Drugs Used for Depression, Bipolar Disorders, and Attention Deficit Hyperactivity Disorders, and Attention Deficit

Question 1

What is the Amine Hypothesis?

Answer 1

the idea that deletion of neurotransmitters like NE, 5HT and DA cause severe depression as indicated by treatment with drugs like reserpine

Question 2

Primary strategy for treating depression?

Answer 2

raise NE, and 5HT

Question 3

What does the acronym SSRIs stand for?

Answer 3

selective serotonin reuptake inhibitors

Question 4

What is the good way to remember the SSRIs by name? (a common suffix)

Answer 4

the “xetines” like fluoxetine and paroxetine but also sertraline, citalopram, and fluvoxamine

Question 5

MOA of SSRIs?

Answer 5

selective blockade of 5HT reuptake

Question 6

What are the uses of SSRIs?

Answer 6

• major depression
• OCD
• bulimia
• anxiety disorders
• premenstrual dysphoric disorder

Question 7

What are the S/E of SSRIs?

Answer 7

anxiety, agitation, bruxism, sexual dysfunction, weight loss

Question 8

Toxicity to remember common with SSRIs?

Answer 8

serotonin syndrome

Question 9

What are the symptoms of serotonin syndrome?

Answer 9

sweating, rigidity, myoclonus, hyperthermia, ANS instability, seizures

Question 10

What are some other drugs that when combined with SSRIs could lead to serotonin syndrome?

Answer 10

MAOIs, TCAs, and meperidine

Question 11

Which SSRIs inhibit cytochrome P450?

Answer 11

fluvoxamine and fluoxetine

Question 12

Which SSRI has the least drug interactions?

Answer 12

citalopram

Question 13

What is the MOA of TCAs?

Answer 13

non-specific blockade of 5HT and NE reuptake

Question 14

TCA suffix?

Answer 14

“pramine”

Question 15

What are some TCA drug names?

Answer 15

amitryptyline
imipramine
clomipramine

Question 16

Uses of TCAs?

Answer 16

major depression

phobic and panic states

OCD

Neuropathic pain

enuresis

Question 17

What are other MOAs of TCAs besides its main serotonin and NE blocking properties?

Answer 17

muscarinic and alpha blockade

Question 18

Toxicity of TCAs and how to remember?

Answer 18

3C’s coma, convulsions, and cardiotoxicity

Question 19

What are some drug interactions of TCAs to remember?

Answer 19

Hypertensive crisis with MAO inhibitors

serotonin syndrome with SSRIs MAOIs, and meperidine

prevent antihypertensive action of alpha 2 agonists

Question 20

What is an important suffix to remember for SNRIs?

Answer 20

“lafaxines”

Question 21

MOA of SNRIs

Answer 21

inhibit reuptake of both serotonin and NE

Question 22

S/E of SNRIs?

Answer 22

anorexia, somnolence, increase BP, SIADH, hepatotoxicity (duloxetine)

Question 23

List/Name the SNRI drugs.

Answer 23

venlafaxine, desvenlafaxine, duloxetine

Question 24

Toxicity of SNRIs?

Answer 24

serotonin syndrome with MAOIs, TCAs and meperidine

Question 25

MAOI MOA?

Answer 25

irreversible inhibition of MAO-A and MAO-B

Question 26

Use of MAOIs?

Answer 26

atypical depression

Question 27

Name some MAOI inhibitors?

Answer 27

phenelzine and tranylcypromine

Question 28

Drug interactions of SNRIs

Answer 28

* serotonin syndrome * NE inc. can lead to hypertensive crisis * drug releasers like tyramine, TCAs, a1 agonists, and levodopa should be avoided

Question 29

Name some other Antidepressants not in the SSRI, SNRI, or TCA category.

Answer 29

trazodone, bupropion, mirtazapine

Question 30

S/E trazodone.

Answer 30

cardiac arrhythmias and priapism, hypotension, sedation, etc

Question 31

Trazodone MOA?

Answer 31

blocks 5HT reuptake blocks 5-HT2B and 5HT2B receptors alpha blocker histamine blocker

Question 32

Bupropion MOA?

Answer 32

dopamine and NE reuptake blocker

Question 33

Use bupropion?

Answer 33

smoking cessation but not main choice

Question 34

Mirtazapine MOA?

Answer 34

a2 antagonist

Question 35

S/E of Mirtazapine?

Answer 35

weight gain

Question 36

Benefit of using SNRIs over TCAs?

Answer 36

like TCA but less autonomic effects

Question 37

Benefit of bupropion of trazodone.

Answer 37

because doesn't affect 5HT it has less sexual S/E

Question 38

Lithium is the DOC for what condition?

Answer 38

bipolar disorders

Question 39

MOA lithium?

Answer 39

prevents recycling inositol (dec PIP2) by blocking inositol monophosphatase dec cAMP

Question 40

What type of drugs should be avoided when using lithium?

Answer 40

lithium is cleared entirely by kidney so drugs that decrease GFR or inhibit sodium reabsorption in nephron may decrease its clearance and increase t1/2. Ex: NSAIDs, ACEI, ARBs, and most diuretics.

Question 41

What is an important distinction to make between the MOA of SSRIs and trazodone?

Answer 41

SSRIs block serotonin reuptake while trazodone blocks serotonin reuptake but also serotonin receptors themselves. Trazodone also has H1 and alpha blockade

Question 42

S/E of Lithium.

Answer 42

narrow TI tremor, flu-like symptoms, life-threatening seizures hypothyroidism and goiter nephrogenic diabetes insipidus (dec ADH effect)

Question 43

How can lithium cause hypothyroidism and goiter?

Answer 43

dec. TSH effects and inhibits 5'-deiodinase

Question 44

How does lithium cause nephrogenic diabetes insipidus?

Answer 44

decreases ADH effect because blocks V2 receptors so water can't be reabsorbed

Question 45

What do you treat lithium induced nephrogenic diabetes insipidus with? Why?

Answer 45

amiloride lithium competes for binding to sodium channels on the principal cells of the collecting duct (ENaC channels) if block these sodium channels then lithium can't come in and decrease ADH effect. More aquaporin channels are produced so water can be reabsorbed

Question 46

What are other drugs used to treat bipolar disorder besides lithium?

Answer 46

valproic acid and carbamazepine

Question 47

What are the teratogenic effects of using lithium?

Answer 47

Epstein anomaly (malformed tricuspid valve

Question 48

Does using methylphenidate or amphetamine have some cardiovascular toxicity?

Answer 48

yes

Question 49

What is the MOA of atomoxetine?

Answer 49

selective NE reuptake inhibitor

Question 50

S/E atomoxetine?

Answer 50

similar to TCAs