Antidepressant

Front 1

Nefazodone: MOA

Back 1

Heterocyclic class.
Mild 5-HT and NE reuptake inhibitor that also antagonizes f-HT2 receptor --> lead to enhanced 5-HT1-mediated neurotransmission.

Front 2

Mirtazapine: MOA

Back 2

Heterocyclic class.
Minimal effects on amine reuptake. But antagonizes 5-HT2 and 5-HT3 receptors--> lead to enhanced 5-HT1 mediated neurotransmission.

Front 3

Venlafaxine: MOA

Back 3

Heterocyclic class.
5-HT reuptake inhibitor at low dose (like SSRI), but NE reuptake inhibitor at high doses.

Front 4

Which heterocyclic antidepressant cause increased appetite and weight gain?

Back 4

Mirtazapine.

Front 5

Which heterocyclic antidepressant cause anorexia and weight loss?

Back 5

Venlafaxine.

Front 6

Name heterocyclic antidepressants.

Back 6

Nefazadone, mirtazapine, venlafaxine.

Front 7

MOA of heterocyclic antidepressants.

Back 7

Inhibit reuptake of NE, 5-HT. (similar to TCA)

Front 8

Difference between MAO-A and MAO-B.

Back 8

MAO-A = selective for 5-HT, NE, andtyramine.

MAO-B = selective for dopamine.

(Use MAO-B in antiparkinsonism--to build up dopamine)

Front 9

Side effect of MAO inhibitors.

Back 9

Orthostatic hypotension.
Impotence.
Hypertensive rxn w/ tyramine intake. (In the absence of MAO activity, tyramine acts as indirect sympathomimetic--> cause NE release from sympathetic nerve terminal--> hypertensive crisis.)
Hyperreflexia, agitation, hallucination, seizure, hyperthermia, hyperpyrexia.
Hepatotoxicity.

Front 10

Reversible MOA inhibitor.

Back 10

Tranycypromine

Front 11

Irreversible MOA inhibitor.

Back 11

Phenelzine and isocarboxazid.

Front 12

Selective for MAO-B and also an antiparkinsonism agent.

Back 12

Selegiline.

Front 13

TCA antidepressant MOA.

Back 13

Inhibits reuptake of NE and 5-HT

Front 14

Antidepressants whose effects no seen for weeks.

Back 14

TCA and SSRI.

Front 15

Imipramine

Back 15

TCA.
Inhibit reuptake of NE, 5-HT. Also block muscarinic, histamine receptors, alpha1 and alpha2-adrenoceptors.

Front 16

Rx enuresis, chronic pain states, acute panic attacks, and phobias.

Back 16

Imipramine (TCA)

Front 17

Side effect of Imipramine (and most TCA).

Back 17

Excessive sedation; 2ndary amines cause less sedation than tertiary amines.
Antichoinergic: blurred vision, dry mouth, urinary retention, constipation, agigation, tachycardia, sweating (amitriptyline produces the most severe anticholinergic effects).
Alpha1 blockade: Postural hypotension, tachycardia.
Additive depression of CNS w/ ethanol, barbiturates.
OD:resp depression, convulsion, arrhythmias, coma.

Front 18

Advantage of SSRI over other antidepressants.

Back 18

Minimal antimuscarinic, antihistamine, and alpha1-adrenoceptor blockade effects.
BUT, clinical effects not seen for several weeks.

Front 19

Paroxetine

Back 19

SSRI

Front 20

Sertaline

Back 20

SSRI

Front 21

Citalopram

Back 21

SSRI

Front 22

Fluvoxamine

Back 22

SSRI

Front 23

Fluoxetine

Back 23

SSRI

Front 24

Which class of antidepressants has high side effect profile.

Back 24

TCA. B/c of anti-M1, anti-H1, and anti-alpha1 effects.

Front 25

Amoxapine

Back 25

Heterocyclics.
2nd generation typicals.

Front 26

Maprotiline

Back 26

Heterocyclics.
2nd generation typicals.

Front 27

Trazodone

Back 27

Heterocyclics.
2nd generation atypicals

Front 28

Bupropion

Back 28

Heterocyclics.
2nd generation atypicals.

Front 29

Nefazodone

Back 29

Heterocyclics.
3rd generation.

Front 30

Mirtazapine

Back 30

Heterocyclics.
3rd generation.

Front 31

Venlafaxine

Back 31

Heterocyclics.
3rd generation.

Front 32

Tranylcypromine

Back 32

MAO

Front 33

Phenelzine

Back 33

MAO

Front 34

Isocarboxazid

Back 34

MAO

Front 35

Selegiline

Back 35

MAO

Front 36

Imipramine

Back 36

TCA.
Tertiary amines.

Front 37

Amitriptyline

Back 37

TCA.
Tertiary amines.

Front 38

Doxepin

Back 38

TCA.
Tertiary amines.

Front 39

Desipramine

Back 39

TCA.
2ndary amines.

Front 40

Nortiptyline

Back 40

TCA.
2ndary amines.

Front 41

Protriptyline

Back 41

TCA.
2ndary amines.

Front 42

SE: sexual problem (loss of desire, impaired arousal, delayed/impaired ejaculation or orgasm)

Back 42

All SSRI. Venlafaxine.
Paroxetine has highest rate.

Can be minimized by "drug holidays" (skip one day dose and resume in 2 days. Could reduce efficacy or lead to serotonin withdrawal symptoms (dizziness, depressed, nausea, confusion).

Front 43

Antidepressant without sexual side effects?

Back 43

First line: bupropion, nefazodone, mirtazapine (if weight gain is not an important consideration).

Second choise: try different SSRI.

Third: Nortriptyline (TCA), if not high overdose or seizure risk.

Front 44

Alternative to sedation/tiredness of SSRI?

Back 44

Adjust day time doses. If tiredness remain, switch to less sedating bupropion.

(Usualy don't develop tolerance to sedation/tiredness)

Front 45

Restlessness or stimulation side effect of antidepressant.

Back 45

Most common w/ bupropion.
Fluoxetine is worse among SSRI.

Citalopram has the least profile.
Switch to trazodone (occasional arrhythmias, but is safe for the majority) or lorazepam.
Consider nefazodone, mirtazapine, or less activating TCA like nortriptyline (if not high overdose or seizure risk).

Front 46

Weight gain problem.
What are the alternative AD?

Back 46

Among SSRI, paroxetine cause wt gain. Tricyclics cause wt gain, too.

Switch to bupropion, nefazodone.

Front 47

Which AD cause GI side effects (nausea, and rarely diarrhea or vomiting)

Back 47

More common w/ SSRI and venlafaxine.
Less common w/ bupropion (gives constipation) and tricyclics.
But tolerance often develops w/in few weeks.
Don't use cisapride, but instead H2 blockers.