TCA

Question 1

Amitriptyline can be used for

Answer 1

1. Depression
2. Neuropathic pain
3. Migraine prophylaxis

Question 2

Common side effect of TCA:

Answer 2

1. GI and sexual dysfunction
2. Anticholinergic
3. Sedation
4. Wt gain
5. Arrhythmia
6. Sz
7. Fetal on overdose

Question 3

SSRI, E.g.

Answer 3

1. Fluxetine
2. Fluvoxamine
3. Escitalopram
4. Citalopram
5. Paroxetine
6. Sertraline

Question 4

Fluoxetine, can be used for

Answer 4

1. Depression
2. OCD
3. BULIMIA nervosa

Question 5

S/e of escitolopram and citalopram

Answer 5

1. Prolonged QTc if high dose in elderly
2. GI and sexual dysfunction
3. Hyponatremia
4. EPSE

Question 6

Mirtazapine, is

Answer 6

1. NaSSA (NorA and specific Serotonergic antidepressant)
2. Used for depression
3. Help to reverse GI and sexual dysfunction from SSRI OR SNRI
4. S.e. sedation, increase appetite and wt gain

Question 7

3 med, FDA approved for treatment of general anxiety

Answer 7

1. Alprazolam
2. Diazepam
3. Lorazepam

Question 8

Serotonergic agent + serotonergic agent or + high dose tramadol, would lead to

Answer 8

Serotonin syndrome

Question 9

S/s of serotonin syndrome:

Answer 9

Mild: insomnia, anxiety, nausea, diarrhoea, high BP, tachycardia, hyperreflexia

Mod: agitation, myoclonus, tremors, mydriasis, flushing, diaphoresis, low fevee

Servere: severe hyperthermia, confusion, rigidity, coma, resp failure, death

Question 10

Which Antidepressant is CYP450 inhibitor and with marked increase AUC

Answer 10

1. Fluvoxamine
2. Paroxetine
3. Bupropion

Question 11

Pt who suddenly discontinue antidepressant treatment(e.g. venlafacine, paroxetine), would develop:

Answer 11

1. Antidepressant discontinuation syndrome “FINISH”
   F: FLU LIKE syndrome
   I: INSOMNIA
   N: NAUSEA /VOMITING
   I: IMBALANCE
   S: SENSORY DISTURBANCE ( burning, tingling electric like sensation)
   H: hyperarousal (anxiety, irritability, agitation, mania, jerkiness)

Question 12

S/e of venlafaxine

Answer 12

HYPERTENSION

Question 13

Bupropion

Answer 13

1.No serotonergic effects (no sexual dysfunction)
2. Not suitable for h/o sz, eating d/o
3. Used for smoking cessation

Question 14

When start antidepressant for young pt <24yr old, need to watch out for:

Answer 14

1. Suicidality risk
2. Need to counsel pt and carers

Question 15

Antidepressant with low risk for CYP interactions:

Answer 15

1. Mirtazapine
2. Escitalopram

Question 16

Which drug is most likely to develop discontinuation syndrome:

Answer 16

1. Paroxetine
2. Venlafaxine
   (Due to short t1/2)

Less likely for fluoxetine (due to long half life)