Antidepressants

Front 1

List MOA of TCAs

Back 1

block SE and NE reuptake
all are good H1 blockers
prolong QT, so avoid depletion of postassium K
are local anesthetics

Front 2

Name TCA that is the most antimuscarinic

Back 2

amytriptyline

Front 3

Name TCA that is the least antimuscarinic

Back 3

desipramine

Front 4

Name an atypical antidepressant that blocks NET, antagonizes D2 (EPS) and has a high risk of seizures

Back 4

Amoxapine

Front 5

Name 2 atypical antidpressants that are 5HT 2a antagonists and also block a1 receptors that results in water retention

Back 5

trazadeone (water)
nefazadone (rare liver failure)

Front 6

Name an atypical antidperessant that is a 5HT 2a antagonist, blocks alfa 1 receptor, is very SEDATIVE and can cause seizures (anesthetic)

Back 6

mertazapine

Front 7

Buproprion is associated with what risk?

Back 7

risk of seizures
but lowest sexual dysfunction risk

Front 8

Name two atypical antidepressants that are mixed NE/ 5HT uptake blockers but are less antimuscarinic than TCAs

Back 8

venlafaxine
duloxetine

Front 9

List antidepressants that solely block SERT, which are also less antimuscarinic and less local anesthetic

Back 9

fluoxetine
fluvoxamine
sertraline
paroxetine (highest affinity for SERT)
citalopram
escitalopram (these last two have the same safety profile)

Front 10

List prominent side effects of SERT high affinity reuptake blockers

Back 10

N and D
prolonged clotting time
insomnia
hyperthermia

Front 11

What antidepressant is associated with akathisia

Back 11

Sertraline

DO not mistake for anxiety

Front 12

Which SSRI increases libido in women?

Back 12

trazadone

Front 13

Which antidepressants have the highest sexual disfunction risk, which the lowest

Back 13

the highest: 25 percent on paroxetine, 10 percent on escitalopram

least risk on bupropion, trazadone (but water retention) and nefazadone (rare liver failure)

Front 14

Which SSRI has clear withdrawal symptoms

Back 14

paroxetine (very high affinity for SERT)

Front 15

If you mix MAOi with narcotics, you can precipitate fatal hypertherimia. Name 2 common narcotics not to mix it with.

Back 15

Meperidine
Tramadol

do not mix with phenylzine (Mao inhibitor)

Front 16

antidepressants that are least likely to inhibit 2D6

Back 16

mirtazapine
venlafaxine
(es)citalopram

Front 17

antidepressants that are very likely to inhibit 2D6

Back 17

fluoxetine
fluvoxamine
paroxetine
nefazadone

Front 18

Discuss relative toxicity of Antidepressants from highest to lowest

Back 18

highest: amoxapine, matrytpiline
TCA's
high: MAOi
Lowest: Bupropion, Fluoxetine, etc

Front 19

What are common side effects of MAOis

Back 19

insomnia
weight gain
sedation
orthostatic hypertension
sexual dysfunciton

Front 20

List antidepressants that are 5HT2A inhibitors

Back 20

mirtazapine
nefazadone
trazadone

Front 21

list antidepressants that are NET inhibitors

Back 21

desipramine
nortryptiline
amoxapine
matriptiline

Front 22

List antidepressants that are SERT inhibitors

Back 22

imipramine
amitryptiline
fluoxetine
fluvoxamine
paroxetine
es-citalopram

Front 23

List 2 MAOis

Back 23

phenelzine
tranylcypromine

Front 24

St. John's wart and cyclosporine
WTF?

Back 24

induces CYP 3A4 so cyclosporine levels drop
hyperforin is the active ingredient
not the red hypericin

Front 25

for neurofibromyalgia what antidepressant class should one use?

Back 25

SERT inhibitors

Front 26

for chornic neuropathies, what antidepressant should one use?

Back 26

TCAs

Front 27

While thiopental and propofol decrease BP and RR, what drug that is similar in effect does not do so and is better for CV and elderly patients and why?

Back 27

etomidate also induces anesthesia in less than a minute, does not eliminate pain reflex nor causes muscle paralysis
unlike propofol and thiopental, it causes only minimal changes in BP and RR, so it is good for CV patients and elderly

Front 28

what anesthetic decreases adrenal gland response to stress?

Back 28

etomidate

Front 29

What is a general anesthetic that induces anesthesia in less than a minute and DOES block the reflex to pain but does not induce muscle paralysis and also causes dissociative state, associated with bad dreams, nightmares and can cause delirium from re-emergence?

Back 29

Ketamine

Front 30

What benzo would you use for perioperative anxiety, conscious sedation and minor surgeries?

Back 30

Midazolam, water soluble, no pain reflex elimination or pain paralysis
provides anesthetic effect

Front 31

What two anesthetics eliminate reflex to pain?

Back 31

ketamine
sufentanil

Front 32

What anesthetic eliminates pain reflex but has to be used with narcotics because of partial awareness

Back 32

sufentanyl

Front 33

What narcotic do you use in anesthesia for cardio cases?

Back 33

Fentanyl: it depresses respiration but maintains cardiac contractility

Front 34

Define MAC

Back 34

a measure of dose and potency of inhalational anesthetics is the minimum alveolar concentration;
measured as a percentage of lung gases that are anesthetic gases when 50 percent of patients are not responding to surgical incision

Front 35

What is an incomplete anesthetic inhalational gas?

Back 35

NO2
it eliminates pain reflex and is as effective as a regular morphine dose. No muscle paralysis, no change in BP or ventilation
20-50 percent from inspired air- analgesia is excellent, but some memory and response to commands is retained
at 50 percent: dysphoria, nausea with a risk of aspiration pneumonia.
Mac is only achieved at hyperbaric conditions

Front 36

Which inhal. anesthetic causes combative behavior, disorientation, is nephrotoxic, but some some elimination of pain reflex and muscle paralysis

Back 36

sevoflurane

Front 37

which inhal anesthetic provides some pain reflex elimination and muscle paralysis, while having a bad odor, irritating the airway, though increasing sympathetic outflow and maintaning CO

Back 37

desflurane

Front 38

What is the major se of halothane

Back 38

halothane hepatitis (rare)

Front 39

Which inhal anesthetic causes myoclonus and is contraindicated in pts with seizures

Back 39

enflurane

Front 40

which inhal anesthetic is not used in the US any longer because it is toxic to the kidneys and its induciton rate is 60 min

Back 40

methoxyflurane

Front 41

What is the most used inhal anesthetic and why

Back 41

isoflurane
largely due to cv safety and increases sympathetic outflow

Front 42

What anesthetic increases bp and rr

Back 42

ether
60 min induction

Front 43

which anesthetic agent causes:
incomplete anesthetic effect
elimination of pain reflex
no muscle paralysis
no change in BP and RR

Back 43

N2O

Front 44

which 3 anesthetic agents inhibit the action of glu on excitatory NMDA receptors
at the spinal level

Back 44

ketamine, n2, xenon