cholesterol and TAGs Very sedating at low doses

Question 37

Pros bupropion?

Answer 37

Good augmentation No weight gain Low mania chance Good in ADHD

Question 38

Cons bupropion?

Answer 38

LOWERS SEIZURE THRESHOLD | Does not treat anxiety

Question 39

Pharma regimen for treatent resistant depression?

Answer 39

SSRI + SNRI + Lithium + antipsychotic ECT