Antidepressant Flash Card Supplement

Question 1 of 33

1

Which of the following drugs are classified as SSRIs?

Select one or more of the following:

Venlafaxine
Imipramine
Paroxetine
Bupropion
Phenylzine
Fluoxetine
Sertraline
Desvenlafaxine
Citalopram
Escitalopram

Explanation

Question 2 of 33

1

Which of the following drugs are classified as SNRIs?

Select one or more of the following:

Imipramine
Duloxetine
Mirtazapine
Fluoxetine
Venlafaxine
Desvenlafaxine
Selegiline

Explanation

Question 3 of 33

1

Which of the following drugs are classified as TCAs?

Select one or more of the following:

Imipramine
Trazodone
Amitriptyline
Clomipramine
Paroxetine
Escitalopram
Duloxetine

Explanation

Question 4 of 33

1

Which of the following drugs are classified as MAO-Is?

Select one or more of the following:

Amitriptyline
Selegiline
Duloxetine
Phenylzine
Citalopram
Bupropion
Trazodone

Explanation

Question 5 of 33

1

Which of the following drugs are classified as Atypical?

Select one or more of the following:

Mirtazapine
Fluoxetine
Amitriptyline
Citalopram
Trazodone
Imipramine
Bupropion

Explanation

Question 6 of 33

1

Fill the blank spaces to complete the text.

Hypothesis
 Abnormally low levels of norepinephrine and/or underlie

Evidence for this hypothesis includes:
 Reserpine, an (old) antihypertensive drug depletes pre-synaptic stores of (NE) and is associated with depressive symptoms.
 Autopsy studies of the brains of depressed suicide victims indicate a level of NE and/or serotonin (5-HT) metabolism in most brain regions
 Drugs found to be beneficial act to enhance NE or 5-HT levels.

A major weakness to this hypothesis is the therapeutic lag – effects of drugs on NE or 5-HT levels are observed yet therapeutic benefit takes a minimum of 1 to 4 to occur

Explanation

Question 7 of 33

1

Fill the blank spaces to complete the text.

Hypothesis
 Depression is associated with elevated levels
 axis is dysregulated
 Abnormal (low) function is common in depression

Explanation

Question 8 of 33

1

Fill the blank spaces to complete the text.

Hypothesis
 Laboratory research indicates that antidepressants BDNF production in
 This requires term (weeks) not term (days) treatment
 BDNF increases neurogenesis and connectivity
 Stress, pain and depression can BDNF
 Imaging studies indicate reduced hippocampal volume (size) in

Explanation

Question 9 of 33

1

Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for children?

Select one or more of the following:

Paroxetine
Citalopram
Escitalopram
Fluoxetine
Sertraline

Explanation

Question 10 of 33

1

Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for adolescents?

Select one or more of the following:

Fluoxetine
Paroxetine
Escitalopram
Citalopram
Sertraline

Explanation

Question 11 of 33

1

Which of the following are uses for Serotonin Selective Reuptake Inhibitors (SSRIs)?

Select one or more of the following:

Depression
PTSD
Premature ejaculation
PMDD
Panic disorder
Bulimia
Menopausal “hot flashes”
Enuresis
OCD
GAD

Explanation

Question 12 of 33

1

Which of the following are true about SSRIs?

Select one or more of the following:

Rapid metabolism requires multiple doses per day
Risk of serotonin syndrome if switching to MAOI
Antagonist for 5-HT2A receptor
Mechanism of action: inhibition of serotonin transporter (SERT)
Some are potent inhibitors of CYP 2D6
Narrow therapeutic index
High selectivity for SERT (serotonin transporter)
Sedating - taken at bedtime
First line (with SNRIs) treatment for depression
High therapeutic index

Explanation

Question 13 of 33

1

Which seven of the following are the adverse effects of SSRIs?

