Antidepressants

Question 1

MAOi chemistry.

Answer 1

Reversible MAOi type A: Moclobemide

Irreversible MAOi type B: Selegiline, Rasagiline, Phenelzine and Tranylcypromine

Question 2

What amino acid should be avoided with MAOi from fermented, aged food. Also explain.

Answer 2

Tyramine- also broke down by MAO, SE increase in BP, HTN crisis

Question 3

TCA drug derivatives examples and amine types.

Answer 3

Dibenzocyclohepatadiene deriv:
Amitriptyline (Elavil) tertiary amine 5HT=NE
Nortriptyline (Aventyl) secondary amine 
5HT>NE
Dibenzapine deriv: 
Desipramine (2nd) 
Imipramine (3rd)

Question 4

DOC for anxiety disorder (OCD)

Answer 4

Clomipramine

Question 5

TCA structures are similar to what type of antipsychotic drugs? And drug examples.

Answer 5

Phenothiazines: Chlorpromazine(aliphatic)
Thioridazine Mesoridazine (piperidine)
Prochlorperazine, Fluoperazine, Thioridazine ___
Trifluoperazine (piperazine)

Question 6

Serotonin Syndrome symptoms.

Answer 6

Agitation restlessness confusion tachy, HTN dilated pupils muscle tremors rigidity sweating diarrhea shivering seizure coma death

Question 7

Common SSRI and TCA SEs. And uncommon.

Answer 7

Both: Anticholinergic, sexual dysfunction
SSRI: INSOMIA, no weight gain
TCA: SEDATION, hypotension

Question 8

For Phenothiazines, this side chain has greater potency and highest pharmacological activity. What drug?

Answer 8

sc containing piperazine derivatives: Trifluoperazine

Question 9

This drug class has no chemical relation to Phenothiazines, produces high incidence extra pyramidal SEs. Give drug example.

Answer 9

Butyrophenones: Haloperidol

Question 10

Must cont. N cont. sc on N for antipsychotic activity drug.

Lack of ring N and sc.

Answer 10

Phenothiazines +N

Thioxanthines -N

Question 11

SSRIs.

Answer 11

Citalopram, Escitalopram, Fluvoxamine, Paroxetine, Fluoxetine, Sertraline, Olanzapine

Question 12

SNRIs.

Answer 12

Venlafaxine, Desvenlafaxine, Duloxetine

Question 13

Fluoxetine indications and t1/2

Answer 13

Children, adolescents and pregnancies
SE: insomia, potent CYP2D6 inhibitor
t1/2 200h - 5 weeks washout period may not require dose tapering

Question 14

Dual acting antidepressants and receptors.

Answer 14

Bupropion- NE & DA
Mirtazapine - NE directly & 5HT indirectly
Trazadone- 5HT2 antagonist with some 5HT reuptake inhibitory properties

Question 15

Trazodone dosing and SE

Answer 15

50-100mg hypnotic
300-400mg excessive sedation
SE: drowsiness and priapism

Question 16

Bupropion DOC and CI.

Answer 16

DOC: smoking cessation and depression
CI: anorexia or bulimia nervosa, head trauma or prior seizure

Question 17

DOC for depression and anxiety?

Major depression?

Answer 17

Fluoxetine

-SSRIs, dual acting, Mirtazapine and Moclobemide-(RIMA)

Question 18

Used as 2nd or 3rd line antidepressants and uses.

Answer 18

TCAs:
Clomi- OCD
Amitriptyline-migraine prophylaxis, chronic pain, neuralgia and depression
Nortriptyline-elderly depressed pts

Question 19

For RIMA: Moclobemide, DIs?

Answer 19

Sympathomimetics, Meperidine, Opioids antiHTN antipsychotics SSRIs Selegiline excessive Tyramine, alcohol
Reduce dose with Cimetidine

Question 20

Serotonin Syndrome occurs with which drugs?

Answer 20

All SSRIs, Venlafaxine, Non seletv MAO, Dextromethorphan, Linezolide, Mirtazapine, Moclobemide
also when combined with each other and with: MAOis, Li meperidine pentazocine

Question 21

Drugs act directly on noradrenergic system and has low rate of GI and sexual SEs but assoc. w sedation and weight gain?

Answer 21

Mirtazapine

Question 22

Prophilactically in treating manic-depressive pt, manic episodes and bipolar depression? And serum level?

Answer 22

Lithium. Should not exceed 1.5mEq/L

Question 23

SSRI onset of action?

TCA?

Answer 23

SSRI: 2-4 weeks and optimal effects 4-6 weeks
TCA: 4-6 weeks

Question 24

Depression with diabetes? Insomia?

Answer 24

Avoid TCA and MAOi due to weight gain

Trazodone-insomia

Question 25

SSRI like Fluoxetine inhibits what cytochrome?

Answer 25

CYP2D6

Question 26

Causes Li+ toxicity.

Answer 26

ACEi, NSAIDs, Thiazides, Fluoxetine SSRIs, dehydration and renal dysfunction
Li conc. varies with Na ions

Question 27

High doses of Venlafaxine (225mg/day) may have effect on?

Answer 27

HTN