Depression and Anxiety
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| State the mechanism of action of the SNRIs: | inhibit reuptake of serotonin & norepinephrine into CNS nerve terminals
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| List the side effects of SNRIs: | insomnia, nervousness, sexual dysfunction, serotonin syndrome, physical dependence/withdrawal symptoms, dry mouth, anorexia, CV effects (HTN, tachycardia)
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| State the mechanism of action of the SSRIs: | inhibit reuptake of serotonin into CNS nerve terminals
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| List the side effects of the SSRIs: | insomnia, nervousness, sexual dysfunction, serotonin syndrome, physical dependence/withdrawal symptoms
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| State the mechanism of action of the TCAs: | inhibit reuptake of serotonin, norepinephrine, & dopamine into CNS nerve terminals
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| List the side effects of the TCAs: | drowsiness, sedation, sexual dysfunction, physical dependence/withdrawal symptoms, anticholinergic side effects, CV effects (HTN & tachycardia), orthostatic hypotension
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| State the mechanism of action of the MAO-inhibitors: | inhibit breakdown of serotonin, norepinephrine, & dopamine in the CNS nerve synapses and inhibit tyramine breakdown in intestines
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| What typically guides drug selection in treatment of depression? | select drugs with fewer side effects; low cost; and can consider family response
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| Which class of antidepressants has the LEAST cardiac effects? | SSRIs (The TCAs & SNRIs have more because they both affect norepinephrine)
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| This SNRI is specifically FDA approved to treat fibromyalgia pain: | duloxetine (Cymbalta)
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| What is the difference between venlafaxine & desvenlafaxine? | one is a prodrug of the other
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| This class of antidepressants is most likely to cause orthostatic hypotension: | TCAs
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| This class of antidepressants is most likely to cause anticholinergic side effects & sedation: | TCAs
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| This class of antidepressants is most likely to cause sexual dysfunction: | SSRIs
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| This class of antidepressants is most likely to worsen dementia: | TCAs (anticholinergic effects)
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| This antidepressant causes sedation (take at bedtime): | trazodone (Desyrel) and mirtazepine (Remeron) and all the TCAs
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| Which antidepressants have life-threatening food interactions? | MAO-inhibitors (tyramine containing foods)
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| This antidepressant is used for smoking cessation: | bupropion (Wellbutrin, Zyban)
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| This antidepressant can be problematic for older men with BPH: | TCAs (because of their anticholinergic side effects – urinary retention)
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| This antidepressant causes weight gain and drowsiness as side effects (take at bedtime): | mirtazepine (Remeron)
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| List some tyramine containing foods: | cheese, liver, smoked meats; soy sauce; bananas; some wines and beers
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| List some food/OTC vasopressors: | chocolate, ginseng, caffeine beverages, oral decongestants, some diet pills
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| Life-threatening hyperpyrexia can occur when MAO-Is are taken with … | meperidine and dextromethorphan containing cough suppressants
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| Life-threatening hypertensive crisis can occur when MAO-Is are taken with … | ephedrine, amphetamines, cocaine, pseudoephedrine, TCA, SSRI, SNRIs
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| List symptoms of serotonin syndrome: | hypo/hypertension, agitation, muscle tightness & twitching, hyperthermia, shivering, tachycardia & other arrhythmias, seizures, coma and death
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| List the general therapeutic uses of the antidepressants: | anxiety (generalized anxiety, phobic disorders, obsessive compulsive disorder), premenstrual dysphoric disorder, bulimia, Tourette's syndrome, bipolar disease, neuropathic pain (diabetic peripheral neuropathy pain, post-herpetic neuralgia/shingles pain)
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| About how long does it take for antidepressants to take effect? | several weeks (3 – 4 weeks)
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| Are antidepressants addictive? | No, antidepressants do not cause psychological dependence. However, they can cause physical dependence and withdrawal symptoms so should not be stopped suddenly
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| Describe the general treatment for generalized anxiety disorders: | daily antidepressant or buspirone with or without a prn benzodiazepine for acute/breakthrough anxiety
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| This drug is used specifically for anxiety only and is NOT an antidepressant or benzodiazepine: | buspirone (Buspar)
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| Autonomic symptoms associated with acute PTSD and panic disorders can be treated with: | beta-blockers
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| Discuss the mechanism of action of buspirone (Buspar): | mechanism is unclear but involves serotonin
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| How fast will buspirone begin to work? | slowly, similar to the antidepressants
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| Classify this drug: amitriptyline | TCA
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| Classify this drug: bupropion | misc antidepressant
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| Classify this drug: buspirone | non-sedating anxiolytic
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| Classify this drug: citalopram | SSRI
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| Classify this drug: desipramine | TCA
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| Classify this drug: desvenlafaxine | SNRI
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| Classify this drug: doxepin | TCA
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| Classify this drug: duloxetine | SNRI
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| Classify this drug: escitalopram | SSRI
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| Classify this drug: fluoxeinte | SSRI
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| Classify this drug: fluvoxamine | SSRI
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| Classify this drug: imipramine | TCA
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| Classify this drug: mirtazapine | misc antidepressant
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| Classify this drug: nortriptyline | TCA
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| Classify this drug: paroxetine | SSRI
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| Classify this drug: phenelzine (Nardil) | MAO-inhibitor
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| Classify this drug: selegiline (Emsam) | selective MAO-B inhibitor
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| Classify this drug: sertraline | SSRI
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| Classify this drug: tranylcypromine (Parnate) | MAO-inhibitor
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| Classify this drug: trazodone | misc antidepressant
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| Classify this drug: venlafaxine | SNRI
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