Select one or more of the following:

Increased risk of bleeding by inhibiting SERT in platelets
Headaches, insomnia or hypersomnia
Significant weight gain in some patients
Increased sweating, urinary retention
Reduced sexual function; may improve over time on drug
Discontinuation syndrome (anxiety, irritability, confusion, crying)
Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision,
confusion
Nausea, GI upset, diarrhea; all improve after the first week
Lowers seizure threshold, problem in epilepsy, alcoholism, eating disorders
Paroxetine is Category D – risk of heart defects with first trimester exposure

Explanation

Question 14 of 33

1

Which of the following are uses of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?

Select one or more of the following:

Neuropathic pain
Vasomotor symptoms of menopause
Social anxiety
Panic disorder
OCD
GAD
Depression
PTSD
Sedation
Stress urinary incontinence

Explanation

Question 15 of 33

1

Which of the following are true about SNRIs?

Select one or more of the following:

Dominant class of antidepressants until ~ 1990s when SSRIs took over
Used for depression, neuropathic pain, GAD, stress urinary incontinence, vasomotor symptoms of menopause
Highly sedating and not associated with tolerance or dependence
Antagonist for 5-HT2A receptor
Drugs have high selectivity for SERT and NET (norepinephrine transporter)
Has CNS stimulating effects, inhibits NE and dopamine transporters; increases presynaptic release of NE and dopamine
Venlafaxine is metabolized to desvenlafaxine by CYP 2D6
Narrow therapeutic index and bothersome side effects explain reduced use
Discontinuation symptoms with venlafaxine and desvenlafaxine are common
Used for depression, GAD, PTSD, OCD, panic disorder, PMDD, bulimia

Explanation

Question 16 of 33

1

Which of the following are the adverse effects of SNRIs?

Select one or more of the following:

Significant weight gain in some patients
Sedation
Discontinuation symptoms with venlafaxine and desvenlafaxine are common
Nausea, GI upset, diarrhea; all improve after the first week
Increased risk of bleeding by inhibiting SERT in platelets
Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
Increased sweating, urinary retention
Reduced sexual function; may improve over time on drug
Headaches, insomnia or hypersomnia
Increased blood pressure and heart rate; not a problem in most patients

Explanation

Question 17 of 33

1

Which of the following are the uses for Tricyclic antidepressants (TCAs)?

Select one or more of the following:

GAD
Enuresis
Cardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
Vasomotor symptoms of menopause
Headaches, insomnia or hypersomnia
Neuropathic pain
Depression
Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
Stress urinary incontinence
Category D – risk of heart defects with first trimester exposure

Explanation

Question 18 of 33

1

Which of the following are true about TCAs?

Select one or more of the following:

Used in depression that is unresponsive to SSRIs and SNRIs
Narrow therapeutic index and bothersome side effects explain reduced use
Drug-drug interactions with CNS depressants, e.g. antihistamines, alcohol, benzodiazepines
Dominant class of antidepressants until ~ 1990s when SSRIs took over
Potentially lethal in overdose
Less selectivity than SSRIs, SNRIs
As a class, they inhibit NET and SERT but variable profiles of individual drugs
Sedating – taken at bedtime
Metabolized by CYP 2D6, serum levels are affected by inhibitors
Efficacy is similar to SSRIs, SNRIs

Explanation

Question 19 of 33

1

Which of the following are the adverse effects of TCAs?

Select one or more of the following:

Sexual side effects
Histamine H1 antagonism: weight gain, sedation
Cardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
Increased risk of bleeding by inhibiting SERT in platelets
Adrenergic α1 antagonism: orthostatic hypertension
Has been associated with priapism
Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
Discontinuation syndrome (flu-like symptoms)
Category D – risk of heart defects with first trimester exposure
Headaches, insomnia or hypersomnia

Explanation

Question 20 of 33

1

Which of the following are true about Trazodone?

Select one or more of the following:

Seldom used as monotherapy
Rapid metabolism requires multiple doses per day
Adjunct with SSRI for patients with insomnia
Has CNS stimulating effects, inhibits NE and dopamine transporters; increases presynaptic release of NE and dopamine
Drugs have high selectivity for SERT and NET (norepinephrine transporter)
Used for depression and anxiety
Appetite stimulating – may be useful in depression plus anorexia
Not associated with sexual side effects, bleeding or weight gain
Antagonist for 5-HT2A receptor
Is used as a hypnotic – highly sedating and not associated with tolerance or dependence

Explanation

Question 21 of 33

1

Which of the following are the adverse effects of Trazodone?

