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Antidepressant Flash Card Supplement
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Questions in this quiz (33)
1Which of the following drugs are classified as SSRIs?
- AVenlafaxine
- BImipramine
- CParoxetine
- DBupropion
- EPhenylzine
- FFluoxetine
- GSertraline
- HDesvenlafaxine
- ICitalopram
- JEscitalopram
2Which of the following drugs are classified as SNRIs?
- AImipramine
- BDuloxetine
- CMirtazapine
- DFluoxetine
- EVenlafaxine
- FDesvenlafaxine
- GSelegiline
3Which of the following drugs are classified as TCAs?
- AImipramine
- BTrazodone
- CAmitriptyline
- DClomipramine
- EParoxetine
- FEscitalopram
- GDuloxetine
4Which of the following drugs are classified as MAO-Is?
- AAmitriptyline
- BSelegiline
- CDuloxetine
- DPhenylzine
- ECitalopram
- FBupropion
- GTrazodone
5Which of the following drugs are classified as Atypical?
- AMirtazapine
- BFluoxetine
- CAmitriptyline
- DCitalopram
- ETrazodone
- FImipramine
- GBupropion
6[blank_start]Amine[blank_end] Hypothesis
Abnormally low levels of norepinephrine and/or [blank_start]serotonin[blank_end] underlie [blank_start]depression[blank_end]
Evidence for this hypothesis includes:
Reserpine, an (old) antihypertensive drug depletes pre-synaptic stores of [blank_start]norepinephrine[blank_end] (NE) and is associated with depressive symptoms.
Autopsy studies of the brains of depressed suicide victims indicate a [blank_start]low[blank_end] 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 [blank_start]immediately[blank_end] yet therapeutic benefit takes a minimum of 1 to 4 [blank_start]weeks[blank_end] to occur- AAmine
- Bserotonin
- Cdepression
- Dnorepinephrine
- Elow
- Fimmediately
- Gweeks
7[blank_start]Neuroendocrine[blank_end] Hypothesis
Depression is associated with elevated [blank_start]cortisol[blank_end] levels
[blank_start]HPA[blank_end] axis is dysregulated
Abnormal (low) [blank_start]thyroid[blank_end] function is common in depression- ANeuroendocrine
- Bcortisol
- CHPA
- Dthyroid
8[blank_start]Neurotrophin[blank_end] Hypothesis
Laboratory research indicates that antidepressants [blank_start]increase[blank_end] BDNF production in [blank_start]hippocampus[blank_end]
This requires [blank_start]long[blank_end] term (weeks) not [blank_start]short[blank_end] term (days) treatment
BDNF increases neurogenesis and [blank_start]synaptic[blank_end] connectivity
Stress, pain and depression can [blank_start]reduce[blank_end] BDNF
Imaging studies indicate reduced hippocampal volume (size) in [blank_start]depression[blank_end]- Aincrease
- Bhippocampus
- Clong
- Dshort
- Esynaptic
- Freduce
- Gdepression
- HNeurotrophin
9Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for children?
- AParoxetine
- BCitalopram
- CEscitalopram
- DFluoxetine
- ESertraline
10Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for adolescents?
- AFluoxetine
- BParoxetine
- CEscitalopram
- DCitalopram
- ESertraline
11Which of the following are uses for Serotonin Selective Reuptake Inhibitors (SSRIs)?
- ADepression
- BPTSD
- CPremature ejaculation
- DPMDD
- EPanic disorder
- FBulimia
- GMenopausal “hot flashes”
- HEnuresis
- IOCD
- JGAD
12Which of the following are true about SSRIs?
- ARapid metabolism requires multiple doses per day
- BRisk of serotonin syndrome if switching to MAOI
- CAntagonist for 5-HT2A receptor
- DMechanism of action: inhibition of serotonin transporter (SERT)
- ESome are potent inhibitors of CYP 2D6
- FNarrow therapeutic index
- GHigh selectivity for SERT (serotonin transporter)
- HSedating - taken at bedtime
- IFirst line (with SNRIs) treatment for depression
- JHigh therapeutic index
13Which seven of the following are the adverse effects of SSRIs?
- AIncreased risk of bleeding by inhibiting SERT in platelets
- BHeadaches, insomnia or hypersomnia
- CSignificant weight gain in some patients
- DIncreased sweating, urinary retention
- EReduced sexual function; may improve over time on drug
- FDiscontinuation syndrome (anxiety, irritability, confusion, crying)
- GAnticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision,
confusion - HNausea, GI upset, diarrhea; all improve after the first week
- ILowers seizure threshold, problem in epilepsy, alcoholism, eating disorders
- JParoxetine is Category D – risk of heart defects with first trimester exposure
14Which of the following are uses of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?
