NU 641 Mental Health Anridepressants
Test Questions with All Correct Answers
When are SNRIs usually used? - Answer- Typically used with MAJOR depression
bipolar, GAD, social phobia and PTSD
What antidepressant does not case weight gain or sexual dysfunction? - Answer-
Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)
What is the name of Bupropion used for smoking cessation? - Answer- Zyban
What is the name of only tetracyclic antidepressant? - Answer- Mirtazapine (Remeron,
Remeron Solutabs)
What is the only SSRI approved for OCD? - Answer- Fluvoxamine (Luvox) is approved
for OCD
SSRIs ADR's: - Answer- CNS, GI, Sexual dysfunction (up to 35% of pts)
Caution in patients with severe hepatic or renal impairment
What important education is needed when SSRIs are first prescribed? - Answer-
Educate that SSRIs do not work right away. Pts may often feel worse and then batter.
Adherence - may take 3-4 weeks until full therapeutic effect
Suicide risk due to feeling worse-
SSRIs and pregnancy - Answer- Pregnancy: Category B/C
Recommended to avoid in 1st and last trimesters
WHat is the only SSRIs recommended to use in pregnancy? - Answer- Risk/benefit:
Sertraline (Zoloft) been used w/o adverse consequences. Is more safe than others but
still not the safest.
SSRIs monitoring - Answer- Close monitoring in first 2-3 weeks, Never give more than 4
wks for first prescription
SSRIs and elderly - Answer- Elderly: watch electrolytes half dose recommended
What kind of initial side effects do occur with SSRIs? - Answer- Initial side effects -
nausea , light-headedness, sedation, muscle restlessness and sleep disruptions -
should be minor and transient
, MOA of Mirtazapine (Remeron) - Answer- tetracyclic antidepressant, central presynaptic
alpha2-adrenergic antagonist effects, which results in increased release of
norepinephrine and serotonin, Also histamine antagonist
Murtazapine ADRs - Answer- VERY Sedating. Has to be given at night
Causes weight gain, sometimes used in elderly for this reason
Trazadone MOA and indications - Answer- Trazadone (Desyrel)
Inhibits reuptake of serotonin, also significantly blocks histamine (H1) and alpha1-
adrenergic receptors
Indications: Depression, mainly used for sleep (off-label)
Black Box Warning Suicide risk for all antidepressants - Answer- As of 2007, all
Antidepressants FDA Black Box Warning
Increased risk of suicidal thought and behavior
Children, adolescents, young adults to age 24
Closely monitor patients for clinical worsening, suicidality, or unusual changes in
behavior, particularly during the initial 1-2 months of therapy or during periods of dosage
adjustments (increases or decreases); the patient's family or caregiver should be
instructed to closely observe the patient and communicate condition with healthcare
provider. A medication guide concerning the use of antidepressants should be
dispensed with each prescription.
Tricyclic Antidepressants (TCAs) examples: - Answer- Amitriptyline (Elavil), nortriptyline
(Pamelor), imipramine (Tofranil), doxepin (Sinequan), desipramine (Norpramin),
clomipramine (Anafranil)
Why TCAs are not first line treatment? - Answer- Nonselective (more side efffects)
Norepinephrine-Serotonin Reuptake Inhibitors
Equally efficacious as other antidepressants but have greater side effects,
less safe in suicidal population-overdose can be fatal
TCAs MOA - Answer- Inhibit reuptake of serotonin and norepinephrine at presynaptic
neuron
Also act on histamine (drowsiness, weight gain) and acetylcholine
TCAs ADRs - Answer- ADR's: paradoxical diaphoresis, causing anticholinergic effects,
orthostatic hypotension, sedation, drowsiness
TCAs are Contraindicated/caution in - Answer- Contraindicated/caution in
cardiovascular disorders, glaucoma, prostatic hypertrophy, or urinary incontinence,
seizure disorders, elderly
Test Questions with All Correct Answers
When are SNRIs usually used? - Answer- Typically used with MAJOR depression
bipolar, GAD, social phobia and PTSD
What antidepressant does not case weight gain or sexual dysfunction? - Answer-
Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)
What is the name of Bupropion used for smoking cessation? - Answer- Zyban
What is the name of only tetracyclic antidepressant? - Answer- Mirtazapine (Remeron,
Remeron Solutabs)
What is the only SSRI approved for OCD? - Answer- Fluvoxamine (Luvox) is approved
for OCD
SSRIs ADR's: - Answer- CNS, GI, Sexual dysfunction (up to 35% of pts)
Caution in patients with severe hepatic or renal impairment
What important education is needed when SSRIs are first prescribed? - Answer-
Educate that SSRIs do not work right away. Pts may often feel worse and then batter.
Adherence - may take 3-4 weeks until full therapeutic effect
Suicide risk due to feeling worse-
SSRIs and pregnancy - Answer- Pregnancy: Category B/C
Recommended to avoid in 1st and last trimesters
WHat is the only SSRIs recommended to use in pregnancy? - Answer- Risk/benefit:
Sertraline (Zoloft) been used w/o adverse consequences. Is more safe than others but
still not the safest.
SSRIs monitoring - Answer- Close monitoring in first 2-3 weeks, Never give more than 4
wks for first prescription
SSRIs and elderly - Answer- Elderly: watch electrolytes half dose recommended
What kind of initial side effects do occur with SSRIs? - Answer- Initial side effects -
nausea , light-headedness, sedation, muscle restlessness and sleep disruptions -
should be minor and transient
, MOA of Mirtazapine (Remeron) - Answer- tetracyclic antidepressant, central presynaptic
alpha2-adrenergic antagonist effects, which results in increased release of
norepinephrine and serotonin, Also histamine antagonist
Murtazapine ADRs - Answer- VERY Sedating. Has to be given at night
Causes weight gain, sometimes used in elderly for this reason
Trazadone MOA and indications - Answer- Trazadone (Desyrel)
Inhibits reuptake of serotonin, also significantly blocks histamine (H1) and alpha1-
adrenergic receptors
Indications: Depression, mainly used for sleep (off-label)
Black Box Warning Suicide risk for all antidepressants - Answer- As of 2007, all
Antidepressants FDA Black Box Warning
Increased risk of suicidal thought and behavior
Children, adolescents, young adults to age 24
Closely monitor patients for clinical worsening, suicidality, or unusual changes in
behavior, particularly during the initial 1-2 months of therapy or during periods of dosage
adjustments (increases or decreases); the patient's family or caregiver should be
instructed to closely observe the patient and communicate condition with healthcare
provider. A medication guide concerning the use of antidepressants should be
dispensed with each prescription.
Tricyclic Antidepressants (TCAs) examples: - Answer- Amitriptyline (Elavil), nortriptyline
(Pamelor), imipramine (Tofranil), doxepin (Sinequan), desipramine (Norpramin),
clomipramine (Anafranil)
Why TCAs are not first line treatment? - Answer- Nonselective (more side efffects)
Norepinephrine-Serotonin Reuptake Inhibitors
Equally efficacious as other antidepressants but have greater side effects,
less safe in suicidal population-overdose can be fatal
TCAs MOA - Answer- Inhibit reuptake of serotonin and norepinephrine at presynaptic
neuron
Also act on histamine (drowsiness, weight gain) and acetylcholine
TCAs ADRs - Answer- ADR's: paradoxical diaphoresis, causing anticholinergic effects,
orthostatic hypotension, sedation, drowsiness
TCAs are Contraindicated/caution in - Answer- Contraindicated/caution in
cardiovascular disorders, glaucoma, prostatic hypertrophy, or urinary incontinence,
seizure disorders, elderly