Select one or more of the following:

Sedation
Potentially lethal in overdose (autonomic, cardiac, seizures)
Has been associated with priapism
Insomnia, restlessness
α1-antagonism: orthostatic hypotension
GI
Lowers seizure threshold, problem in epilepsy, alcoholism, eating disorders
Orthostatic hypotension
Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision,
confusion
Anorexia

Explanation

Question 22 of 33

1

Which of the following are true about Bupropion?

Select one or more of the following:

Has CNS stimulating effects, inhibits NE and dopamine transporters
Not sedating
Irreversible inhibition of MAO-A and MAO-B; long duration of effect
Antagonist at adrenergic α2 and 5-HT2 receptor
Drugs have high selectivity for SERT and NET (norepinephrine transporter)
Not used for anxiety
As effective as nicotine patches for smoking cessation
Not associated with sexual side effects, bleeding or weight gain
Increases presynaptic release of NE and dopamine
High selectivity for SERT

Explanation

Question 23 of 33

1

Which of the following are adverse effects of Bupropion?

Select one or more of the following:

Cardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
Anorexia
Insomnia
Lowers seizure threshold
Increased risk of bleeding by inhibiting SERT in platelets
Agitation, anxiety, headache, nausea
Significant weight gain in some patients
Sexual side effects
Sedation
Problem in epilepsy, alcoholism, eating disorders

Explanation

Question 24 of 33

1

Which of the following are true about Mirtazapine?

Select one or more of the following:

Sedating – useful for depression with insomnias
Antagonist at adrenergic α2 and 5-HT2 receptor
Used for depression, neuropathic pain, GAD, stress urinary incontinence, vasomotor symptoms of menopause
High selectivity for SERT (serotonin transporter)
Drug-drug interactions with alcohol, benzodiazepines
Used in neuropathic pain, enuresis
H1 antagonist
Metabolized by CYP 2D6, serum levels are affected by inhibitors
Appetite stimulating – may be useful in depression plus anorexia
Not associated with sexual side effects

Explanation

Question 25 of 33

1

Which of the following are adverse effects of Mirtazapine?

Select one or more of the following:

Orthostatic hypotension
Headaches, insomnia or hypersomnia
Dry mouth
Increased risk of bleeding by inhibiting SERT in platelets
Constipation
Category D – risk of heart defects with first trimester exposure
Weight gain
Has been associated with priapism
Nausea, GI upset, diarrhea; all improve after the first week
Cardiac conduction delays; arrhythmogenic: Potentially lethal in overdose

Explanation

Question 26 of 33

1

Which of the following are true about Monoamine oxidase inhibitors (MAOIs)?

Select one or more of the following:

Potential for drug/food interactions
MAO-B: metabolizes dopamine
Antagonist at adrenergic α2 and 5-HT2 receptor
MAO-B: metabolizes NE, 5-HT and dopamine
MAO-A: metabolizes NE, 5-HT and dopamine
Inhibits NE and dopamine transporters and increases presynaptic release of NE and dopamine
Irreversible inhibition of MAO-A and MAO-B; long duration of effect
MAO-A: metabolizes dopamine
Used in treatment resistant depression
Is used as a hypnotic – highly sedating and not associated with tolerance or dependence

Explanation

Question 27 of 33

1

Which of the following are adverse effects of MOAIs?

