Tricyclic Antidepressants Quiz
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Questions and Answers

Which tricyclic antidepressant (TCA) is considered the most effective for treating Obsessive-Compulsive Disorder (OCD)?

  • Clomipramine (correct)
  • Doxepin
  • Imipramine
  • Amitriptyline

What is a common adverse anticholinergic effect associated with tricyclic antidepressants (TCAs) that might require management with sugarless gum or fluoride lozenges?

  • Urinary retention
  • Constipation
  • Dry mouth (correct)
  • Blurred vision

Which condition is a contraindication for the use of tricyclic antidepressants (TCAs) due to potential cardiac effects?

  • Pre-existing heart conditions (correct)
  • Panic disorder
  • Chronic pain
  • Generalized Anxiety Disorder

For a patient experiencing urinary hesitancy as a side effect of tricyclic antidepressant (TCA) treatment, which medication might be considered for management?

<p>Bethanechol (C)</p> Signup and view all the answers

Which of the following is NOT a typical ECG change associated with tricyclic antidepressant (TCA) use?

<p>Elevated ST segments (D)</p> Signup and view all the answers

What is a significant risk when using tricyclic antidepressants (TCAs) for individuals with bipolar depression?

<p>Induction of mania (B)</p> Signup and view all the answers

What is the most common autonomic adverse effect associated with tricyclic antidepressants (TCAs) that can lead to falls or injuries?

<p>Orthostatic hypotension (D)</p> Signup and view all the answers

Besides SSRIs, what is another class of medications that TCAs could be considered as an alternative to?

<p>SSRIs (A)</p> Signup and view all the answers

Which tricyclic antidepressant (TCA) is associated with the lowest risk of causing orthostatic hypotension?

<p>Nortriptyline (A)</p> Signup and view all the answers

Why should tricyclic antidepressants (TCAs) be stopped several days prior to elective surgery?

<p>To prevent hypertensive episodes during surgery (B)</p> Signup and view all the answers

Which of the following is a common side effect of tricyclic antidepressant (TCA) use due to its anticholinergic and antihistaminergic properties?

<p>Sedation (C)</p> Signup and view all the answers

Which tricyclic antidepressant (TCA) is most likely to cause parkinsonian symptoms, akathisia, and dyskinesia?

<p>Amoxapine (D)</p> Signup and view all the answers

What specific risk is associated with maprotiline, regarding the dosage and use?

<p>Increased risk of seizures, especially with rapid dose escalation or high doses (B)</p> Signup and view all the answers

Which of the following is a rare but serious hepatic effect associated with tricyclic antidepressants (TCAs)?

<p>Fulminant acute hepatitis (B)</p> Signup and view all the answers

What are the primary symptoms of neonatal withdrawal syndrome caused by tricyclic antidepressant (TCA) exposure during pregnancy?

<p>Tachypnea, cyanosis, irritability, and poor sucking reflex (B)</p> Signup and view all the answers

Which of these is NOT a common neurologic effect of tricyclic antidepressants (TCAs)?

<p>Ataxia (C)</p> Signup and view all the answers

Which of the following is a common symptom of serotonin syndrome?

<p>Myoclonus, hyperthermia, and rigidity (D)</p> Signup and view all the answers

Which of the following SSRIs is LEAST likely to be associated with withdrawal symptoms?

<p>Fluoxetine (D)</p> Signup and view all the answers

Which of the following SSRIs is metabolized by the CYP3A4 enzyme and should not be administered with alprazolam, triazolam and diazepam?

<p>Fluvoxamine (B)</p> Signup and view all the answers

Which of the following is a common side effect associated with venlafaxine?

<p>Nausea (D)</p> Signup and view all the answers

Which of the following statements is correct about the use of bupropion?

<p>It is contraindicated with MAOIs due to the risk of causing a hypertensive crisis. (C)</p> Signup and view all the answers

Which of the following best describes how mirtazapine increases norepinephrine and serotonin?

<p>Through antagonism of presynaptic alpha-2 adrenergic receptors and blockade of postsynaptic serotonin receptors (B)</p> Signup and view all the answers

What is a primary therapeutic indication for duloxetine besides depression?

<p>Neuropathic pain associated with diabetes (C)</p> Signup and view all the answers

What is a significant precaution associated with the use of duloxetine?

<p>Should not be prescribed for patients with hepatic insufficiency and end stage renal disease or uncontrolled narrow angle glaucoma (D)</p> Signup and view all the answers

Which of the following is NOT a common adverse reaction associated with milnacipran or levomilnacipran?

