Messias TBL

Question 1

What is the current largest use of TCA’s?

Answer 1

Chronic Pain (Neuropathies)

Question 2

TCA’s Efx. on the CNS?

Answer 2

• Delirium, confusion, and manic rxns
• Sedation/Weight Gain
• Tremor
• REDUCED SEIZURE THRESHOLD

Question 3

TCA’s EFX. on Autonomics?

Answer 3

Antimuscarinic:
-Tertiary amines>secondary amines
-Dry mouth, blurred vision constipation
-DON'T USE W/ NARROW ANGLE GLAUCOMA
Alpha adrenergic antagonist:
-Secondary amines>tertiary amines
-Orthostatic hypotension, reflex tachycardia, and arrhytmias

Question 4

Tx. of acute overdose of TCA’s?

Answer 4

• Maintain Respiration
• Gastric Lavage W/Activated Charcoal
• Supportive Care
• Anti-arrhytmic agents for arrhythmias
• Benzodiazepines for seizures
• Bicarbonate to correct acidosis

Question 5

Drug Interactions w/ TCA’s

Answer 5

MAO Inhibitors and TCA usage can lead to hypertensive crisis!
When switching from the two drugs:
TCA->MAO 1 week
MAO->TCA 2 weeks

Question 6

SSRI Clinical Uses?

Answer 6

1) Depression
2) Combined with lithium for bipolar depression
3) Panic disorders (first choice for many however some choose benzodiazepines because of SSRI’s latency)
5) Generalized anxiety disorder
6) Obsessive compulsive d/o

Question 7

What are the metabolites of SSRI’s Fluoxetine and Sertraline?

Answer 7

Norflouxetine (critical) and Desmethylsertraline (minimal activity)

Question 8

Which SSRI may down regulate B-Adrenergic Receptors?

Answer 8

SERTRALINE

Question 9

Which of the two: flouxetine and sertraline are more potent?

Answer 9

Sertraline

Question 10

Which class of depression drug has a warning for cardiac birth defects?

Answer 10

SSRI’s

Question 11

Which SSRI is known to extend QT intervals?

Answer 11

Citalopram

Question 12

Which two SSRI’s do NOT inhibit P450?

Answer 12

Sertraline and Citalopram (IDEAL FOR POOR LIVER FXNIONING)

Question 13

Which SSRI is known to bind to plasma proteins displacing warfarin and digoxin?

Answer 13

Fluoxetine

Question 14

Combination of SSRI’s and what type of drug causes Serotonin Syndrome (5HT Toxicity)?

Answer 14

MAO Inhibitors

Question 15

Venlafaxine:

Answer 15

SSNRI

• Inhibits both 5-HT and NE reuptake
• High doses may produce “high”
• More selective for 5-HT than amitriptyline

Question 16

Duloxetine:

Answer 16

When compared to venlafaxine the inhibition of serotonin and NE is more equivalent

Question 17

Which 2nd generation anti-depressant blocks the 5-HT 2A receptor?

Answer 17

Trazodone (is also a moderate antagonist of alpha-2 adrenergic receptors)
-Nefazodone does this as well but unlike Trazodone it inhibits SER and NE

Question 18

What receptor does Mirtazepine block? Other General Properties?

Answer 18

• Blocks H1 Receptors
• Blocks Presynaptic alpha2 receptors
• Increased release of NE and 5-HT

Question 19

Which 2nd gen. AD can lead to permanent impotence?

Answer 19

Trazodone (only recommended as first line drug in men with enlarged prostate)
Nefazodone also has sexual side effects however not as drastic as above

Question 20

Which 2nd gen AD can have a hepatotoxic event?

Answer 20

Nefazodone, events includes rare fatalities and situations needing transplantation

Question 21

Averse fx. of mirtazepine?

Answer 21

Sedation, and INCREAED APPETITE and weight gain.

Question 22

Which two SSRI’s do not inhibit P450?

Answer 22

• sertraline

- citalopram

Question 23

Which SSRI displaces warfarin?

Answer 23

Fluoxetine

Question 24

SSRI’s used with MAOI’s can produce:

Answer 24

serotonin syndrome

-auto instability, hyperthermia, rigidity

Question 25

Sides of bupropion?

Answer 25

Dizziness, dry mouth, psychosis, tremors, INCREASED AGITATION MOST COMMON

Question 26

Which 2nd gen. misc. AD is known for drowsiness, orthostatic hypotension, and dry mouth? Emphasis on priapism?!?

Answer 26

Trazadone!

Question 27

Which 2nd gen. AD is known for hepatotoxicity?

Answer 27

NEFAZODONE

Question 28

Which 2nd gen is associated with sedation and weight gain?

Answer 28

Mirtazapine

Question 29

Which 2nd Gen. Inhibits CYP3A4?

Answer 29

NEFAZODONE