Victoria Wright
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WEEK 10 Quiz am Antidepressant Flash Card Supplement, erstellt von Victoria Wright am 22/03/2017.

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Victoria Wright
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Antidepressant Flash Card Supplement

Antidepressant Flash Card Supplement

Frage 1 von 33

1

Which of the following drugs are classified as SSRIs?

Wähle eine oder mehr der folgenden:

  • Venlafaxine

  • Imipramine

  • Paroxetine

  • Bupropion

  • Phenylzine

  • Fluoxetine

  • Sertraline

  • Desvenlafaxine

  • Citalopram

  • Escitalopram

Erklärung

Frage 2 von 33

1

Which of the following drugs are classified as SNRIs?

Wähle eine oder mehr der folgenden:

  • Imipramine

  • Duloxetine

  • Mirtazapine

  • Fluoxetine

  • Venlafaxine

  • Desvenlafaxine

  • Selegiline

Erklärung

Frage 3 von 33

1

Which of the following drugs are classified as TCAs?

Wähle eine oder mehr der folgenden:

  • Imipramine

  • Trazodone

  • Amitriptyline

  • Clomipramine

  • Paroxetine

  • Escitalopram

  • Duloxetine

Erklärung

Frage 4 von 33

1

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

Wähle eine oder mehr der folgenden:

  • Amitriptyline

  • Selegiline

  • Duloxetine

  • Phenylzine

  • Citalopram

  • Bupropion

  • Trazodone

Erklärung

Frage 5 von 33

1

Which of the following drugs are classified as Atypical?

Wähle eine oder mehr der folgenden:

  • Mirtazapine

  • Fluoxetine

  • Amitriptyline

  • Citalopram

  • Trazodone

  • Imipramine

  • Bupropion

Erklärung

Frage 6 von 33

1

Fülle die Lücken, um den Text zu vervollständigen.

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

Erklärung

Frage 7 von 33

1

Fülle die Lücken, um den Text zu vervollständigen.

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

Erklärung

Frage 8 von 33

1

Fülle die Lücken, um den Text zu vervollständigen.

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

Erklärung

Frage 9 von 33

1

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

Wähle eine oder mehr der folgenden:

  • Paroxetine

  • Citalopram

  • Escitalopram

  • Fluoxetine

  • Sertraline

Erklärung

Frage 10 von 33

1

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

Wähle eine oder mehr der folgenden:

  • Fluoxetine

  • Paroxetine

  • Escitalopram

  • Citalopram

  • Sertraline

Erklärung

Frage 11 von 33

1

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

Wähle eine oder mehr der folgenden:

  • Depression

  • PTSD

  • Premature ejaculation

  • PMDD

  • Panic disorder

  • Bulimia

  • Menopausal “hot flashes”

  • Enuresis

  • OCD

  • GAD

Erklärung

Frage 12 von 33

1

Which of the following are true about SSRIs?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 13 von 33

1

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

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 14 von 33

1

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

Wähle eine oder mehr der folgenden:

  • Neuropathic pain

  • Vasomotor symptoms of menopause

  • Social anxiety

  • Panic disorder

  • OCD

  • GAD

  • Depression

  • PTSD

  • Sedation

  • Stress urinary incontinence

Erklärung

Frage 15 von 33

1

Which of the following are true about SNRIs?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 16 von 33

1

Which of the following are the adverse effects of SNRIs?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 17 von 33

1

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

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 18 von 33

1

Which of the following are true about TCAs?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 19 von 33

1

Which of the following are the adverse effects of TCAs?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 20 von 33

1

Which of the following are true about Trazodone?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 21 von 33

1

Which of the following are the adverse effects of Trazodone?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 22 von 33

1

Which of the following are true about Bupropion?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 23 von 33

1

Which of the following are adverse effects of Bupropion?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 24 von 33

1

Which of the following are true about Mirtazapine?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 25 von 33

1

Which of the following are adverse effects of Mirtazapine?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 26 von 33

1

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

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 27 von 33

1

Which of the following are adverse effects of MOAIs?

Wähle eine oder mehr der folgenden:

  • 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

Erklärung

Frage 28 von 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

Klicke und ziehe, um den Text zu vervollständigen.

    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

Erklärung

Frage 29 von 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

Klicke und ziehe, um den Text zu vervollständigen.

    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

Erklärung

Frage 30 von 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

Klicke und ziehe, um den Text zu vervollständigen.

    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

Erklärung

Frage 31 von 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

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    efficacy
    similar
    different
    SNRIs
    TCAs
    SSRIs
    MAOIs
    adverse effects
    history
    Bupropion

Erklärung

Frage 32 von 33

1

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

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    venlafaxine
    trazodone
    mirtazapine
    SERT inhibition
    5-HT2A, 2C, 3 antagonist
    NE and DA potentiating
    MAOIs
    bupropion

Erklärung

Frage 33 von 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,

Klicke und ziehe, um den Text zu vervollständigen.

    H1
    M
    α1
    TCAs
    orthostatic hypotension
    SSRIs
    MOAIs
    anorexia
    sedation
    insomnia
    high
    low

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