CNS Part 3

Question 1

What are the SNRIs

Answer 1

Meds that affect both serotonin and norepinephrine

Venlafaxine
Duloxetine
Desvenlafaxine

Question 2

What can SNRIs be useful for other than depression?

Answer 2

Chronic pain associated with central and neuropathic pain conditions

Question 3

How Does venlafaxine work?

Answer 3

Blocks serotonin and and dopamine
Low doses act like SSRI
High doses act like SNRI

Question 4

When is venlafaxine indicated

Answer 4

Migraine headache prophylaxis (off label)

Question 5

When does venlafaxine show therapeutic effect?

Answer 5

2-4 weeks

Question 6

What are the AEs of venlafaxine

Answer 6

CNS headache, nervousness, somnolence, insomnia
GI - nausea, weight loss
Sweating, sexual dysfunction, diastolic hypertension, hyponatremia in elderly, neonatal withdrawal syndrome

Question 7

What is duloxetine indicated in

Answer 7

Neuropathic pain, fibromyalgia, chronic musculoskeletal pain

Question 8

What affects duloxetine absorption

Answer 8

Food reduces the rate and it is highly albumin bound

Question 9

What are the AEs of duloxetine

Answer 9

Nausea, headache, dry mouth, sweating, blurred vision

Question 10

What drugs inhibit duloxetine

Answer 10

Cimetadine, Luvox, Coro, TCAs, and quinidine

Question 11

How long does it take for the full SNRI response?

Answer 11

8-12 weeks

Question 12

Which SNRI has the worst withdrawal

Answer 12

Venlafaxine

Question 13

What are the atypical antidepressants

Answer 13

Bupropion, megadome, trazodone, mirtazapine, maprotiline

Question 14

Which atypical anntidpressant is a tetracycline antidepressant

Answer 14

Maprotiline

Question 15

What are the indications for bupropion?

Answer 15

Stimulant, appetite suppressant, depression, SAD, smoking cessation, obesity, low libido

Question 16

What are the AEs of bupropion

Answer 16

Seizures, dry mouth, nausea, insomnia, dizziness, anxiety, tremor

Question 17

How long should the washout period between MOAI and bupropion be?

Answer 17

2 weeks

Question 18

Which MOAI blocks MAOa and MAOb

Answer 18

Phenelzine

Question 19

Which MOAI acts similar to amphetamine and blocks reuptake of serotonin and catecholamines

Answer 19

Tranylcypromine

Question 20

Which MAOI is a non selective

Answer 20

Isocarboxazide

Question 21

Which MAOI is MAOa inhibition at low doses and MAOb at higher

Answer 21

Selegiline

Question 22

What is the MOA of MAOI

Answer 22

degraded NE, serotonin, and dopamine into inactive products.
It is irreversible

Question 23

What can MAO inhibition accidentally result in?

Answer 23

Tyramine toxicity which leads to a hypertensive crisis

Question 24

What food cause high tyramine levels

Answer 24

Plants, and animals, cheese, bananas, avocados, pineapple

Question 25

What are the second line uses of MAOI

Answer 25

Bulimia, OCD, and panic attacks

Question 26

What happens when MAOIs are given with other antidepressants

Answer 26

Hypertensive crisis or serotonin syndrome

Question 27

What are the three SNRIs

Answer 27

Venlafaxine, duloxetine, desvenlafaxine

Question 28

What adverse effect happens only in the elderly population on patients taking Venlafaxine

Answer 28

Hyponatremia

Question 30

What reduces the absorption rate of duloxetine

Answer 30

Taking with food

Question 31

Which SNRI causes blurred vision

Answer 31

Duloxetine

Question 32

How long does it take to see the effect effects of SNRIs

Answer 32

8 to 12 weeks to see the full response

Question 33

Which SNRI is more common to have discontinuation syndrome

Answer 33

Venlafaxine

Question 34

Which atypical antidepressant is a tetracyclic antidepressant that increases Norepinephrine

Answer 34

Maprotiline

Question 35

Which antidepressant is atypical antagonist of alpha two and serotonin receptors

Answer 35

Mirtazapine

Question 36

Which antidepressant down regulated, serotonin, receptors, and weekly inhibits serotonin reuptake

Answer 36

Trazodone

Question 37

Which atypical antidepressant is a weak dopamine, and Norepinephrine reuptake inhibitor

Answer 37

Bupropion

Question 38

When are atypical antidepressants preferred over first line agents?

Answer 38

When patients want lower incidence of weight gain and sexual side effects

Question 39

How long until you see the antidepressant effects of bupropion

Answer 39

One to three weeks

Question 40

Which MAOI is a non-selective inhibitor

Answer 40

Isocarboxazide

Question 41

Which MAOI can inhibit both MAOA and MOAB at higher doses

Answer 41

Selegiline

Question 42

What is the mechanism of action of MAOIs

Answer 42

They degrade norepinephrine and serotonin and dopamine into inactive products and irreversibly inhibit in the MOA and or B

Question 43

What can MAOI inhibition result in

Answer 43

Tire mean toxicity which leads to hypertensive crisis 

Question 44

What food should patients taking in MOAI avoid do the tyramine toxicity

Answer 44

Marinated meat, poultry, fish cheese, bananas, avocados, pineapple, and other foods that act as catecholamine releasing agents

Question 45

What are the second line therapeutic uses of monamine oxidation inhibitors?

Answer 45

Bulimia OCD and panic attacks

Question 46

True or false monoamine oxidase inhibitor can be combined with other antidepressants

Answer 46

False, it can lead to hypertensive crisis or serotonin syndrome

Question 47

What medications are classified as MAOI

Answer 47

Trancypromine, Selegiline, and phenelzine