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Questions and Answers
What is the adverse effect of fluvoxamine?
What is the adverse effect of fluvoxamine?
What is the contraindication of Duloxetine?
What is the contraindication of Duloxetine?
What is the mechanism of action of Bupropion?
What is the mechanism of action of Bupropion?
What is the side effect of Mirtazapine?
What is the side effect of Mirtazapine?
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What is the mechanism of action of Nefazodone and Trazodone?
What is the mechanism of action of Nefazodone and Trazodone?
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What is the adverse effect of SSRIs when combined with MAOI or Melatonin?
What is the adverse effect of SSRIs when combined with MAOI or Melatonin?
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What is the mechanism of action of SNRIs?
What is the mechanism of action of SNRIs?
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What is the side effect of Trazodone?
What is the side effect of Trazodone?
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What is the type of MAOI that Tranylcypromine is?
What is the type of MAOI that Tranylcypromine is?
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What is the advantage of SNRIs over TCAs?
What is the advantage of SNRIs over TCAs?
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What is the blocking action of Alpha1 that leads to postural hypotension?
What is the blocking action of Alpha1 that leads to postural hypotension?
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Which of the following is NOT a therapeutic use of Tricyclic Antidepressants (TCAs)?
Which of the following is NOT a therapeutic use of Tricyclic Antidepressants (TCAs)?
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What is the mechanism of analgesic activity of Tricyclic Antidepressants (TCAs)?
What is the mechanism of analgesic activity of Tricyclic Antidepressants (TCAs)?
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Which of the following is a side effect of Tricyclic Antidepressants (TCAs)?
Which of the following is a side effect of Tricyclic Antidepressants (TCAs)?
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What is the advantage of Lofepramine over other TCAs?
What is the advantage of Lofepramine over other TCAs?
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What is the treatment of acute toxicity of Tricyclic Antidepressants (TCAs)?
What is the treatment of acute toxicity of Tricyclic Antidepressants (TCAs)?
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What is the effect of Tricyclic Antidepressants (TCAs) on alpha2-receptors?
What is the effect of Tricyclic Antidepressants (TCAs) on alpha2-receptors?
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What is the advantage of Selective Serotonin Reuptake Inhibitors (SSRIs) over Tricyclic Antidepressants (TCAs)?
What is the advantage of Selective Serotonin Reuptake Inhibitors (SSRIs) over Tricyclic Antidepressants (TCAs)?
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What is the therapeutic use of Selective Serotonin Reuptake Inhibitors (SSRIs)?
What is the therapeutic use of Selective Serotonin Reuptake Inhibitors (SSRIs)?
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What is the primary characteristic of depression?
What is the primary characteristic of depression?
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Which of the following is a characteristic of Selective Serotonin Reuptake Inhibitors (SSRIs)?
Which of the following is a characteristic of Selective Serotonin Reuptake Inhibitors (SSRIs)?
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Which neurotransmitter is increased in the brain in schizophrenia?
Which neurotransmitter is increased in the brain in schizophrenia?
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What is the mechanism of action of tricyclic antidepressants (TCA)?
What is the mechanism of action of tricyclic antidepressants (TCA)?
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Which of the following is a selective serotonin re-uptake inhibitor (SSRI)?
Which of the following is a selective serotonin re-uptake inhibitor (SSRI)?
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What is the effect of tricyclic antidepressants on the brain?
What is the effect of tricyclic antidepressants on the brain?
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Which of the following is a pharmacological effect of tricyclic antidepressants?
Which of the following is a pharmacological effect of tricyclic antidepressants?
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What is the fate of tricyclic antidepressants after oral administration?
What is the fate of tricyclic antidepressants after oral administration?
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Which of the following is a type of antidepressant drug?
Which of the following is a type of antidepressant drug?
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What is the effect of tricyclic antidepressants on the histamine receptors?
What is the effect of tricyclic antidepressants on the histamine receptors?
