Pharmacology: Antidepressants; Questions &
Answers 100% Solved
Generally, how do all antidepressants work? Correct answer-All currently available
antidepressant drugs *enhance monoamine neurotransmission* by one of several mechanisms.
The most common mechanism is the inhibition of the seroto...
Pharmacology: Antidepressants; Questions &
Answers 100% Solved
Generally, how do all antidepressants work? Correct answer-All currently available
antidepressant drugs *enhance monoamine neurotransmission* by one of several mechanisms.
The most common mechanism is the inhibition of the serotonin transporter (SERT), the
norepinephrine transporter (NET), or both.
Name the MAO inhibitors. Correct answer-• Isocarboxazid (hydrazine derivative)
• Phenelzine (hydrazine derivative)
• Tranylcypromine (non-hydrazine derivative)
• Selegiline (non-hydrazine derivative)
What are the two kinds of MAO? Correct answer-There are two isozymes of MAO: MAO-
A and MAO-B. MAO-A preferentially deaminates norepinephrine, epinephrine and serotonin.
Dopamine and tyramine are metabolized by both isozymes.
What is the mechanism of action for MAO inhibitors? Correct answer-MAO inhibitors
inactivate the enzyme, permitting neurotransmitter molecules to escape degradation and,
therefore, to both accumulate within the presynaptic neuron and leak into the synaptic space.
This is believed to cause activation of norepinephrine and serotonin receptors, and it may be
responsible for the indirect antidepressant action of these drugs.
Which MAO inhibitors are non-selective and irreversible? Correct answer-Isocarboxazid,
phenelzine and tranylcypromine bind irreversibly and nonselectively to MAO-A and MAO-B.
, Pharmacology: Antidepressants; Questions &
Answers 100% Solved
Which kind of MAO inhibitor is better in treating major depression? Correct answer-
Experimentally, selective MAO-A inhibitors are thought to be more effective in treating major
depression than type B inhibitors.
Which MAO inhibitor is approved to treat early Parkinson's disease? Correct answer-The
MAO-B inhibitor *selegiline* is approved for treatment of early Parkinson's disease.
What happens with high doses of selegiline? Correct answer-Selegiline has also
antidepressant effects, particularly at high doses that also inhibit MAO-A or yield amphetamine-
like metabolites. Selegiline is the first antidepressant available in a transdermal delivery system.
Do MAO inhibitors have immediate antidepressant effects? Correct answer-No. Although
MAO is fully inhibited after several days of treatment, the antidepressant action of the MAO
inhibitors is delayed several weeks.
Which MAO inhibitors may produce insomnia or agitation? Correct answer-Selegiline and
tranylcypromine have an amphetamine-like stimulant effects that may produce agitation or
insomnia.
What are the clinical uses of MAO inhibitors? Correct answer-MAO inhibitors are now
*rarely used* due to toxicity and potentially lethal food and drug interactions. Their primary use
is in the *treatment of depression unresponsive to other antidepressants*.
, Pharmacology: Antidepressants; Questions &
Answers 100% Solved
What are the adverse effects of MAO inhibitors? Correct answer-Possible adverse effects
of treatment with MAO inhibitors include drowsiness, orthostatic hypotension, blurred vision,
dry mouth, dysuria, and constipation.
How are MAO inhibitors administered? Correct answer-MAO inhibitors are well absorbed
orally but suffer high first-pass metabolism.
What are the signs of MAO inhibitor overdose, and how can it be managed? Correct
answer-An overdose can produce autonomic instability, hyperadrenergic symptoms, psychotic
symptoms, confusion, delirium, fever, and seizures. It should be managed with cardiac
monitoring, vital support and gastric lavage.
Which drugs may cause serotonin syndrome when given with MAO inhibitors? Correct
answer-Serotonergic agents such as SSRIs, SNRIs, TCAs or meperidine may result in a life-
threatening serotonin syndrome when given with MAOi.
What are the symptoms of serotonin syndrome? Correct answer-The syndrome includes
hyperthermia, muscle rigidity, myoclonus, and rapid changes in mental status and vital signs. It
is caused by overstimulation of 5-HT1A and 5-HT2 receptors.
How can serotonin syndrome be avoided with MAO inhibitors? Correct answer-Most
serotonergic antidepressants should be discontinued at least 2 weeks before starting a MAO
inhibitor. Fluoxetine, because of its long half-life, should be discontinued 4-5 weeks before a
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