MOOD 8

Question 1

Celexa, bc of increased risk of Qtc prolongation and torsades, should NOT be concurrently prescribed in what six situations?

Answer 1

1. PImozide (neuroleptic, used for treatment resistant Tourettes)
2. QT >500
3. Cardiac problems (recent MI, uncompensated HF, Congenital long QT, hypoK or hypoMg, bradycardia.)
4. Class 1A drugs: (Quinidine, Procainamide)
5. Class 3 drugs: (Amiodarone, Sotalol )
6. Medications that prolong QT

Question 2

Celexa, bc of increased risk of Qtc prolongation and torsades, should be avoided in what (5) cardiac problems?

Answer 2

• recent MI
• uncompensated HF
• Congenital long QT
• hypoK or hypoMg
• bradycardia

Question 3

What is the triad Serotonin Syndrome?

Answer 3

1. Mental status change
2. Neuromuscular change: hyperreflexia, myoclonus, ocular clonus shivering, rigidity
3. Autonomic instability: Mydriasis, tachycardia, diaphoresis, diarrhea, vomit, fever.

Question 4

Other than antidepressants, what (6) medication classes can cause serotonin syndrome?

Answer 4

1. Antimigraine: Triptans
2. Opioids
3. Antiemetics: Odansatron, metoclopramide.
4. Abx: Linezolid
5. Supplements: St Johns wart, tryptophan
6. drugs of abuse: MDMA, LSD, cocaine, amphetamines.

Question 5

Serotonin Syndrome is similar in presentation with NMS….what are the key differences?

Answer 5

SS more likely to have:

• Shivering
• Hyperreflexia
• Myoclonus
• V/D

NMS more likely to have:

• Fever
• Muscle rigidity.

Question 6

What is the mnemonic for anticholinergic toxicity?

Answer 6

Red as a beet
Dry as a bone
Hot as a hare
Full as a flask
mad as a hatter
Blind as a bat

Question 7

What are the common symptoms of Serotonergic Antidepressant Discontinuation Syndrome?

Answer 7

1. Dizziness
2. Flu-like
3. Insomnia
   4 Nausea
4. “shock like” sensation
5. Reemergence of anxiety and mood symptoms.

Question 8

What is the MOA of Bupropion?

Answer 8

NE and DA reuptake inhibitor.

Question 9

What is the MOA of Mirtazapine?

Answer 9

alpha-2 presynaptic antagonist (causing increased release of Monoamines from presynaptic neuron)

5-HT2 and 5-HT3 antagonist (so little GI or sexual SE)

Question 10

What are the SE of Mirtazapine to be aware of?

Answer 10

1. Neutropenia (1:1000)
2. Sedation at low dose, activation at higher dose.
3. HTN (increase adrenergic drive)
4. Hypotension (alpha 1 antagonism)
5. Weight gain, increased appetite, dizziness, constipation.