Drug group - Antidepressant

Question 1

Antidepressant drug types

Answer 1

1. Tricyclic antidepressants
2. Monoamine oxidase inhibitors
3. Selective serotinin reuptake inhibitors
4. Noradrenaline reuptake inhibitors
5. Serotonin and noradrenaline reuptake inhibitors
6. Serotonin antagonists an reuptake inhibitors (SARIs)

Question 2

Tricyclic antidepressant - drug names

Answer 2

1. Amitryptiline - more sedative
2. Lofepramine - less anticholinergic
3. Clomipramine - only effective OCD drug

Question 3

Tricyclic antidepressant - mechanism of action

Answer 3

1. Block serotonin transporters (SERT) and noradrenaline transporters (NET) to inhibit reuptake of 5-HT (serotonin) and NA (noradrenaline)
2. increase extracellular levels and enhance neurotransmission
3. Antagonise - M1-muscarinic receptor/H1-histaminergic/alpha 1 adrenergic receptors which causes side effects

Question 4

Tricyclic antidepressant - indication

Answer 4

1. Depression - 2nd line
   - particularly useful when sedation required
2. Panic disorder - 2nd line
3. OCD - 2nd line

Question 5

Tricyclic antidepressant - contraindic

Answer 5

1. MI/arrythmias
2. severe Liver disease
3. Acute porphyria
4. manic phase of bipolar

Question 6

Tricyclic antidepressant - side effects

Answer 6

1. muscarinic M1 receptor antagonist - anticholinergic effects
   - dry mouth/blurred vision/constipation/impotence
2. histaminergic H1 - antihistamine effects e.g. sedation + weight gain
3. Alpha 1 - adrenergic - antisympathetic e.g. postural hypotension

Question 7

MAOIs - mechanism of action

Answer 7

1. inhibit monoamine oxidase to prevent the breakdown of amine neurotransmitters such as;
   - 5-HT, NA, melatonin

Question 8

MAOIs - drug names

Answer 8

1. Phenelzine - irreversible inhibitor

2. Moclobemide - reversible inhibitors/ fewer side effects

Question 9

MAOIs - indications

Answer 9

1. Depression - 2nd line
2. Panic disorder - 3rd line
3. Phobic disorder - 3rd line
4. OCD - 3rd line

Question 10

MAOIs - contraindic

Answer 10

1. use of TCA or SSRI
2. pheochromocytoma
3. Manic phase of bipolar disorder

Question 11

MAOIs- side effect

Answer 11

1. postural hypotension/ dizziness
2. Serotonin syndrome - interaction with TCA and SSRIs cause increase in serotonin + hypertensive crisis
3. irreversible inhibitors prevent breakdown of dietary amines (tyramine) found in aged cheese
   - > hypertensive crisis

Question 12

SSRI - drug names

Answer 12

1. Fluroxetine
2. Citalopram
3. Setraline

Question 13

SSRI - mechanism

Answer 13

1. selectively inhibits presynaptic reuptake of 5-HT into neurones
2. increases the amount of 5-HT neurotransmitter available for transmission

Question 14

SSRI - indication

Answer 14

1. Depression - 1st line
2. GAD - 1st line
3. Panic disorder - 1st line
4. Phobic disorder - 1st line

Question 15

SSRI contraindic

Answer 15

1. Cardiovascular disease
2. Diabetes mellitus
3. Manic phase of bipolar
4. Epilepsy
5. Glucoma

Question 16

SSRI - side effects

Answer 16

1. GI upset
2. Anorexia
3. Increase in anxiety - only for a few early days
4. Increased suicide risk in young patients

Question 17

NARI drug names

Answer 17

1. Reboxetine (Lofepramine)

Question 18

NARI indication

Answer 18

1. depression ( second line )

2. Panic disorder

Question 19

NARI contraindic/caution

Answer 19

1. cardiovascular disease
2. epilepsy
3. BPH, urinary retention, risk of glaucoma
4. Hepatic/renal impairment
5. Bipolar disorder

Question 20

Side effects of NARI

Answer 20

1. Nausea/ dry mouth/ Constipation/ urinary retention
2. Drowsiness
3. Adrenergic side effects :
   - tachycardia
   - Palpitations
   - Vasodilation
   - Hypertension
   - Postural hypotension

Question 21

SNRI drug names

Answer 21

1. Venlafaxine

2. Duloxetine

Question 22

mechanism of action of SNRI

Answer 22

1. inhibit the reuptake of 5-HT and NA into neurones and produce theraputic effects by increasing serotonin and noradrenaline
2. inhibit dopamine reuptake

Question 23

indications of SNRI

Answer 23

1. Depression - more effective SSRIs for severe depression so used in 2nd or 3rd line
2. GAD - 1st

Question 24

contraindication of SNRI

Answer 24

1. CVS disease
2. Hypertenison
3. Arrythmias
4. Epilepsy

Question 25

SARI ( serotonin antagonists and reuptake inhibitors) | - DRUG NAMES

Answer 25

1. Trazodone

Question 26

SARI mechanism of action

Answer 26

1. Predominantly acts as a Serotonin receptor antagonist but also has a weak inhibitory effect on serotonin reuptake 2. Potent alpha-1 adrenergic blockade 3. No muscarinic blockade

Question 27

SARI indications

Answer 27

1. Depression - particularly useful where sedation is required 2. GAD

Question 28

NASSAs

Answer 28

noradrenaline and specific serotonergic antidepressants

Question 29

NSSAs drug names

Answer 29

Mirtazapine

Question 30

NSSA indication

Answer 30

depression (2nd line)