Select one or more of the following:

Dry mouth
Insomnia, restlessness
Discontinuation syndrome
Anorexia
Orthostatic hypotension
Headaches, insomnia or hypersomnia
Potentially lethal in overdose (autonomic, cardiac, seizures)
Weight gain
Constipation
Increased sweating, urinary retention

Explanation

Question 28 of 33

1

❌ ❌
 ❌ (delirium), ❌ (hypertension, tachycardia, sweating) and ❌ (tremor), also ❌, shivering
 ❌ serotonergic ❌ at least ❌ before starting MAOI; ❌ requires 5 weeks
 Discontinue MAOI for 2 weeks ❌ starting a serotonergic agent
 Linezolid (antimicrobial), dextromethorphan, sumatriptan, tramadol, ❌, St. John’s wart can cause serotonin syndrome in the presence of ❌ or MAOI

Drag and drop to complete the text.

Serotonin

Syndrome

Cognitive

autonomic

somatic

fever

Discontinue

antidepressants

2 weeks

6 weeks

4 weeks

before

after

SSRI

SNRI

methadone

fluoxetine

phenylzine

amitriptyline

Continue

sweating

nausea

Explanation

Question 29 of 33

1

Therapeutic use of antidepressants: ❌
Requires ❌ for benefit
❌ is ❌, if inadequate response then switch or ❌ another agent
~❌ respond to ❌ agent
~❌ respond if treatment is ❌
e.g. SSRI + bupropion/atypical antipsychotic
Many patients continue ❌ doses for year

Drag and drop to complete the text.

Depression

1-2 months

2-4 months

Trial period

4-12 weeks

add

30%

70%

initial

optimized

maintenance

paroxetine

bupropion

trazodone

90%

10%

50%

Anxiety

Pain

Explanation

Question 30 of 33

1

Therapeutic uses of ❌:
 Depression
 ❌
- SSRIs and SNRIs are approved for PTSD, OCD, social anxiety, GAD and panic disorder
- Slower onset of benefit than ❌
 ❌
- Effects on pain are ❌ of antidepressant effects
- ❌, SNRIs are more effective than others
 ❌
- ❌ and sertraline are approved therapies
 ❌
- ❌
- As effective as nicotine patches
 ❌
- More success with ❌ than ❌
- ❌ stimulates appetite and used in anorexia
 ❌
- ❌
- Most antidepressants (except bupropion, ❌) have sexual side effects
 ❌
- SSRIs and SNRIs show benefit

Drag and drop to complete the text.

antidepressants

Anxiety

Pain

Premenstrual Dysphoric Disorder

Smoking Cessation

Eating Disorders

Premature ejaculation

Menopausal “hot flashes”

benzodiazepines

independent

TCAs

Fluoxetine

Bupropion

bulimia

anorexia

Mirtazapine

SSRIs

SNRIs

MOAIs

mirtazapine

Explanation

Question 31 of 33

1

Choosing an antidepressant
 At the population level, ❌ is ❌ for all drugs
 SSRIs and ❌ are first line therapies
 choice is often based on ❌, potential drug interactions, patient ❌
 ❌

Drag and drop to complete the text.

efficacy

similar

different

SNRIs

TCAs

SSRIs

MAOIs

adverse effects

history

Bupropion

Explanation

Question 32 of 33

1

Antidepressants: Mechanisms of action
 ❌ (SSRIs)
 NET and SERT inhibition (❌, TCAs)
 5-HT2C agonist (❌)
 α2 antagonist (❌)
 ❌ (mirtazapine)
 MAO inhibition (❌)
 ❌ (❌)

Drag and drop to complete the text.

venlafaxine

trazodone

mirtazapine

SERT inhibition

5-HT2A, 2C, 3 antagonist

NE and DA potentiating

MAOIs

bupropion

Explanation

Question 33 of 33

1

Adverse effects
 Mirtazapine has ❌ affinity for ❌
 Antagonism of M, H1 and α1 is characteristic of ❌
- Dry mouth, sedation, ❌
- Cardiotoxicity
 ❌
- Weight gain, sexual dysfunction, drug interactions (plasma protein binding, drug metabolism), nausea, ❌

Drag and drop to complete the text.

H1

M

α1

TCAs

orthostatic hypotension

SSRIs

MOAIs

anorexia

sedation

insomnia

high

low

	Created by Victoria Wright about 7 years ago

WEEK 10 Quiz on Antidepressant Flash Card Supplement, created by Victoria Wright on 22/03/2017.

