Mood Stabilizers

Question 1

Biogenic Amine Hypothesis

Answer 1

Depression is due to deficiency of monoamines, such as NE, Serotonin at key sites in the brain

Question 2

MOA of Antidepressants

Answer 2

Inhibits reuptake of NE by blocking NET
Inhibits reuptake of 5-HT by blocking SERT

Question 3

Tertiary Amine TCAs

Answer 3

Amitriptyline (Elavil®)
Clomipramine (Anafranil®)
Imipramine (Tofranil®)
Doxepine (Aponal®)
Trimipramine (Surmontil®)
Dosulepine/ Dothiepin (Prothiaden®)

Question 4

Secondary Amine TCAs

Answer 4

Desipramine (Norpramin®)
Protriptyline (Vivactil®)
Nortryptyline (Pamelor®)

Question 5

A/Es of TCAs

Answer 5

Orthostatic Hypotension
Autonomic Side Effects
Cardiac Conduction Delays & Heart Block
Sexual Dysfunction
Sedation
Seizures
Weight Gain
Cardiac dysrhythmia

Question 6

Process involved in the biotransformation of Amitriptyline to Nortriptyline

Answer 6

N-demethylation

Question 7

Useful in the treatment of Nocturnal Enuresis (Bed Wetting) due to its Anticholinergic Effects

Answer 7

Imipramine

Question 8

Treatment of TCAs Toxicity

Answer 8

NaHCO3

Question 9

MOA of Selective serotonin reuptake inhibitors (SSRIs)

Answer 9

Inhibits reuptake of 5-HT!

Question 10

Most widely used drugs for treatment of depression and anxiety disorders

Answer 10

SSRIs

Question 11

TF: SSRIs are much safer than TCAs, as it seldom cause cardiac arrhythmia and seizures

Answer 11

True

Question 12

Selective Serotonin Reuptake Inhibitor
(SSRIs)

Answer 12

• Fluoxetine
• Paroxetine
• Fluvoxamine
• Sertraline
• Citalopram
• Escitalopram

Question 13

Fluoxetine

Answer 13

Depression
Panic
Bulimia
Anorexia nervosa
OCD

Converted to Norfluoxetine
Half-life: 2.5 Days

Question 14

Fluvoxatine

Answer 14

OCD, panic attack

Question 15

Can be used for elderly

Answer 15

Sertraline
SE: Sedation

Question 16

Paroxetine

Answer 16

For hot flushes and perimenopause (Low dose)

Question 17

A/Es of SSRIs

Answer 17

Increase alertness
Nervousness
Dizziness
Insomnia

Question 18

Serotonin Norepinephrine Reuptake
Inhibitor (SNRI)

Answer 18

Duloxetine - For neuropathic pain & GAD
Venlafaxine - Less affinity to NE reuptake
Milnacipran - For fibriomyalgia
Levomilnacipran (S-isomer)

Question 19

Noradrenaline Reuptake Inhibitor (NaRI)

Answer 19

Raboxetine

Question 20

Selective Serotonin Reuptake Enhancer (SSRE)

Answer 20

Tianeptine (Stablon®)

Question 21

Non-Selective Monoamine oxidase inhibitors (MAOIs)

Answer 21

Phenelzine (Nardil®)
Isocarboxacid
Tranylcypromine (Parnate®)

Question 22

Selective MAOI-A

Answer 22

Moclobemide (Aurorix®)

Question 23

Selective MAOI-B

Answer 23

Selegeline (Eldepryl®)

Question 24

MAOIs + SSRIs

Answer 24

Serotonin Syndrome

Question 25

MAOIs + Tyramine

Answer 25

Hypertension Crisis

Question 26

Weak inhibitor of the neuronal reuptake of dopamine, norepinephrine, and serotonin

Answer 26

Bupropion

Question 27

Bupropion MOA

Answer 27

Noncompetitive antagonist at nicotinic cholinergic receptors

Question 28

Bupropion clinical uses

Answer 28

Smoking deterrent Treatment of obesity (Bupropion + Naltrexone)

Question 29

5-HT2 antagonists

Answer 29

Nefazodone (Serzone®) - Hepatotoxic Trazodone (Desyrel®) - Cause Priapism (prolonged, painful erection) - ZODONE

Question 30

Tetracyclic antidepressant, alpha 2 receptor blocker

Answer 30

Mirtazapine - cause agranulocytosis

Question 31

Extracts of St. John's Wort

Answer 31

Hypericin - fewer SE, less effective

Question 32

Mania

Answer 32

Delusion Increased libido Elevated mood Talkativeness

Question 33

Lithium carbonate MOA

Answer 33

Reduces formation of Inositol triphosphate (IP3)

Question 34

1st line treatment & prevention of bipolar disorder

Answer 34

Lithium

Question 35

Diuretics + Lithium carbonate

Answer 35

Increase Li toxicity

Question 36

Adverse Effects of Lithium carbonate

Answer 36

Low Therapeutic Index Tremor, N/V Neurotoxic Cardiotoxic Polyuria Hypothyroidism Teratogenic (Eibstein anomaly)

Question 37

Idiosyncratic Reactions of Lithium Carbonate

Answer 37

Nephrogenic DI Thyroid abnormalities Ebstein Anomaly Alteration Levels of: a. Acetazolamide b. “xanthine” drugs c. Sodium competes with Li excretion *Increased levels of ACEi, NSAIDs, Thiazide Diuretics

Question 38

Alternative drugs for Bipolar disorder

Answer 38

Carbamazepine Lamotrigine Valproic acid Benzodiazepine - relieve manic symptoms

Question 39

For rapid cycling bipolar disorder and has better safety profile than Lithium

Answer 39

Valproic Acid

Question 40

For acute mania and prophylaxis for depressive phase of bipolar disorder

Answer 40

Carbamazepine (Tegretol)

Question 41

Atypical Psychotics can be used for Bipolar Disorder

Answer 41

Risperidone Olanzapine Aripiprazole Arsenapine