Depression - Ott and Watts

Question 1

Which SSRI can cause dose-dependent QTc prolongation?

Answer 1

Citalopram

Question 2

Which SSRIs are 2D6 inhibitors?

Answer 2

Fluoxetine, Paroxetine

Question 3

Which SSRI has a long half life (96-144 hours)?

Answer 3

Fluoxetine

Question 4

Fluvoxamine is an inhibitor of which CYP enzymes?

Answer 4

1A2, 2C19

Question 5

What birth defect can paroxetine cause?

Answer 5

Septal wall defect

Question 6

Which SSRI may cause more GI upset than other antidepressants?

Answer 6

Sertraline

Question 7

What adverse effect is associated with SSRIs, especially in the elderly?

Answer 7

Hyponatremia

Question 8

Duloxetine has an FDA warning for what?

Answer 8

Hepatotoxicity

Question 9

Amitriptyline is a ____________ amine

Answer 9

tertiary

Question 10

TCAs have a narrow therapeutic index and can be fatal in overdose due to what adverse effects?

Answer 10

cardiac arrhythmias
seizures

Question 11

For MAOIs, there must be a ____ week washout period before switching antidepressants

Answer 11

2

Question 12

MAOIs should be used with caution due to risk of what adverse events?

Answer 12

Serotonin syndrome
Hypertensive crisis

Question 13

When taking mirtazapine, sedation and increased appetite occur with doses ≤ ______ mg/day

Answer 13

15

Question 14

T/F: you can use vilazodone and vortioxetine in combination with SSRIs.

Answer 14

FALSE

Question 15

Antidepressant withdrawal syndrome is common with all antidepressants EXCEPT:

Answer 15

Fluoxetine

Question 16

What are the four FDA-approved augmentation agents?

Answer 16

Aripiprazole
Brexpiprazole
Cariprazine
Quetiapine

Question 17

MOA of vortioxetine

Answer 17

SSRI + 5HT1a agonist + 5HT3 antagonist

Question 18

MOA of vilazodone

Answer 18

SSRI
some 5HT1a agonism

Question 19

What was the first antidepressant? What class was it?

Answer 19

Imipramine - TCA

Question 20

Biogenic amine hypothesis of depression

Answer 20

1. Reserpine causes depression by depleteing NE and 5HT
2. Agents that increase 5HT and NE are effective for treating depression

Question 21

Neuroendocrine hypothesis of depression

Answer 21

Changes in hypothalamic-pituatary-adrenal (HPA) axis -
1. overactivity of HPA and elevated CRF found in almost all depressed patients
2. elevated CRF causes insomina, anxiety, etc.
3. Antidepressants reduce CRF levels

Question 22

Neurotrophic hypothesis of depression

Answer 22

1. brain-derived neurotrophic factor (BDNF) has antidepressant activity in animals
2. depressed patients have reduced levels of BDNF
3. Antidepressants increase BDNF levels

Question 23

MAOIs mechanism of action

Answer 23

Monoamine oxidase degrades NE and serotonin - inhibitors therefore increase the amount of NE and 5HT packed in vesicles which is then released into synapse

Question 24

Non-selective MAO inhibitors

Answer 24

Phenelzine (Nardil)
Tranylcypromine (Parnate)

Question 25

MAO-B selective MAOIs

Answer 25

Selegiline (Ensam)
Safinamide (Xadago)

Question 26

MAO-A selective MAOIs

Answer 26

Moclobemide (Manerix)

Question 27

When taking an MAOI, you should avoid foods with what? What are examples of these foods?

Answer 27

Foods with tyramine:
aged cheeses, sour cream, beer, red wine, avocados, bananas

Question 28

Major side effects of tertiary amines (TCAs)

Answer 28

Sedation
Weight gain
Autonomic side effects

Question 29

Examples of tertiary amines

Answer 29

Imipramine (Tofranil)
Amitriptyline (Elavil)
Clomipramine (Anafranil)
Doxepin (Adapin)

Question 30

In general, side effects of ALL TCAs are….

Answer 30

anticholinergic
CV
neurological
Weight gain

Question 31

Serotonin syndrome symptoms

Answer 31

hyperthermia, muscle rigidity, myoclonus, restlessness, sweating, shivering, seizures

Question 32

Serotonin syndrome treatment

Answer 32

1. stop medication
2. serotonin antagonists - cyproheptadine, methysergide
3. benzos for myoclonus

Question 33

What two drugs are 5HT2 antagonists and weak SERT inhibitors?

Answer 33

Trazodone (Desyrel)
Nefazadone (Serzone)

Question 34

Rapidly acting antidepressants are ______ antagonists

Answer 34

NMDA