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Depression and Anxiety
| Question | Answer |
|---|---|
| State the mechanism of action of the SNRIs: | inhibit reuptake of serotonin & norepinephrine into CNS nerve terminals |
| List the side effects of SNRIs: | insomnia, nervousness, sexual dysfunction, serotonin syndrome, physical dependence/withdrawal symptoms, dry mouth, anorexia, CV effects (HTN, tachycardia) |
| State the mechanism of action of the SSRIs: | inhibit reuptake of serotonin into CNS nerve terminals |
| List the side effects of the SSRIs: | insomnia, nervousness, sexual dysfunction, serotonin syndrome, physical dependence/withdrawal symptoms |
| State the mechanism of action of the TCAs: | inhibit reuptake of serotonin, norepinephrine, & dopamine into CNS nerve terminals |
| List the side effects of the TCAs: | drowsiness, sedation, sexual dysfunction, physical dependence/withdrawal symptoms, anticholinergic side effects, CV effects (HTN & tachycardia), orthostatic hypotension |
| 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 |
| What typically guides drug selection in treatment of depression? | select drugs with fewer side effects; low cost; and can consider family response |
| Which class of antidepressants has the LEAST cardiac effects? | SSRIs (The TCAs & SNRIs have more because they both affect norepinephrine) |
| This SNRI is specifically FDA approved to treat fibromyalgia pain: | duloxetine (Cymbalta) |
| What is the difference between venlafaxine & desvenlafaxine? | one is a prodrug of the other |
| This class of antidepressants is most likely to cause orthostatic hypotension: | TCAs |
| This class of antidepressants is most likely to cause anticholinergic side effects & sedation: | TCAs |
| This class of antidepressants is most likely to cause sexual dysfunction: | SSRIs |
| This class of antidepressants is most likely to worsen dementia: | TCAs (anticholinergic effects) |
| This antidepressant causes sedation (take at bedtime): | trazodone (Desyrel) and mirtazepine (Remeron) and all the TCAs |
| Which antidepressants have life-threatening food interactions? | MAO-inhibitors (tyramine containing foods) |
| This antidepressant is used for smoking cessation: | bupropion (Wellbutrin, Zyban) |
| This antidepressant can be problematic for older men with BPH: | TCAs (because of their anticholinergic side effects – urinary retention) |
| This antidepressant causes weight gain and drowsiness as side effects (take at bedtime): | mirtazepine (Remeron) |
| List some tyramine containing foods: | cheese, liver, smoked meats; soy sauce; bananas; some wines and beers |
| List some food/OTC vasopressors: | chocolate, ginseng, caffeine beverages, oral decongestants, some diet pills |
| Life-threatening hyperpyrexia can occur when MAO-Is are taken with … | meperidine and dextromethorphan containing cough suppressants |
| Life-threatening hypertensive crisis can occur when MAO-Is are taken with … | ephedrine, amphetamines, cocaine, pseudoephedrine, TCA, SSRI, SNRIs |
| List symptoms of serotonin syndrome: | hypo/hypertension, agitation, muscle tightness & twitching, hyperthermia, shivering, tachycardia & other arrhythmias, seizures, coma and death |
| 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) |
| About how long does it take for antidepressants to take effect? | several weeks (3 – 4 weeks) |
| 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 |
| Describe the general treatment for generalized anxiety disorders: | daily antidepressant or buspirone with or without a prn benzodiazepine for acute/breakthrough anxiety |
| This drug is used specifically for anxiety only and is NOT an antidepressant or benzodiazepine: | buspirone (Buspar) |
| Autonomic symptoms associated with acute PTSD and panic disorders can be treated with: | beta-blockers |
| Discuss the mechanism of action of buspirone (Buspar): | mechanism is unclear but involves serotonin |
| How fast will buspirone begin to work? | slowly, similar to the antidepressants |
| Classify this drug: amitriptyline | TCA |
| Classify this drug: bupropion | misc antidepressant |
| Classify this drug: buspirone | non-sedating anxiolytic |
| Classify this drug: citalopram | SSRI |
| Classify this drug: desipramine | TCA |
| Classify this drug: desvenlafaxine | SNRI |
| Classify this drug: doxepin | TCA |
| Classify this drug: duloxetine | SNRI |
| Classify this drug: escitalopram | SSRI |
| Classify this drug: fluoxeinte | SSRI |
| Classify this drug: fluvoxamine | SSRI |
| Classify this drug: imipramine | TCA |
| Classify this drug: mirtazapine | misc antidepressant |
| Classify this drug: nortriptyline | TCA |
| Classify this drug: paroxetine | SSRI |
| Classify this drug: phenelzine (Nardil) | MAO-inhibitor |
| Classify this drug: selegiline (Emsam) | selective MAO-B inhibitor |
| Classify this drug: sertraline | SSRI |
| Classify this drug: tranylcypromine (Parnate) | MAO-inhibitor |
| Classify this drug: trazodone | misc antidepressant |
| Classify this drug: venlafaxine | SNRI |
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