<p>Bradycardia (B)</p> Signup and view all the answers

Which statement is true about how fluoxetine is metabolized?

<p>Metabolized by CYP2D6 (D)</p> Signup and view all the answers

Which SSRI is most likely to produce a discontinuation syndrome?

<p>Paroxetine (C)</p> Signup and view all the answers

What is a clinical consideration when dosing vilazodone?

<p>It should be taken with food to achieve adequate drug concentrations (D)</p> Signup and view all the answers

Which of the following is NOT an indication for use of venlafaxine?

<p>Obsessive compulsive disorder (A)</p> Signup and view all the answers

What is a key characteristic of nefazodone's half-life?

<p>Short half-life resulting in a steady state in 4-5 days (B)</p> Signup and view all the answers

Which medication is FDA-approved for fibromyalgia but not for depression?

<p>Milnacipran (D)</p> Signup and view all the answers

Flashcards

TCAs: Alternative to SSRIs

TCAs can be an alternative option for patients who cannot tolerate SSRIs.

TCAs and Bipolar Depression

TCAs are not suitable for patients with bipolar depression as they can trigger manic episodes.

TCAs: Anticholinergic Effects

TCAs can cause a range of anticholinergic side effects, including dry mouth, constipation, and blurred vision.

TCAs: Dosage Adjustments

TCAs can interact with other medications, requiring careful dosage adjustments based on individual genetic differences.

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TCAs: Orthostatic Hypotension

TCAs can cause orthostatic hypotension, leading to dizziness and potential falls.

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TCAs: Psychosis Worsening

TCAs can worsen psychotic symptoms in patients with pre-existing psychosis.

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TCAs: Cardiac Effects

TCAs can affect the heart rhythm, especially at higher doses.

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TCAs: Confusion and Delirium

TCAs can cause confusion and delirium, especially in elderly patients or those with dementia.

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Serotonin Syndrome: What are the most severe symptoms?

Symptoms include restlessness, agitation, hyperreflexia, autonomic instability, myoclonus, seizures, hyperthermia, uncontrollable shivering, rigidity, delirium, coma, status epilepticus, cardiovascular collapse, and death.

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SNRIs: What is the most frequent side effect?

The most common side effect is nausea, which can be controlled by prescribing a selective serotonin antagonist or mirtazapine.

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SNRIs: What conditions are venlafaxine and desvenlafaxine prescribed for?

Venlafaxine and desvenlafaxine: Used for Major Depressive Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, and Anxiety Disorder.

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SNRIs: What important precaution should be taken when discontinuing these medications?

It is important to discontinue the medication slowly to avoid a withdrawal syndrome.

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Bupropion: What is its mechanism of action?

Bupropion inhibits the reuptake of norepinephrine and possibly dopamine, making it less likely to cause sexual dysfunction or sedation.

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Bupropion: For what conditions is it prescribed?

Bupropion is used for depression, smoking cessation, bipolar disorders, ADHD, cocaine detoxification, and hypoactive sexual desire disorder.

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Bupropion: What are some important precautions to be aware of?

Bupropion can cause psychotic symptoms, seizures, and may interact with MAOIs.

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Mirtazapine: How does it work?

Mirtazapine increases both norepinephrine and serotonin through a different mechanism than SSRIs.

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Mirtazapine: What conditions is it prescribed for?

Mirtazapine is used for depression, insomnia, cancer-related nausea and diarrhea, and can be combined with SSRIs or venlafaxine.

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Mirtazapine: What are some important precautions to be aware of?

Mirtazapine is associated with somnolence, agranulocytosis, and potential drug interactions with alcohol and benzodiazepines.

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SNRIs: What are some common side effects?

The most common side effects of SNRIs include nausea, constipation, hyperhidrosis, tachycardia, erectile dysfunction, vomiting, and palpitations.

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Drug Interactions: SSRIs and Clozapine

SSRIs should not be used with clozapine due to the risk of increasing clozapine concentrations and seizures.

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Drug Interactions: SSRIs and Zolpidem

SSRIs may increase the duration and severity of zolpidem-induced side effects, including hallucinations.

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Drug Interactions: Fluvoxamine and other medications.

Fluvoxamine has the highest risk of drug-drug interactions due to its metabolism by CYP3A4, which can be inhibited by ketoconazole.

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Drug Interactions: Fluoxetine

Fluoxetine can be administered with low doses of tricyclic drugs and is metabolized by CYP2D6.

