Victoria Wright
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WEEK 10 Test sobre Antidepressant Flash Card Supplement, creado por Victoria Wright el 22/03/2017.

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Antidepressant Flash Card Supplement

Pregunta 1 de 33

1

Which of the following drugs are classified as SSRIs?

Selecciona una o más de las siguientes respuestas posibles:

  • Venlafaxine

  • Imipramine

  • Paroxetine

  • Bupropion

  • Phenylzine

  • Fluoxetine

  • Sertraline

  • Desvenlafaxine

  • Citalopram

  • Escitalopram

Explicación

Pregunta 2 de 33

1

Which of the following drugs are classified as SNRIs?

Selecciona una o más de las siguientes respuestas posibles:

  • Imipramine

  • Duloxetine

  • Mirtazapine

  • Fluoxetine

  • Venlafaxine

  • Desvenlafaxine

  • Selegiline

Explicación

Pregunta 3 de 33

1

Which of the following drugs are classified as TCAs?

Selecciona una o más de las siguientes respuestas posibles:

  • Imipramine

  • Trazodone

  • Amitriptyline

  • Clomipramine

  • Paroxetine

  • Escitalopram

  • Duloxetine

Explicación

Pregunta 4 de 33

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • Amitriptyline

  • Selegiline

  • Duloxetine

  • Phenylzine

  • Citalopram

  • Bupropion

  • Trazodone

Explicación

Pregunta 5 de 33

1

Which of the following drugs are classified as Atypical?

Selecciona una o más de las siguientes respuestas posibles:

  • Mirtazapine

  • Fluoxetine

  • Amitriptyline

  • Citalopram

  • Trazodone

  • Imipramine

  • Bupropion

Explicación

Pregunta 6 de 33

1

Rellena los espacios en blanco para completar el texto.

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

Explicación

Pregunta 7 de 33

1

Rellena los espacios en blanco para completar el texto.

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

Explicación

Pregunta 8 de 33

1

Rellena los espacios en blanco para completar el texto.

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

Explicación

Pregunta 9 de 33

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • Paroxetine

  • Citalopram

  • Escitalopram

  • Fluoxetine

  • Sertraline

Explicación

Pregunta 10 de 33

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • Fluoxetine

  • Paroxetine

  • Escitalopram

  • Citalopram

  • Sertraline

Explicación

Pregunta 11 de 33

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • Depression

  • PTSD

  • Premature ejaculation

  • PMDD

  • Panic disorder

  • Bulimia

  • Menopausal “hot flashes”

  • Enuresis

  • OCD

  • GAD

Explicación

Pregunta 12 de 33

1

Which of the following are true about SSRIs?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 13 de 33

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 14 de 33

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • Neuropathic pain

  • Vasomotor symptoms of menopause

  • Social anxiety

  • Panic disorder

  • OCD

  • GAD

  • Depression

  • PTSD

  • Sedation

  • Stress urinary incontinence

Explicación

Pregunta 15 de 33

1

Which of the following are true about SNRIs?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 16 de 33

1

Which of the following are the adverse effects of SNRIs?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 17 de 33

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 18 de 33

1

Which of the following are true about TCAs?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 19 de 33

1

Which of the following are the adverse effects of TCAs?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 20 de 33

1

Which of the following are true about Trazodone?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 21 de 33

1

Which of the following are the adverse effects of Trazodone?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 22 de 33

1

Which of the following are true about Bupropion?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 23 de 33

1

Which of the following are adverse effects of Bupropion?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 24 de 33

1

Which of the following are true about Mirtazapine?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 25 de 33

1

Which of the following are adverse effects of Mirtazapine?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 26 de 33

1

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

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 27 de 33

1

Which of the following are adverse effects of MOAIs?

Selecciona una o más de las siguientes respuestas posibles:

  • 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

Explicación

Pregunta 28 de 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

Arrastra y suelta para completar el texto.

    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

Explicación

Pregunta 29 de 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

Arrastra y suelta para completar el texto.

    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

Explicación

Pregunta 30 de 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

Arrastra y suelta para completar el texto.

    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

Explicación

Pregunta 31 de 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

Arrastra y suelta para completar el texto.

    efficacy
    similar
    different
    SNRIs
    TCAs
    SSRIs
    MAOIs
    adverse effects
    history
    Bupropion

Explicación

Pregunta 32 de 33

1

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

Arrastra y suelta para completar el texto.

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

Explicación

Pregunta 33 de 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,

Arrastra y suelta para completar el texto.

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

Explicación

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