Q2 Antidepressants Module

Question 1

depression is a result of which neurotransmitters

Answer 1

• low: serotonin, NE, and dopamine

Question 2

MOA of MAOIs

Answer 2

• irreversible inhibition of MAO-A and MAO-B

- slows down metabolism of neurotransmitters

Question 3

what else does monoamine oxidase break down

what happens if it can’t break it down

Answer 3

• tyramine
• excess tyramine displaces serotonin, NE, and DA.
• excess NE and DA causes vasoconstriction leading ot hypertensive emergency

Question 4

what does MAO-A break down

Answer 4

• tyramine
• serotonin
• NE
• dopamine

Question 5

what does MAO-B break down

Answer 5

• dopamin

Question 6

examples of MAOis

Answer 6

• Selegiline
• Tranycypromine
• Phenelzine

MAO TPS

Question 7

importance of Selegiline at lose doses

how do you give it

Answer 7

• just MAO-B inhibitor
• bypasses GI tract
• it’s a patch

Question 8

negative effect of MAOi combined with SSRI

Answer 8

• serotonin syndrome

Question 9

symptoms of serotonin syndrome

Answer 9

• hyperthermia
• autonomic instability
• delirium
• muscle rigidity

Question 10

when switching from an SSRI to an MAOi, how long must you wait

what about when switching from Fluoxetine specifically

what is the big risk

Answer 10

• 2 weeks
• 5 weeks
• serotonin syndrome

Question 11

what do we use MAOIs to treat

Answer 11

• atypical depression

Question 12

what class of drug is Clomipramine

what do we use it to treat

Answer 12

• TCA

- OCD

Question 13

what do we use to treat OCD

Answer 13

• Clomipramine

Question 14

what are examples of tertiary TCAs

Answer 14

• amitriptylline
• imipramine
• clomipramine

IM AM CLO

Question 15

what are examples of secondary TCAs

Answer 15

• nortriptylline
• protriptylline
• desipramine

DES NO PRO (Dis no problem)

Question 16

adverse effects of TCAs

Answer 16

• cardiotoxicity

Question 17

we use low dose TCAs for what

Answer 17

• neuropathic pain
• migraine prophy
• insomnia

Question 18

when SSRIs are used for MDD, it can take how long to see a response

what symptoms improve first

what symptoms improve last

Answer 18

• 3-4 weeks
• energy level
• anhedonia, mood, cognitive symptoms

Question 19

warning with SSRIs

Answer 19

• may cause suicidal thoughts and behaviors in children and young adults

Question 20

shorter half-life of SSRIs can cause

Answer 20

• withdrawal syndrome

Question 21

non transient adverse effects of SSRIs

Answer 21

• SIADH

- sexual adverse effects

Question 22

SIADH adverse effect of SSRIs is most common in what population

Answer 22

• elderly

Question 23

what are some examples of SSRIs

half lives

what is the benefit/bad part with half lives

Answer 23

• paroxetine (less than 24 hours)
• citalopram (24 hours)
• escitalopram (24 hours)
• sertraline (24 hours)
• fluoxetine (a week)
• short half lives can result in withdrawal syndrome

Question 24

transient effects of SSRIs

Answer 24

• GI upset

- headache

Question 25

paroxetine and fluoxetine inhibit watch out for _____ when combined with antipsychotics

Answer 25

- 2D6 | - extra pyramidal symptoms

Question 26

symptoms of SSRI and SNRI withdraw syndrome

Answer 26

- flu-like symptoms - light headedness - uneasiness - sensory disturbance - headache - FLUSH

Question 27

what are the examples of SNRIs

Answer 27

- venlafaxine - desvenlafaxine - duloxetine - milnacipram - levomilnacpram - VDM

Question 28

side effect of venlafaxine

Answer 28

- dose related HTN

Question 29

side effect of duloxetine

Answer 29

- LFT increase

Question 30

effects of milnacipram and levomilnacpram

Answer 30

- norepinephrine effects

Question 31

SNRIs are used for treatment of

Answer 31

- pain

Question 32

Trazadone used to treat side effects

Answer 32

- insomnia | - orthostatic hypotension

Question 33

Nefazodone side effects

Answer 33

- hepatotoxicity

Question 34

Buproprion used to treat avoid in side effects

Answer 34

- Antidepressant that doesn't cause sexual dysfunction!! - smoking cession - ADHD - Anxiety - Bipolar - epilepsy - seizure disoders - constipation - insomnia

Question 35

side effects of Mirtazapine

Answer 35

- weight gain | - sedation

Question 36

adverse effects of lithium

Answer 36

- polydipsia and polyuria - nephrogenic DI - Ebstein's anomaly if in first trimester

Question 37

what organs can lithium interact with what side effects

Answer 37

- thyroid - hypothyroidism/goiter | - kidney

Question 38

what drugs do you avoid taking with lithium due to kidney effects

Answer 38

- thiazide diuretics - ACE inhibitors and ARBs - NSAIDs