Antidepressant Flash Card Supplement

Question 1 of 33

Which of the following drugs are classified as SSRIs?

Select one or more of the following:

Explanation

Question 2 of 33

Which of the following drugs are classified as SNRIs?

Select one or more of the following:

Explanation

Question 3 of 33

Which of the following drugs are classified as TCAs?

Select one or more of the following:

Explanation

Question 4 of 33

Which of the following drugs are classified as MAO-Is?

Select one or more of the following:

Explanation

Question 5 of 33

Which of the following drugs are classified as Atypical?

Select one or more of the following:

Explanation

Question 6 of 33

Fill the blank spaces to complete the text.

Explanation

Question 7 of 33

Fill the blank spaces to complete the text.

Hypothesis  Depression is associated with elevated levels  axis is dysregulated  Abnormal (low) function is common in depression

Explanation

Question 8 of 33

Fill the blank spaces to complete the text.

Hypothesis  Laboratory research indicates that antidepressants BDNF production in  This requires term (weeks) not term (days) treatment  BDNF increases neurogenesis and connectivity  Stress, pain and depression can BDNF  Imaging studies indicate reduced hippocampal volume (size) in

Explanation

Question 9 of 33

Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for children?

Select one or more of the following:

Explanation

Question 10 of 33

Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for adolescents?

Select one or more of the following:

Explanation

Question 11 of 33

Which of the following are uses for Serotonin Selective Reuptake Inhibitors (SSRIs)?

Select one or more of the following:

Explanation

Question 12 of 33

Which of the following are true about SSRIs?

Select one or more of the following:

Explanation

Question 13 of 33

Which seven of the following are the adverse effects of SSRIs?

Select one or more of the following:

Explanation

Question 14 of 33

Which of the following are uses of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?

Select one or more of the following:

Explanation

Question 15 of 33

Which of the following are true about SNRIs?

Select one or more of the following:

Explanation

Question 16 of 33

Which of the following are the adverse effects of SNRIs?

Select one or more of the following:

Explanation

Question 17 of 33

Which of the following are the uses for Tricyclic antidepressants (TCAs)?

Select one or more of the following:

Explanation

Question 18 of 33

Which of the following are true about TCAs?

Select one or more of the following:

Explanation

Question 19 of 33

Which of the following are the adverse effects of TCAs?

Select one or more of the following:

Explanation

Question 20 of 33

Which of the following are true about Trazodone?

Select one or more of the following:

Hypothesis
 Depression is associated with elevated levels
 axis is dysregulated
 Abnormal (low) function is common in depression

Hypothesis
 Laboratory research indicates that antidepressants BDNF production in
 This requires term (weeks) not term (days) treatment
 BDNF increases neurogenesis and connectivity
 Stress, pain and depression can BDNF
 Imaging studies indicate reduced hippocampal volume (size) in

Therapeutic use of antidepressants: ❌
Requires ❌ for benefit
❌ is ❌, if inadequate response then switch or ❌ another agent
~❌ respond to ❌ agent
~❌ respond if treatment is ❌
e.g. SSRI + bupropion/atypical antipsychotic
Many patients continue ❌ doses for year

Choosing an antidepressant
 At the population level, ❌ is ❌ for all drugs
 SSRIs and ❌ are first line therapies
 choice is often based on ❌, potential drug interactions, patient ❌
 ❌

Antidepressants: Mechanisms of action
 ❌ (SSRIs)
 NET and SERT inhibition (❌, TCAs)
 5-HT2C agonist (❌)
 α2 antagonist (❌)
 ❌ (mirtazapine)
 MAO inhibition (❌)
 ❌ (❌)

Adverse effects
 Mirtazapine has ❌ affinity for ❌
 Antagonism of M, H1 and α1 is characteristic of ❌
- Dry mouth, sedation, ❌
- Cardiotoxicity
 ❌
- Weight gain, sexual dysfunction, drug interactions (plasma protein binding, drug metabolism), nausea, ❌