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Which of the following tricyclic antidepressants has the strongest sedative effect?
Which of the following tricyclic antidepressants has the strongest sedative effect?
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Study Notes
Antidepressant Drugs
- Classification of antidepressants:
- Tricyclic antidepressants (TCA)
- Selective serotonin re-uptake inhibitors (SSRIs)
- Serotonin/norepinephrine re-uptake inhibitors (SNRIs)
- Atypical antidepressants
- Monoamine oxidase inhibitors (MAOIs)
Tricyclic Antidepressants (TCA)
- Mechanism of action:
- Inhibit pre-synaptic neuronal reuptake of NA & 5HT, leading to accumulation of these transmitters in the synaptic clefts in the brain
- Pharmacokinetics:
- Well absorbed orally
- High 1st pass effect
- Pass the blood-brain barrier (BBB)
- Metabolized in the liver
- Conjugated with glucuronic acid and excreted in urine
- Pharmacological effects:
- Antidepressant
- Sedation (amitriptyline > imipramine > desipramine)
- Anticholinergic (amitriptyline > imipramine > desipramine)
- Antihistamine (H1 & H2 blockers)
- Alpha1 blocking action, leading to postural hypotension
- Therapeutic uses:
- Depression
- Obsessive compulsive disorders (clomipramine or fluvoxamine is better)
- Panic and phobic states
- Chronic pain
- Nocturnal enuresis (anticholinergic action)
- Peptic ulcer (doxepin), blocks muscarinic & H2 receptors
- Attention deficit syndrome in children
- Side effects:
- Anticholinergic (atropine-like) action
- Sympathomimetic effects
- CNS: sedation, tremors, confusion, delirium, and seizures
- CVS: postural hypotension, arrhythmia, tachycardia, and cardiomyopathy
- Weight gain
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Advantages:
- No sedation
- No anticholinergic effects
- No postural hypotension
- No weight gain
- Less delay in the onset of action
- Effective in resistant cases to TCA & MAOI
- Uses:
- Mild to moderate depression
- Obsessive compulsive disorders (fluvoxamine)
- Bulimia (increased desire to eat)
Serotonin/Norepinephrine Re-uptake Inhibitors (SNRIs)
- Venlafaxine and duloxetine
- Treat cases of depression which are resistant to SSRIs
- Treat depression accompanied by neuropathic pain
- No activity at adrenergic, muscarinic, or histamine receptors, resulting in fewer adverse effects than TCA
- Duloxetine is contraindicated in hepatic insufficiency and end-stage renal disease
Atypical Antidepressants
- Have action at several different sites
- Not more efficacious than TCAs or SSRIs, but have different side effects profiles
- Include:
- Bupropion
- Mirtazapine
- Nefazodone and trazodone
Bupropion
- Inhibits noradrenaline and dopamine reuptake
- Decreases craving for nicotine in tobacco abusers
- Side effects: dry mouth, sweating, tremor, and seizures at high doses
Mirtazapine
- Blocks presynaptic alpha2-receptors, increasing NA and serotonin
- Blocks 5HT2 receptors
- May cause sedation and weight gain
Nefazodone and Trazodone
- Weak serotonin reuptake inhibitors
- Block postsynaptic 5-HT2 receptors
- Both agents block H1-receptors, leading to sedation
- Trazodone blocks α1, leading to priapism
Monoamine Oxidase Inhibitors (MAOIs)
- Hydrazine group: phenelzine, isocarboxazid
- Non-hydrazine group: tranylcypromine, moclobemide, and clorgyline
- Selegiline
Amine Hypothesis of Mood
- Psychic depression: decrease in concentration of noradrenaline and serotonin in the brain
- Elevated mood: increase in noradrenaline and serotonin in the brain
- Schizophrenia: increased dopamine in the brain
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Description
This quiz covers the effects and side effects of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in treating depression, anxiety, and other disorders.