- ANeuropathic pain
- BVasomotor symptoms of menopause
- CSocial anxiety
- DPanic disorder
- EOCD
- FGAD
- GDepression
- HPTSD
- ISedation
- JStress urinary incontinence
15Which of the following are true about SNRIs?
- ADominant class of antidepressants until ~ 1990s when SSRIs took over
- BUsed for depression, neuropathic pain, GAD, stress urinary incontinence, vasomotor symptoms of menopause
- CHighly sedating and not associated with tolerance or dependence
- DAntagonist for 5-HT2A receptor
- EDrugs have high selectivity for SERT and NET (norepinephrine transporter)
- FHas CNS stimulating effects, inhibits NE and dopamine transporters; increases presynaptic release of NE and dopamine
- GVenlafaxine is metabolized to desvenlafaxine by CYP 2D6
- HNarrow therapeutic index and bothersome side effects explain reduced use
- IDiscontinuation symptoms with venlafaxine and desvenlafaxine are common
- JUsed for depression, GAD, PTSD, OCD, panic disorder, PMDD, bulimia
16Which of the following are the adverse effects of SNRIs?
- ASignificant weight gain in some patients
- BSedation
- CDiscontinuation symptoms with venlafaxine and desvenlafaxine are common
- DNausea, GI upset, diarrhea; all improve after the first week
- EIncreased risk of bleeding by inhibiting SERT in platelets
- FAnticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
- GIncreased sweating, urinary retention
- HReduced sexual function; may improve over time on drug
- IHeadaches, insomnia or hypersomnia
- JIncreased blood pressure and heart rate; not a problem in most patients
17Which of the following are the uses for Tricyclic antidepressants (TCAs)?
- AGAD
- BEnuresis
- CCardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
- DVasomotor symptoms of menopause
- EHeadaches, insomnia or hypersomnia
- FNeuropathic pain
- GDepression
- HAnticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
- IStress urinary incontinence
- JCategory D – risk of heart defects with first trimester exposure
18Which of the following are true about TCAs?
- AUsed in depression that is unresponsive to SSRIs and SNRIs
- BNarrow therapeutic index and bothersome side effects explain reduced use
- CDrug-drug interactions with CNS depressants, e.g. antihistamines, alcohol, benzodiazepines
- DDominant class of antidepressants until ~ 1990s when SSRIs took over
- EPotentially lethal in overdose
- FLess selectivity than SSRIs, SNRIs
- GAs a class, they inhibit NET and SERT but variable profiles of individual drugs
- HSedating – taken at bedtime
- IMetabolized by CYP 2D6, serum levels are affected by inhibitors
- JEfficacy is similar to SSRIs, SNRIs
19Which of the following are the adverse effects of TCAs?
- ASexual side effects
- BHistamine H1 antagonism: weight gain, sedation
- CCardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
- DIncreased risk of bleeding by inhibiting SERT in platelets
- EAdrenergic α1 antagonism: orthostatic hypertension
- FHas been associated with priapism
- GAnticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
- HDiscontinuation syndrome (flu-like symptoms)
- ICategory D – risk of heart defects with first trimester exposure
- JHeadaches, insomnia or hypersomnia
20Which of the following are true about Trazodone?
- ASeldom used as monotherapy
- BRapid metabolism requires multiple doses per day
- CAdjunct with SSRI for patients with insomnia
- DHas CNS stimulating effects, inhibits NE and dopamine transporters; increases presynaptic release of NE and dopamine
- EDrugs have high selectivity for SERT and NET (norepinephrine transporter)
- FUsed for depression and anxiety
- GAppetite stimulating – may be useful in depression plus anorexia
- HNot associated with sexual side effects, bleeding or weight gain
- IAntagonist for 5-HT2A receptor
- JIs used as a hypnotic – highly sedating and not associated with tolerance or dependence
21Which of the following are the adverse effects of Trazodone?
- ASedation
- BPotentially lethal in overdose (autonomic, cardiac, seizures)
- CHas been associated with priapism
- DInsomnia, restlessness
- Eα1-antagonism: orthostatic hypotension
- FGI
- GLowers seizure threshold, problem in epilepsy, alcoholism, eating disorders
- HOrthostatic hypotension
- IAnticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision,
confusion - JAnorexia
22Which of the following are true about Bupropion?