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Drug Interactions: Sertraline

Sertraline can displace warfarin from plasma proteins and may increase prothrombin time.

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What is orthostatic hypotension?

TCAs can cause a decrease in blood pressure when standing up, leading to dizziness and potential falls. This is known as orthostatic hypotension.

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What are the anticholinergic effects of TCAs?

TCAs have anticholinergic properties, which block the action of acetylcholine in the body. This can lead to side effects like dry mouth, constipation, blurred vision, and urinary retention.

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Which TCAs cause sedation?

Some TCAs, like amitriptyline, trimipramine, and doxepin, are more sedating than others. These effects are due to their anticholinergic and antihistaminergic properties.

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What are some common neurological effects of TCAs?

TCAs can cause tremors, especially fine, rapid tremors and myoclonic twitches, in the tongue and upper extremities. These effects are more common than rarer neurological effects like speech blockage or ataxia.

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Why should TCAs be stopped before surgery?

TCAs should be stopped several days before elective surgery to prevent potential hypertensive episodes. This is especially important for patients taking TCAs for chronic pain.

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What are some allergic and hematologic effects of TCAs?

TCAs can cause allergic reactions, such as skin rashes (exanthematous rashes). Rarely, they can also cause blood cell abnormalities like agranulocytosis or leukopenia.

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What are the potential hepatic effects of TCAs?

TCAs can cause mild increases in liver enzyme levels, which are usually self-limiting. However, rarely, they can cause a severe and potentially life-threatening condition known as fulminant acute hepatitis.

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What are the teratogenicity and pregnancy risks associated with TCAs?

TCAs can cross the placenta and cause neonatal withdrawal syndrome in babies born to mothers who were taking TCAs during pregnancy. This syndrome can manifest with symptoms like rapid breathing, irritability, and poor sucking reflex.

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Study Notes

Chapter 7: Depression

  • Key symptoms of depression include: depressed mood and loss of interest or pleasure.
  • Depression can be a physical illness, characterized by exhaustion and lack of motivation.
  • A classic presentation of a depressed patient includes stooped posture, decreased movement, and a downward gaze.
  • Observable signs of depression often include generalized psychomotor retardation.
  • Neurovegetative symptoms of depression include somatic or physical symptoms.

Table 7-1: Neurovegetative Symptoms of Depression

  • Common symptoms include fatigue/low energy and inattention.
  • Sleep disturbances, such as insomnia and early morning awakenings, are also common.
  • Poor appetite and weight loss can occur.
  • Other symptoms such as decreased libido, sexual performance issues, and menstrual irregularities are also possibly associated.
  • Symptoms are often worse in the morning

Most Common Complaint: Reduced Energy

  • Increased Appetite
  • Weight Gain
  • Sleeping longer than usual
  • Young age of onset
  • Higher likelihood of comorbid disorders (e.g., anxiety, substance use disorders, or somatic symptom disorders).
  • Atypical (reversed neurovegetative symptoms)

Dysphoria and Anhedonia

  • Dysphoria is a term for depressed mood.
  • Anhedonia refers to the inability to experience pleasure from activities formerly enjoyable.

Other Key Symptoms

  • Cognitive symptoms: reports of difficulty concentrating and thinking problems.
  • Judgement assessment: done by reviewing recent patient actions and behaviors during the interview.

Additional Information on Major Depressive Disorder (Diagnositc Information)

  • 5 or more symptoms must be present for at least two weeks.
  • Symptoms include anhedonia, depressed mood and other SIGECAPS factors such as: sleep (difficulty), interest (loss), guilt, energy (loss), concentration (difficulty), appetite (loss), psychomotor retardation (slow movement), suicide ideation
  • Altered sleep: difficulty sleeping and early morning awakening
  • Altered activity or energy
  • Decreased concentration
  • SI/plan
  • Depressing thoughts
  • With psychotic features: congruent mood
  • With melancholic features: aka endogenous depression, associated with autonomic and endocrine changes, without external life supports.
  • With atypical features: reversal of typical neurovegetative symptoms (increased appetite, sleep, and younger age of onset) and a higher incidence of severe psychomotor slowing.

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Description

Test your knowledge on tricyclic antidepressants (TCAs) and their effects on mental health disorders, particularly Obsessive-Compulsive Disorder (OCD). This quiz covers common side effects, contraindications, and management strategies for patients using TCAs. Challenge yourself to identify important considerations in TCA treatment.

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