Antidepressants

Question 1

Tricyclic Antidepressants (TCA’s)

Answer 1

AMITRIPTYLINE (ELAVIL), DOXEPINE (SINEQUAN)
MOA: Blocks the reuptake of norepinephrine and serotonin into nerves
-Oldest class of drugs, not used as much for depression
-Takes weeks to develop therapeutic effects, now used for neuropathic pain (fibromyalgia, bed wetting, diabetic neuropathy)

Question 2

Adverse Effects of TCAs

Answer 2

Anticholinergic: Dry mouth, constipation, blurred vision, mydriasis, urinary retention due to muscarinic receptor blockade
Orthostatic hypotension, drowsiness, sedation, weight gain due to histamine receptor blockade

Question 3

Selective Serotonin Re uptake Inhibitors (SSRIs)

Answer 3

Escitalopram (Lexapro), Fluoxetine (Prozac), Sertraline (Zoloft)
MOA: selectively blocking reuptake of serotonin

Question 4

SSRIs Adverse Effects

Answer 4

• Nausea, weight gain, anxiety, dizziness, dry mouth, trouble sleeping, sexual dysfunction for longterm, BLEEDING RISK here; no aspirin, ibuprofen, warfarin, naproxen
• Suicide risk with younger patients, risk is a lot higher

Question 5

Serotonin Syndrome

Answer 5

Symptoms: anxiety, restlessness, sweating, muscle spasms, shaking, fever, rapid heartbeat, vomiting and diarrhea

Question 6

Serotonin-Norepinephrine Re uptake Inhibitors

Answer 6

DULOXETINE (CYMBALTA), VENLAFAXINE (EFFEXOR)
MOA: Selectively blocking the reabsorption of the neurotransmitters serotonin and norepinephrine
Develop over the course of 6-8 weeks, used for fibromyalgia and diabetic neuropathy

Question 7

SNRIs Adverse Effects

Answer 7

Nausea, dizziness, sweating, tiredness, constipation, insomnia, sexual dysfunction is super common with duloxetine and venlafaxine
OTHER weird thing that can happen here is that you can’t be taking these if u have uncontrolled narrow angle or angle closure glaucoma

Question 8

Monoamine Oxidase Inhibitors (MAOIs)

Answer 8

• SELEGILINE (EMSAM) for Parkinson’s mostly
  MOA: Block activity of monoamine oxidase, an enzyme that breaks down norepinephrine, serotonin and dopamine in the brain and other parts of the body

Question 9

MAOI adverse effects

Answer 9

Hyperintensive crisis: MAOIs + tyramine- containing foods or beverages may cause dangerous elevations in blood pressure (cheese, wine, soy)
Significant drug interactions
Drugs that increase biogenic amines for eg TCAS, meperidine, dextromethorphan.
More adverse: CNS stimulation-anxiety, agitation, mania, orthostatic hypotension

Question 10

Atypical Drug Adverse Effects

Answer 10

Dry mouth, constipation, dizziness, lightheadedness
Mirtazapine and Trazodone: abnormal heart rhythms
Trazodone: rare sexual disorder called priapism
Nafezodone: liver failure
No buproprium

Question 11

St. John’s Wort

Answer 11

Contains variety of biologically active compounds. Standardized by amount of hypertension