Antidepressants and anxiolytics

Question 1

What is the mechanism of action of TCAs?

Answer 1

Inhibits SERT and NERT: increases levels of serotonin and norepinephrine

Question 2

What are the “typical” side effects of TCAs?

Answer 2

1. From increased NE: tachycardia, hypertension, agitation, and insomnia
2. From increased 5-HT: stomach upset, sexual dysfunction, serotonin syndrome, increased bleeding

Question 3

What are special side effects of TCAs?

Answer 3

Cardiovascular toxicity: reflex tachycardia and QT prolongation

Question 4

T/F: TCAs are preferred in suicidal patients

Answer 4

False, they have the highest risk of death in overdose due to cardiac effects

Question 5

What are names of TCAs?

Answer 5

Amitriptyline, desipramine, nortriptyline

Question 6

What is the mechanism of SSRIs?

Answer 6

Inhibit SERT and increase serotonin

Question 7

What are common side effects of SSRIs?

Answer 7

From increased 5-HT: Stomach upset (GI issues), sexual dysfunction, serotonin syndrome, increased bleeding

Question 8

What drugs are SSRIs?

Answer 8

Fluoxetine, fluvoxamine, paroxetine, escitalopram, citalopram, sertraline

Question 9

What is the mechanism of action of SNRIs?

Answer 9

Inhibit SERT and NET: increase serotonin and norepinephrine

Question 10

What are common side effects of SNRIs?

Answer 10

1. From increased NE: tachycardia, hypertension (check bp) , agitation, and insomnia
2. From increased 5-HT: Stomach upset (GI issues), sexual dysfunction, serotonin syndrome, increased bleeding

Question 11

What is a special side effect of SNRIs?

Answer 11

They can cause really bad high blood pressure because they have no off target effects (no alpha 1 blockade)

Question 12

What drugs are SNRIs?

Answer 12

Duloxetine, venlafaxine, desvenlafaxine

Question 13

What is the mechanism of action of NDRI’s?

Answer 13

Inhibits DAT and NET: increase dopamine and norepinephrine

Question 14

What are the side effects of NDRI’s?

Answer 14

1. From increased dopamine: psychosis and increased risk of seizures
2. From increased NE: tachycardia, hypertension, agitation, and insomnia

Question 15

What are special fun facts about NDRI’s?

Answer 15

• It does not cause sexual dysfunction
• It decreases appetite and can actually cause weight loss
• It is contraindicated in patients with seizure disorders (BBW)
• When combined with naltrexone, it is approved as a weight management drug (contrave)

Question 16

What drug is an NDRI?

Answer 16

Bupropion

Question 17

Mirtazapine MOA?

Answer 17

alpha 2 antagonist & 5-HT2A antagonist

Question 18

Mirtazapine side effects GO…

Answer 18

Sedation and weight gain due to H1-antagonism

Question 19

Trazodone MOA?

Answer 19

Inhibits NET and SERT; 5-HT2 antagonist & H1-antagonist

Question 20

Trazzie side effects

Answer 20

Sedation and weight gain due to H1-antagonism; priapism

Question 21

Nefazodone MOA?

Answer 21

Inhibits NET and SERT; 5-HT2 antagonist

Question 22

Nefazodone side effects

Answer 22

Sedation, weight gain, and hepatotoxic (BBW)

Question 23

Nefazodone side effects

Answer 23

Sedation, weight gain, and hepatotoxic (BBW)

Question 24

T/F: There is less sexual dysfunction with atypical antidepressants

Answer 24

True

Question 25

T/F: MAO-inhibitors are first line antidepressants

Answer 25

False ya dummy- They are only used for treatment-resistant depression now bc

Question 26

MOA Inhibitors mechanism of action?

Answer 26

Inhibit MAO(A) and increase serotonin and norepinephrine

Question 27

What are common adverse effects seen with MAO-Is?

Answer 27

1. From increased NE: tachycardia, hypertension (and orthostatic hypotension d/t octopamine), agitation, and insomnia 2. From increased 5-HT: Stomach upset (GI issues), sexual dysfunction, serotonin syndrome, increased bleeding

Question 28

What are fun facts you should know about MAO-Is?

Answer 28

Drug food interactions can lead to hypertensive crisis so avoid tyramine-containing foods (wine and cheese)

Question 29

What are examples of MAO-I's?

Answer 29

Selegiline, phenelzine, tranylcypromine

Question 30

What classes are good treatment options for anxiety?

Answer 30

SSRI, SNRI, TCA, BDZ, buspar, propanolol

Question 31

What can SSRIs be used for?

Answer 31

generalized anxiety disorder, panic disorder, social anxiety disorder, OCD, and PTSD

Question 32

What can SNRIs be used for?

Answer 32

generalized anxiety disorder, panic disorder, social anxiety disorder

Question 33

What can TCAs be used for?

Answer 33

OCD (clomipramine)

Question 34

What can benzodiazepines be used for?

Answer 34

Generalized anxiety disorder and panic disorder

Question 35

What can buspirone be used for?

Answer 35

Generalized anxiety disorder

Question 36

T/F: SSRIs are the agents of choice for long term treatment of anxiety related disorders

Answer 36

True

Question 37

What is paroxetine used for?

Answer 37

generalized anxiety disorder, panic disorder, social anxiety disorder, OCD, and PTSD

Question 38

What can sertraline be used for?

Answer 38

panic disorder, social anxiety disorder, OCD, and PTSD

Question 39

What can fluoxetine be used for?

Answer 39

Panic disorder and OCD

Question 40

What can fluvoxamine be used for?

Answer 40

OCD only

Question 41

What can escitalopram be used for?

Answer 41

GAD

Question 42

Buspirone

Answer 42

- Only anxiolytic activity - Least effective tx for anxiety - Most effective after 1-4 weeks of treatment

Question 43

What is the MOA of buspar?

Answer 43

It is a partial agonist at 5-HT2A receptors

Question 44

What are side effects of buspirone?

Answer 44

Dizziness and non-specific chest pain