Quiz 2

Question 1

SSRIs compared to TCAs

Answer 1

• similar efficacy in depression
• clear improvement in safety margin
• less severe side effects

Question 2

main ADE of SSRIs

Answer 2

serotonin syndrome

Question 3

early hypothesis of SSRI action

Answer 3

enhance synaptic 5HT due to reuptake inhibition

Question 4

delayed hypothesis of SSRI action

Answer 4

altered gene expression and brain function

Question 5

SSRIs work well in people with

Answer 5

negative effect

- often fail to relieve symptoms of decreased positive effect

Question 6

SSRI side effects

Answer 6

hyponatremia, agitation, anxiety, panic attacks, restlessness, psychomotor retardation, mild parkinsonian & dystonic movements, rapid muscle movements during the night, inhibition of spinal reflexes of orgasm and ejaculation, N/V, increased bowel motility, GI cramps & diarrhea

Question 7

what is a main issue with SSRIs?

Answer 7

sexual dysfunction (>50%)

Question 8

effects of too much serotonin

Answer 8

anxiety, insomnia, sexual dysfunction, GI, serotonin syndrome. cardiac valve pathology

Question 9

effects of too little serotonin

Answer 9

bulimia, panic, OCD, depression

Question 10

Fluoxetine (Prozac)

Answer 10

• increases NE & DA
• good for pts with reduced positive effect
• metabolite has longer half-life and drug interactions

Question 11

sertraline (Zoloft)

Answer 11

• anxiolytic
• increase DA
• some positive effects

Question 12

paroxetine (Paxil)

Answer 12

• reduce anxiety symptoms
• weak NET inhibition
• block NOs (->sexual dys.)
• withdrawal symptoms

Question 13

fluvoxamine (Luvox)

Answer 13

• OCD & anxiety

Question 14

citalopram (cipramil)

Answer 14

• mild H1 blocker
• not many side effects
• R & S enantiomers

Question 15

S-citalopram (Escitalopram)

Answer 15

• pure S
• NO H1 activity
• NO CYP2D6 inhibition
• selective for ONLY SERT

Question 16

o SNRIs

Answer 16

• serotonin NE reuptake inhibitors

- duloxetine, venlafaxine

Question 17

venlafaxine (Effexor)

Answer 17

• blocks SRT (low doses)

- blocks NET (high doses

Question 18

levomilnacipran (Fetzima)

Answer 18

• greater potency for NERT than SERT

- no direct effects on DA

Question 19

o NDRIs

Answer 19

• NE dopamine reuptake inhibitors)

- bupropion

Question 20

bupropion (Wellbutrin)

Answer 20

• weak inhibitor of both NET and DAT
• metbolites are more potent
• for pts who cannot tolerate SSRIs or dont respond

Question 21

duloxetine (Cymbalta)

Answer 21

• blocker of 5HT and NE uptake

- chronic pain & pain w/ depression

Question 22

NRIs

Answer 22

• NE selective reuptake inhibitors

- atomoxetine(Strattera- ADHD), reboxetine (not FDA approved), viloxazine (depression)

Question 23

SARIs

Answer 23

• serotonin antagonist reuptake inhibitors

- trazodone, nefazodone

Question 24

trazodone (Desyrel)

Answer 24

• sedative antidepressant (H1 and alpha1)

Question 25

NaSSA

Answer 25

- noradrenergic specific serontonergic antidepressants | - mirtazapine

Question 26

mirtazapine (Remeron)

Answer 26

- antidepressant with strong sedative | - potent antagonist of alpha 2

Question 27

vilazadone (Viibryd)

Answer 27

- SSRI+ 5HT 1A partial agonist | - improved mood w/in one week

Question 28

what part of St. johns wort is thoughr ro help with depression?

Answer 28

Hyperforin

Question 29

unwanted effect of ST johns wort

Answer 29

inductionof P450 3A4

Question 30

major depression is a result of

Answer 30

neuronal loss in the hippocampus and prefrontal cortex

Question 31

myoclonic seizure

Answer 31

sudden muscle jerks (arms, legs)

Question 32

clonic seizures

Answer 32

decreased muscle tone followed by jerking

Question 33

tonic seizures

Answer 33

muscle stiffening

Question 34

atonic

Answer 34

loss of muscle tone (drop seizures)

Question 35

therapeutic targets for treating seizures

Answer 35

- blockade of excitatory (glutamatergic) input - strengthening of inhibitory (GABA) input - block NA channels - block CA channels