- AHas CNS stimulating effects, inhibits NE and dopamine transporters
- BNot sedating
- CIrreversible inhibition of MAO-A and MAO-B; long duration of effect
- DAntagonist at adrenergic α2 and 5-HT2 receptor
- EDrugs have high selectivity for SERT and NET (norepinephrine transporter)
- FNot used for anxiety
- GAs effective as nicotine patches for smoking cessation
- HNot associated with sexual side effects, bleeding or weight gain
- IIncreases presynaptic release of NE and dopamine
- JHigh selectivity for SERT
23Which of the following are adverse effects of Bupropion?
- ACardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
- BAnorexia
- CInsomnia
- DLowers seizure threshold
- EIncreased risk of bleeding by inhibiting SERT in platelets
- FAgitation, anxiety, headache, nausea
- GSignificant weight gain in some patients
- HSexual side effects
- ISedation
- JProblem in epilepsy, alcoholism, eating disorders
24Which of the following are true about Mirtazapine?
- ASedating – useful for depression with insomnias
- BAntagonist at adrenergic α2 and 5-HT2 receptor
- CUsed for depression, neuropathic pain, GAD, stress urinary incontinence, vasomotor symptoms of menopause
- DHigh selectivity for SERT (serotonin transporter)
- EDrug-drug interactions with alcohol, benzodiazepines
- FUsed in neuropathic pain, enuresis
- GH1 antagonist
- HMetabolized by CYP 2D6, serum levels are affected by inhibitors
- IAppetite stimulating – may be useful in depression plus anorexia
- JNot associated with sexual side effects
25Which of the following are adverse effects of Mirtazapine?
- AOrthostatic hypotension
- BHeadaches, insomnia or hypersomnia
- CDry mouth
- DIncreased risk of bleeding by inhibiting SERT in platelets
- EConstipation
- FCategory D – risk of heart defects with first trimester exposure
- GWeight gain
- HHas been associated with priapism
- INausea, GI upset, diarrhea; all improve after the first week
- JCardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
26Which of the following are true about Monoamine oxidase inhibitors (MAOIs)?
- APotential for drug/food interactions
- BMAO-B: metabolizes dopamine
- CAntagonist at adrenergic α2 and 5-HT2 receptor
- DMAO-B: metabolizes NE, 5-HT and dopamine
- EMAO-A: metabolizes NE, 5-HT and dopamine
- FInhibits NE and dopamine transporters and increases presynaptic release of NE and dopamine
- GIrreversible inhibition of MAO-A and MAO-B; long duration of effect
- HMAO-A: metabolizes dopamine
- IUsed in treatment resistant depression
- JIs used as a hypnotic – highly sedating and not associated with tolerance or dependence
27Which of the following are adverse effects of MOAIs?
- ADry mouth
- BInsomnia, restlessness
- CDiscontinuation syndrome
- DAnorexia
- EOrthostatic hypotension
- FHeadaches, insomnia or hypersomnia
- GPotentially lethal in overdose (autonomic, cardiac, seizures)
- HWeight gain
- IConstipation
- JIncreased sweating, urinary retention
28[blank_start]Serotonin[blank_end] [blank_start]Syndrome[blank_end]
[blank_start]Cognitive[blank_end] (delirium), [blank_start]autonomic[blank_end] (hypertension, tachycardia, sweating) and [blank_start]somatic[blank_end] (tremor), also [blank_start]fever[blank_end], shivering
[blank_start]Discontinue[blank_end] serotonergic [blank_start]antidepressants[blank_end] at least [blank_start]2 weeks[blank_end] before starting MAOI; [blank_start]fluoxetine[blank_end] requires 5 weeks
Discontinue MAOI for 2 weeks [blank_start]before[blank_end] starting a serotonergic agent
Linezolid (antimicrobial), dextromethorphan, sumatriptan, tramadol, [blank_start]methadone[blank_end], St. John’s wart can cause serotonin syndrome in the presence of [blank_start]SSRI[blank_end] or MAOI- ASerotonin
- BSyndrome
- CCognitive
- Dautonomic
- Esomatic
- Ffever
- GDiscontinue
- Hantidepressants
- I2 weeks
- J6 weeks
- K4 weeks
- Lbefore
- Mafter
- NSSRI
- OSNRI
- Pmethadone
- Qfluoxetine
- Rphenylzine
- Samitriptyline
- TContinue
