Depression Symptoms Treatment

June 3rd, 2010 by admin

Case: Antidepressant agents. Questions – Answers

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Contents

Questions
Answers
Pharmacology pearls

Questions

[1] Which of the following agents is contraindicated in a patient with epilepsy?

A. Bupropion

B. Fluoxetine

C. Mirtazapine

D. Venlafaxine

[2] The antidepressant action of imipramine is thought to be caused by which of the following?

A. Blockade of prejunctional α₂-adrenoceptors

B. Blockade of prejunctional neuronal norepinephrine and serotonin uptake transporters in the CNS

C. Increased numbers of β-adrenoceptors

D. Inhibition of monoamine oxidase

[3] Which of the following antidepressant agents inhibits hepatic microsomal enzymes to cause clinically significant drug-drug interactions?

A. Fluoxetine

B. Imipramine

C. Phenelzine

D. Trazodone

Answers

[1] A. Bupropion causes seizures in a small but significant number of patients. This number is reduced with use of the slow-release form.

[2] B. Imipramine and other TCAs block prejunctional neuronal norepinephrine and or serotonin uptake transporters in the CNS. Phenelzine and tranylcypromine inhibit monoamine oxidase. The heterocyclic agent mirtazapine blocks prejunctional α₂-adrenoceptors to enhance serotonin and norepinephrine neurotransmission.

[3] A. The SSRI fluoxetine inhibits cytochrome P450 and therefore can significantly elevate the level of other drugs metabolized by these hepatic enzymes.

Pharmacology pearls

SSRIs are the most commonly prescribed antidepressants because of their favorable side effect profile. Sexual disturbances and GI effects are common, however.

TCAs may lead to toxicity as a result of cardiac arrhythmias.

The antidepressant agents are roughly equivalent in their therapeutic action. However, individual patients may respond to, or tolerate, one better than another.

Small beginning doses of many antidepressant agents are usually preferred because with time tolerance may occur to some of their adverse effects.

Bupropion is contraindicated in patients with seizure disorders.

Case: Antidepressant agents. Discussion Class Drugs used to treat depression are classified as TCAs, atypical heterocyclic (second- and third-generation) agents, SSRIs, and monoamine oxidase inhibitors (MAOIs). Other conditions for which certain antidepressant agents are used include panic disorder, obsessive-compulsive disease (OCD), bipolar affective disorder, chronic pain, and enuresis. SSRIs are ...
Antidepressants: Pharmacology The use of antidepressants in the treatment of depression remains the best-understood use of these medications; however, there is a growing list of other indications for antidepressants, including panic disorder (PD), obsessive-compulsive disorder (OCD), bulimia and posttraumatic stress disorder (PTSD). Many of these illnesses ...
Case: Antidepressant agents A 30-year-old woman presents to your office for the evaluation of fatigue. For the past 2 months she has felt run down. She says that she doesn't feel like participating in activities that she previously enjoyed, such as her weekly softball games. She has ...
Antidepressants: Drug Interactions The most common drug interaction with antidepressants is their influence on the metabolism of other drugs. Antidepressants are metabolized through catabolic enzymes located in a variety of places, but primarily in the smooth endoplasmic reticulum of hepatocytes: the cytochrome P450 (CYP) enzymes. Many other ...
Management of treatment-resistant depression: Switching antidepressants If lithium augmentation is ineffective, it should be discontinued and the antidepressant changed (Table 5). A lack of response to one of the newer agents in a class, such as the selective serotonin reuptake inhibitors (SSRIs), does not predict lack of response to ...

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Tags: antidepressant, antidepressants, Bupropion, epilepsy, Fluoxetine, Imipramine, Mirtazapine, Phenelzine, SSRIs, TCAs, Tranylcypromine, Trazodone, Venlafaxine
Posted in Pharmacotherapy