E1- Antidepressants

Question 1

What drugs are classified as TCAs?

Answer 1

Amitriptyline
Imipramine
Nortriptyline
Desipramine

Question 2

What is the MOA of TCAs?

Answer 2

Inhibit reuptake of NE and 5-HT; also block alpha, histamine, and muscarinic receptors

Question 3

What are the uses of TCAs?

Answer 3

Depression (2nd to last choice)
Chronic pain (TMJ) Fibromyalgia
Enuresis

Question 4

What are the tertiary amine TCAs?

Answer 4

Amitriptyline

Imipramine

Question 5

What are the secondary amine TCAs? (primarily block NE re-uptake)

Answer 5

Nortriptyline

Desipramine

Question 6

Do tertiary or secondary amines produce more seizures and are more sedating?

Answer 6

Tertiary amines

Question 7

How are TCAs metabolized?

What should you avoid?

Answer 7

CYP2D6 (do not take with Fluoxetine- inhibits 2D6)

Question 8

What are SE of TCAs?

Answer 8

Weight gain
Antihistamine effects
Anticholinergic effects
Alpha blocker effects 
Analgesia
SIADH
Sexual dysfunction
Decreased seizure threshold

Question 9

Are TCAs safe in pregnancy?

Answer 9

Yes

Question 10

What is seen with TCA OD? How is it treated?

Answer 10

Torsades de pointes

Magnesium, isoproterenol, and cardiac pacing

Question 11

What are TCA drug interactions?

Answer 11

Fluoxetine (inhibits metabolism)
MAOIs (serotonin syndrome)
SSRIs
Amphetamines (HTN)
Alcohol/CNS depressants (sedation)
Anticholinergics

Question 12

What drugs are classified as SSRIs?

Answer 12

Fluoxetine
Sertraline
Paroxetine
Citalopram
Escitalopram

Question 13

What is the MOA of SSRIs?

Answer 13

Selectively inhibit the reuptake of 5-HT

Question 14

What are the uses of SSRIs?

Answer 14

Depression
Panic disorder
Bulimia
Alcoholism
Obsessive-compulsive disorder & social anxiety = Paroxetine

Question 15

What are SE of Fluoxetine?

Answer 15

Inhibits CYP2D6 (most drug interactions of SSRIs)
Impairs blood glucose in diabetics

Question 16

Which SSRI is least likely to cause drug interactions and preferred in the elderly?

Answer 16

Sertraline

Question 17

What is DOC for depression?

Answer 17

Citalopram

Question 18

What are SE of SSRIs?

Answer 18

Weight gain/loss
GI: nausea, loss of appetite, constipation
Anxiety/insomnia (Fluoxetine or Sertraline)
Sexual dysfunction
Photosensitivity

Question 19

Because SSRIs inhibit CYP3A4 and 2D6, what drug interactions should you watch for?

Answer 19

TCAs
Phenytoin
Carbamazepine

Question 20

What drug interactions of SSRIs can cause serotonin syndrome?

Answer 20

St. John’s Wort
Amphetamines
MAOIs
Meperidine (opioid)

Question 21

What drug interaction of SSRIs can cause heart block and hypotension?

Answer 21

B-blockers

Question 22

Fluoxetine can inhibit the conversion to the active compound of what drug?

Answer 22

Codeine (opioid)

Question 23

What drug interaction of SSRIs can increase risk of seizures?

Answer 23

Tramadol

Question 24

What drugs are classified as SNRIs?

Answer 24

Venlafaxine

Duloxetine

Question 25

What is the MOA of SNRIs?

Answer 25

Inhibit reuptake of NE and 5-HT

Question 26

What are the uses of SNRIs? (3)

Answer 26

Depression Neuropathic pain Post-menopausal hot flashes

Question 27

What drugs are classified as MAOIs?

Answer 27

Phenelzine | Selegiline

Question 28

What is the MOA of MAOIs?

Answer 28

Irreversibly inhibit MAOs

Question 29

MAO-A metabolizes what?

Answer 29

NE, DA, and 5-HT in both the CNS and GI tract

Question 30

MAO-B metabolizes what?

Answer 30

DA in the CNS, but not the GI tract

Question 31

What is the MOA of Phenelzine?

Answer 31

Inhibits both MAO-A and MAO-B (increases NE, 5-HT and DA)

Question 32

What is the use of Phenelzine?

Answer 32

Depression that has not responded to other drugs (LAST choice)

Question 33

What is the MOA of Selegiline?

Answer 33

Selectively inhibits MAO-B (increases DA)

Question 34

What are the uses of Selegiline?

Answer 34

Depression that has not responded to other drugs (LAST choice) Parkinson's

Question 35

What are SE of MAOIs?

Answer 35

``` HTN crisis (Phenelzine) -Avoid foods with tyramine (red wine, beer, aged cheese) Orthostatic hypotension Weight gain Anticholinergic effects ```

Question 36

What drug interactions of MAOIs can lead to serotonin syndrome/hyperpyrexia?

Answer 36

TCAs SSRIs Meperidine Dextromethorphan

Question 37

What drug interactions of MAOIs can lead to severe HTN?

Answer 37

OTC cold/cough medications Phenylephrine Ephedrine Amphetamines

Question 38

What is the MOA of Bupropion?

Answer 38

Inhibits DA reuptake

Question 39

What are uses of Bupropion?

Answer 39

ADHD Alcoholism Extended release for smoking cessation (Zyban)

Question 40

What are SE of Bupropion?

Answer 40

Seizures Anxiety, insomnia, restlessness, tremor, psychosis Tachycardia

Question 41

What is the MOA of Mirtazapine?

Answer 41

Blocks presynaptic alpha2 receptors --> increase release of NE 5-HT

Question 42

What are uses of Mirtazapine?

Answer 42

Eliminates SE associated with SSRIs | good choice for depressed pt with insomnia and anxiety

Question 43

What is the MOA of Atomoxetine?

Answer 43

Selective inhibitor of NE reuptake

Question 44

What is the use of Atomoxetine?

Answer 44

First non-stimulant tx of ADHD (good choice for addicts, no euphoria)

Question 45

What is the MOA of Trazodone?

Answer 45

5-HT2A receptor antagonist

Question 46

What are the uses of Trazodone?

Answer 46

Sleep aide and pain management

Question 47

What is a SE of Trazodone?

Answer 47

Priapism

Question 48

What may be effective in the tx of mild depression?

Answer 48

St. John’s Wort

Question 49

What is a SE of St. John’s Wort?

Answer 49

Photosensitivity

Question 50

What are drug interactions of St. John’s Wort?

Answer 50

``` DO NOT combine with other antidepressants (serotonin syndrome) Oral contraceptives Digoxin Protease inhibitors Warfarin ```