- Usweating
- Vnausea
29Therapeutic use of antidepressants: [blank_start]Depression[blank_end]
Requires [blank_start]1-2 months[blank_end] for benefit
[blank_start]Trial period[blank_end] is [blank_start]4-12 weeks[blank_end], if inadequate response then switch or [blank_start]add[blank_end] another agent
~[blank_start]30%[blank_end] respond to [blank_start]initial[blank_end] agent
~[blank_start]70%[blank_end] respond if treatment is [blank_start]optimized[blank_end]
e.g. SSRI + bupropion/atypical antipsychotic
Many patients continue [blank_start]maintenance[blank_end] doses for year- ADepression
- B1-2 months
- C2-4 months
- DTrial period
- E4-12 weeks
- Fadd
- G30%
- H70%
- Iinitial
- Joptimized
- Kmaintenance
- Lparoxetine
- Mbupropion
- Ntrazodone
- O90%
- P10%
- Q50%
- RAnxiety
- SPain
30Therapeutic uses of [blank_start]antidepressants[blank_end]:
Depression
[blank_start]Anxiety[blank_end]
- SSRIs and SNRIs are approved for PTSD, OCD, social anxiety, GAD and panic disorder
- Slower onset of benefit than [blank_start]benzodiazepines[blank_end]
[blank_start]Pain[blank_end]
- Effects on pain are [blank_start]independent[blank_end] of antidepressant effects
- [blank_start]TCAs[blank_end], SNRIs are more effective than others
[blank_start]Premenstrual Dysphoric Disorder[blank_end]
- [blank_start]Fluoxetine[blank_end] and sertraline are approved therapies
[blank_start]Smoking Cessation[blank_end]
- [blank_start]Bupropion[blank_end]
- As effective as nicotine patches
[blank_start]Eating Disorders[blank_end]
- More success with [blank_start]bulimia[blank_end] than [blank_start]anorexia[blank_end]
- [blank_start]Mirtazapine[blank_end] stimulates appetite and used in anorexia
[blank_start]Premature ejaculation[blank_end]
- [blank_start]SSRIs[blank_end]
- Most antidepressants (except bupropion, [blank_start]mirtazapine[blank_end]) have sexual side effects
[blank_start]Menopausal “hot flashes”[blank_end]
- SSRIs and SNRIs show benefit- Aantidepressants
- BAnxiety
- CPain
- DPremenstrual Dysphoric Disorder
- ESmoking Cessation
- FEating Disorders
- GPremature ejaculation
- HMenopausal “hot flashes”
- Ibenzodiazepines
- Jindependent
- KTCAs
- LFluoxetine
- MBupropion
- Nbulimia
- Oanorexia
- PMirtazapine
- QSSRIs
- RSNRIs
- SMOAIs
- Tmirtazapine
31Choosing an antidepressant
At the population level, [blank_start]efficacy[blank_end] is [blank_start]similar[blank_end] for all drugs
SSRIs and [blank_start]SNRIs[blank_end] are first line therapies
choice is often based on [blank_start]adverse effects[blank_end], potential drug interactions, patient [blank_start]history[blank_end]
[blank_start]Bupropion[blank_end]- Aefficacy
- Bsimilar
- Cdifferent
- DSNRIs
- ETCAs
- FSSRIs
- GMAOIs
- Hadverse effects
- Ihistory
- JBupropion
32Antidepressants: Mechanisms of action
[blank_start]SERT inhibition[blank_end] (SSRIs)
NET and SERT inhibition ([blank_start]venlafaxine[blank_end], TCAs)
5-HT2C agonist ([blank_start]trazodone[blank_end])
α2 antagonist ([blank_start]mirtazapine[blank_end])
[blank_start]5-HT2A, 2C, 3 antagonist[blank_end] (mirtazapine)
MAO inhibition ([blank_start]MAOIs[blank_end])
[blank_start]NE and DA potentiating[blank_end] ([blank_start]bupropion[blank_end])- Avenlafaxine
- Btrazodone
- Cmirtazapine
- DSERT inhibition
- E5-HT2A, 2C, 3 antagonist
- FNE and DA potentiating
- GMAOIs
- Hbupropion
33Adverse effects
Mirtazapine has [blank_start]high[blank_end] affinity for [blank_start]H1[blank_end]
Antagonism of M, H1 and α1 is characteristic of [blank_start]TCAs[blank_end]
- Dry mouth, sedation, [blank_start]orthostatic hypotension[blank_end]
- Cardiotoxicity
[blank_start]SSRIs[blank_end]
- Weight gain, sexual dysfunction, drug interactions (plasma protein binding, drug metabolism), nausea, [blank_start]insomnia[blank_end]- AH1
- BM
- Cα1
- DTCAs
- Eorthostatic hypotension
- FSSRIs
- GMOAIs
- Hanorexia
- Isedation
- Jinsomnia
- Khigh
- Llow
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