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61 Cards in this Set

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  • Back
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According to the biogenic amine theory, depression is due to a deficiency of which two neurotransmitters in the brain
Serotonin (5-HT)
Norepinephrine (NE)
None
Where in the neuron is monamine oxidase (MOA) located
Mitochondria
None
Where in the body is MAO located
Neuron
Liver
GI tract
None
MAOa inactivates which neurotransmitters
5-HT; NE
MAOb inactivates which neurotransmitter
Dopamine (DA)
What is the mechanism of action of MAOIs
Inactivation of MAO thereby increasing levels of 5-HT, NE, and DA in presynaptic neurons with subsequent leakage of neurotransmitter into the synaptic cleft
Name three nonselective MAOIs
Tranylcypromine
Phenelzine
Isocarboxazid
None
Which medication selectively inhibits MAOb at low to normal doses yet loses its selectivity at higher doses
Selegiline
Selegiline is commonly used in the treatment of which disease
Parkinson disease
MAOa also inactivates which monamine commonly found in certain cheese (aged), alcoholic beverages, fish, chocolates, red wines, and processed meats
Tyramine (inactivated by MAO in the GI tract)
MAOIs are the drugs of choice for treating what type of depression
Atypical depression
How long does it take to see antidepressant effects in patients who are started on an MAOI
2-4 weeks
How long should a patient wait from the time of discontinuing an MAOI to the time of starting a new antidepressant medication
At least 2 weeks
What are the adverse effects of MAOIs
Orthostatic hypotension
Blurred vision
Drowsiness
Xerostomia
Constipation
Urinary retention
None
What life-threatening condition may develop when MAOIs and selective serotonin reuptake inhibitors (SSRIs) are used concomitantly
Serotonin syndrome
None
What characterizes serotonin syndrome
Rigidity
Diaphoresis
Hyperthermia
Seizures
Autonomic instability
Myoclonus
None
What life-threatening condition may develop when patients taking MAOIs ingest food containing tyramine
Hypertensive crisis
What characterizes hypertensive crisis
Hypertension
Tachycardia
Cardiac arrhythmias
Headache
Stroke
Nausea
Vomiting
None
A serotonin-like syndrome may develop when MAOIs are used concomitantly with what common OTC medication used to suppress cough
Dextromethorphan
A serotonin-like syndrome may develop when MAOIs are used concomitantly with which opioid analgesic
Meperidine
None
What is the mechanism of action of tricyclic antidepressants (TCAs)
Inhibits reuptake of 5-HT and NE into presynaptic neurons thereby increasing neurotransmitter concentrations in the synaptic cleft
What other types of neurotransmitter and hormonal receptors, other than 5-HT and NE, are inhibited by TCAs
Muscarinic
α-adrenergic
Histaminergic
None
How long does it take to see antidepressant effects in patients who are started on a TCA
4-6 weeks
Give examples of TCAs
Imipramine→Desipramine
Amitriptyline→Nortriptyline
Clomipramine
Doxepin
Protriptyline
None
What is the name of the active metabolite of amitriptyline that selectively inhibits NE uptake
Nortriptyline
What is the name of the active metabolite of imipramine that selectively inhibits NE uptake
Desipramine
Which TCA is also used for the treatment of certain types of neuropathic pain and for the prevention of migraine headaches
Amitriptyline
Which TCA is commonly used to treat obsessive-compulsive disorder (OCD)
Clomipramine
Which TCA is also used to treat pediatric nocturnal enuresis
Imipramine
Why is imipramine used for childhood enuresis
Increases contraction of internal sphincter of bladder; Decreases stage 3 and 4 sleep
What are the adverse effects of the TCAs
Xerostomia
Blurred vision
Urinary retention
Constipation
Precipitation of acute glaucoma attacks
Cardiac arrhythmias
Seizures (lowers seizure threshold)
Orthostatic hypotension with reflex tachycardia
Sedation
Serotonin syndrome when combined with MAOIs and/or SSRIs
Coma
None
What are the “3-C’s” of TCA toxicity
Coma, convulsions, and cardiotoxicity
Can overdosing on a TCA lead to death
Yes
Can overdosing on a SSRI lead to death
No
What is the mechanism of action of amoxapine and maprotiline
Inhibits reuptake of NE into presynaptic neurons thereby increasing neurotransmitter concentrations in the synaptic cleft
What is the mechanism of action of trazodone and nefazodone
Inhibits reuptake of 5-HT into presynaptic neurons thereby increasing neurotransmitter concentrations in the synaptic cleft
Which antidepressant, trazodone or nefazodone, can inhibit cytochrome P-450 enzymes
Nefazodone
None
What adverse effect is unique to trazodone
Priapism
What is the mechanism of action of bupropion
Weak inhibitor of DA, 5-HT and NE uptake
Bupropion is also used in what setting (other than depression)
Smoking cessation; OCD
Does bupropion cause sexual dysfunction
No
Is bupropion safe to use in patients with epilepsy
No (lowers seizure threshold)
What is the mechanism of action of mirtazapine
α2 antagonist (results in increased release of NE and 5-HT)
Name an α2 antagonist that is used in the treatment of sexual dysfunction
Yohimbine
What is the major side effect of mirtazapine
Weight gain via appetite stimulation (may be beneficial in depressed patients who become anorexic)
What is the mechanism of action of venlafaxine
Potent inhibitor of 5-HT and NE reuptake; weak inhibitor of DA reuptake
What is the major side effect of venlafaxine
Hypertension
What is the mechanism of action of duloxetine
Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)
Give examples of SSRIs
Fluoxetine→Norfluoxetine
Fluvoxamine
Paroxetine
Sertraline
Citalopram
Escitalopram
None
What is the prototype of the SSRI drug class
Fluoxetine
What is the longest-acting SSRI
Fluoxetine
What is the half-life of fluoxetine
5 days
Fluoxetine is also used in what setting (other than depression)
Premenstrual dysphoric disorder (PMDD)
Bulimia nervosa
OCD
Panic disorder
Selective mutism
None
Which SSRI has a sole FDA indication for the treatment of OCD
Fluvoxamine
What is the name of fluoxetine’s active metabolite
Norfluoxetine
What kind of drug interactions may SSRIs produce
Inhibition of cytochrome P-450 enzymes
Do SSRIs cause sexual dysfunction
Yes (anorgasmia)
Do SSRIs cause cardiac arrhythmias
No (unlike TCAs)
What are the adverse effects of SSRIs
Sexual dysfunction
Agitation
Anxiety
Seizures (with overdose)
Nausea
Vomiting
Diarrhea
Sedation
None
Which SSRI is also FDA approved for social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder
Paroxetine
Which SSRIs cause the least amount of drug-drug interactions
Sertraline
Citalopram
Escitalopram
None