8) Pharmacy

Question 1

Why might depression be more common in older people (1 in 5)?

Answer 1

Co-morbid conditions

Not functioning how they used to

Question 2

What is the epidemiology of mental health disorders in prisons?

Answer 2

9 in 10 have a mental health disorder

Question 3

Which gender is more likely to commit suicide?

Answer 3

Male

Question 4

Why does depression need to be treated?

Answer 4

Risk of mortality

High morbidity

Question 5

Describe the stepped care model for treating depression:

Answer 5

Based on severity of depression, there are different steps to treating. From assessment, to medication and therapy to ECT

Question 6

Give some examples of SSRIs:

Answer 6

Citalopram
Fluoxetine
Escitalopram
Sertraline

Question 7

What is the mechanism of SSRIs?

Answer 7

Block reuptake of serotonin into pre-synaptic neurones, increasing serotonin in synaptic cleft

Question 8

What are some side effects of SSRIs?

Answer 8

Nausea
Erectile dysfunction 
Weight loss
Agitation 
Sleep disturbance

Question 9

What are the main interactions in terms of antidepressants?

Answer 9

SSRI and NSAID - increased risk of bleeding

Citalopram and antipsychotics - increased risk of QT prolongation

Question 10

Give some examples of TCAs:

Answer 10

Amitriptyline

Clomipramine

Question 11

What is the mechanism of TCAs?

Answer 11

Blocking reuptake of NA and serotonin into pre-synaptic neurones

Question 12

What side effect caused TCAs to be phased out?

Answer 12

Cardiotoxic in overdose

Question 13

What are MAOIs and how do they work?

Answer 13

Monoamine oxidase inhibitors

Irreversibly inhibiting action of monoamine oxidase which breaks down NA and serotonin

Question 14

Give some examples of MAOIs:

Answer 14

Phenelzine

Trancypromine

Question 15

What are some side effects of MAOIs?

Answer 15

Nausea
Constipation
Hypertension

Question 16

Give some examples of SNRIs:

Answer 16

Venlafaxine

Duloxetine

Question 17

What is a NaSSA?

Answer 17

Noradrenaline and specific serotonergic agent

Question 18

Give an example of an NaSSA:

Answer 18

Mirtazepine

Question 19

How do NaSSAs work?

Answer 19

Presynaptic alpha 2 receptor antagonist - increase NA and serotonin neurotransmission

Question 20

What is the most cost-effective drug for treating depression?

Answer 20

Mirtazapine

Question 21

How long do anti-depressants take to work?

Answer 21

4-6 weeks

Question 22

How long should the drugs be taken before a dose change?

Answer 22

6 weeks

Question 23

What conditions should be treated with special precautions?

Answer 23

Pregnancy
Breast feeding
Liver failure
Renal failure