Antidepressents

Question 1

3 medication targets that help with depression

Answer 1

1. NE
2. dopamine
3. serotonin

Question 2

MAO inhibitor overall target

Answer 2

non-selctive blockade of MAO enzyme that is repsonsible for breakdowm of catecholamines s

Question 3

Phenelzine

Answer 3

MAO B and MAO A inhibitor

Question 4

Selegiline

Answer 4

MAO-B selectivity inhibitor

tx for Parkinson’s

Question 5

concern of MAO inhibitor

Answer 5

hypertensive crisis with consumption of foods containing tyramine

• avoid with other Anti-D due to amplification of effects

Question 6

tricyclic antidepressants

Answer 6

Primarily involves inhibition of the re-uptake of NE & to some extent 5HT

Question 7

amitriptyline

Answer 7

tricyclic Anti-D

also used for neuropathies , migraine, sleep at lower doses

Question 8

SE of tricyclic Anti-D

Answer 8

• bind to post-synaptic receptors
• weight gain
• dry mouth, constipation, urinary retention, blurred vision
• reduced/loss of libido

EKG changes with QT prolongation and some sodium blocks

Question 9

benadryl

Answer 9

anti-histamine

but also block muscarinic

Question 10

what is kd again?

Answer 10

lower value indicates tighter binding

Question 11

in case of overdose if Tri. Anti-D?

• induce or not induce vomiting?
• use activated characoal?
• what if we see QRS widening?

Answer 11

• do not induce vomiting: can lead to increase risk for aspiration and rapid neuro and hemodynamic deterioration
• yes: tend to see delayed gastric emptying
• • in case of QRS widening: alkalinize serum with NaHCO3

Question 12

SSRIs

Answer 12

Selectively block pre-synaptic re-uptake of serotonin

Question 13

Why start with SSRIs?

Answer 13

easiest to start with

Question 14

SSRIs all undergo

Answer 14

extensive hepatic metabolism

Question 15

most common SE with SSRIs?

Answer 15

nausea and headaches

Question 16

SSRIs with anxiety and restlessness and tremor might be due to a slight increase with

Answer 16

dopamine

Question 17

can we dive anti-D to bipolar patients?

Answer 17

Nope might induce mania/or hypomania episodes

Question 18

excitalopram might cause

Answer 18

QT prolongation

Question 19

SIADH might be associated with which SE

Answer 19

hyponatremia

Question 20

serotonin syndrome

Answer 20

vague constellation of symptoms:

• autonomic: shivering, tachychardia
• CNS: agitation
• GI: nausea
• neuromuscular: weakness

Question 21

SNRIs

Answer 21

inhibit reuptake of both serotonin and NE

Question 22

Duloxetine

Answer 22

SNRIs

can laso be used to tx. nerve related pain

Question 23

trazodone

Answer 23

serotonin modulator

give too much and they will sleep the day away

Question 24

Bupropion (Wellbutrin IR, SR, XR)

Answer 24

MOA: primarily blocks re-uptake of dopamine and to some extent NE

Question 25

Mirtazapine (Remeron) possible SE?

Answer 25

primary activity at blocking alpha-2-receptors sedation and weight gain possible SE

Question 26

A 29 yo woman is diagnosed with a major depressive disorder. She is otherwise healthy and has no known drug allergies. She has recently entered into a new relationship and is concerned about taking a medication 1. bupropion 2. citaalopram 3. fluoxetine 4. venlafaxine

Answer 26

bupropion

Question 27

If difficulty sleeping or poor appetite: what is preferred?

Answer 27

Mirtazapine or Paroxetine may be preferred

Question 28

If sexual dysfunction: what is preferred?

Answer 28

Bupropion or Mirtazapine may be preferred

Question 29

If h/o cardiovascular disease: caution?

Answer 29

Caution use of TCAs, SNRIs, MAOIs

Question 30

Risk for overdose: avoid what?

Answer 30

Avoid TCAs

Question 31

History of seizures: avoid what?

Answer 31

Avoid Bupropion