Pharm, antidepressants, Linger

Question 1

What are the sSRIs

Answer 1

citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
setraline

Question 2

what are the Selective serotonin NE reuptake inhibitors

Answer 2

duloxetine

venlafaxine

Question 3

what tricyclic antideppressants are used in depression

Answer 3

amitriptyline
desipramine
imipramine
nortriptyline

Question 4

what is the 5-HT2 antagonist used in depression

Answer 4

tazodone

Question 5

what are the tetracyclic and unicyclic agents

Answer 5

buproprion

mirtazapine

Question 6

what MAOI is used in depression

Answer 6

selegiline

Question 7

forms MAOI selegiline is available in

Answer 7

transdermal patch
sublingual
bypass gut and liver for increased bioavialability

Question 8

MOA SSRI

Answer 8

allosterically inhibit serotonin transporter to increase [ ] in cleft
80% SET blocked at therapeutic dose

Question 9

what is MOA proposed for chronic use SSRI

Answer 9

down regulation post synaptic %-HT2a R density

Question 10

SNRIs and tricyclic antidepressant MOA

Answer 10

inhibit SERT and NET increasing NT [ ]

Question 11

affinity of tricyclic antidepressants for R

Answer 11

muscarinic too, Histamine and alpha adrenergic

Question 12

5-HT2 antagonist MOA

Answer 12

trazodone and nefazodone

antagonize postsynaptic R to enhance tone

Question 13

MOA Bupropion

Answer 13

selective inhibitor of dopamine transporter stimulates release NE and DA
no direct effect on serotonin reuptake or R

Question 14

MAOI MOA

Answer 14

cause accumulation NE 5-HT and DA in vesiicles at nerve endings

Question 15

MOA selefiline

Answer 15

selective irreversible MAO-B inhibitor at low doses

nonselective MAOA/B inhibitor at high dosese (depression)

Question 16

MOA phenelzine and tranylcypromine

Answer 16

nonselective irreversible MAOIs

Question 17

which tricyclic antidepressants stimulate muscarinic R the most

Answer 17

amitriptyline

protriptyline

Question 18

which antidepressants work on SERT the most

Answer 18

citalopram
clomipramine
fluoxetine
flucoxamine
parozetine
sertraline

Question 19

which antidepressants have highest affinity for NET

Answer 19

despramine

protriptyline

Question 20

70-80% depressino patients achieve remission via what

Answer 20

switching to another agent or augmentation by addition of another drug

Question 21

When adequate response for depression achieved, what is therapy recommendation

Answer 21

minimum 6-12 mo to reduce risk of relapse

Question 22

patients considered for long term maintenance when

Answer 22

> 2 MDD episodes in previous 5 years or >3 in lifetime

Question 23

second most common use antidepressants

Answer 23

anxiety disorders

PTSD, OCD, social anxiety, generalized anxiety and panic disorder

Question 24

OCD is known to respond to what agents

Answer 24

serotonergic agents like fluoxetine and fluvoxamine, paroxetine and clompramine

Question 25

what antidepressants are used in pain disorders

Answer 25

TCA and SSRI

Question 26

What antidepressants are used for premenstrual dysphoric disorder

Answer 26

SSRIs fluoxetine setraline

Question 27

Tx schedule for premenstrual dysphoric disorder

Answer 27

2 weeks during luteal phase

Question 28

which antidepressants are used in eatind disorders

Answer 28

fluoxetine and others | bulimia not anorexia

Question 29

what antidepressants are used for insomina

Answer 29

amitriptyline and trazodone

Question 30

Which TCA is used for pruritis

Answer 30

doxepin because works on histamine R

Question 31

first line for Tx MDD and anxiety

Answer 31

SSRIs because fewer antimuscarinic effects and less cardiotoxic in overdose

Question 32

What is a drug for depression in patients who cannot tolerate sexual dysfunction, weight gain and sedation

Answer 32

bupropion

Question 33

2nd 3rd line agents for MDD

Answer 33

TCAs and MAOIs because potentially lethal in overdose need titration to achieve therapeutic dose serious effects and interactions

Question 34

Adverse effects of all antidepressants

Answer 34

increased suicidality in patients under age 25

Question 35

side effects SSRIs

Answer 35

mild sedation and antimuscarinic effects GI: nuasea, vomiting, upset stomach, constipation diminished sexual function libido delayed orgasm, diminished arousal HA, insomnia, hypersomnia and weight gain

Question 36

What is discontinuation syndrome

Answer 36

dizziness and paresthesia after sudden discontinuation | seen with SSRI and SNRI and TCA

Question 37

Serotonin syndrome

Answer 37

overdose SSRI or concurrent MAOI use

Question 38

CI to SSRI

Answer 38

patients displaying active manic Sx | paroxetine CI in pregnant patients

Question 39

Adverse effects to SNRIs

Answer 39

serotonergic effects and! noradrenergic like insomnia, anxiety and agitation inc BP and HR venlafaxine inc bleeding risk and related with cardiac toxicity in overdose

Question 40

adverse effects TCA

Answer 40

``` anticholinergic: dry mouth, constipation urinary retention, blurred vision and confusion orthostatic hypotension weight gain and sedation cardiotoxicity arrhythmias and heart block hepatic dysfunction hyponatremima hematologic abnormalities sexual side effects like sSRI ```

Question 41

which TCA exhibit marked antimuscarinic and cardiac side effects

Answer 41

imipramine and amitriptyline

Question 42

CI to TCA

Answer 42

arrhythmias, recent MI, liver disease, glaucoma, mania

Question 43

adverse effects 5-HT2 antagonist

Answer 43

sedation and GI disturbances | orthostatic hypotension

Question 44

black box warning nefazodone

Answer 44

hepatotoxicity and potentially lethal hepatic failure

Question 45

adverse effects bupropion

Answer 45

agitation and insomnia and anorexia

Question 46

which antidepressants do not have significant sexual side effects

Answer 46

5-HT2 antagonists | bupropion and mirtazapine

Question 47

adverse effects MAOIs

Answer 47

orthostatic hypotension and weight gain | highest rate sexual side effects!!!!!!!!

Question 48

discontinuation syndrome in MAOI

Answer 48

delirium like presentation with psychosis, excitement and confusion

Question 49

amitriptyline overdose

Answer 49

arrhythmia, altered mental status and seizures

Question 50

amitriptyline overdose

Answer 50

arrhythmia, altered mental status and seizures | gastric decontamination is helpful up to 8 hr post ingestion

Question 51

MAOI overdose

Answer 51

``` autonomic instability hyperadrenergic Sx psychotic Sx confusion delirium, fever and seizures ```

Question 52

pharmokinetics of antidepressants

Answer 52

inhibitors of CYP450 or substrates

Question 53

St Johns wort PK

Answer 53

herbal med that induces CYP450 | used to Tx depression

Question 54

Sx serotonin syndrome

Answer 54

cognitive: delirium, agitation coma ANS: HTN, tachy, hyperthermia, diaphoreses somatic: myoclonus, hyperreflexia, tremor

Question 55

switching between SSRI and MAOI

Answer 55

current therapy needs to be discontinued for at least 2 weeks ***6 weeks for fluoxetine because longer half life***

Question 56

Tx serotonin syndrome

Answer 56

withdraw offending drug, sedation with benzo, paralysis, intubation, ventilation consider 5-HT2 block with cyproheptadine or clorpromazine

Question 57

Foods with significant amounts tyramine

Answer 57

pickled, aged, smoked, marinated, meats (spoiled), chocolate, alcoholic beverages, fermented foods like cheese

Question 58

CI with tyramine food

Answer 58

MAOI because normally metabolized by MAO so with large amounts leads to HTN crisis NE release from peripheral nerves and inc HR and BP (potentially fatal!*)