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YR5 Psychiatry > Anti-depressants > Flashcards

Anti-depressants Flashcards

1
Q

Recall the symptoms of suddenly stopping antidepressant medication

A

FIRM STOP
Flu-like Sx
Insomnia
Restlesness
Mood swings

Sweating
Tummy problems
Off-balance (ataxia)
Paraesthesia

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2
Q

Recall 4 examples of SSRIs

A

For Sadness, Panic, Compulsion:
Fluoxetine
Sertraline
Paroxetine
Citalopram

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3
Q

Recall one important risk of SSRIs

A

May increase suicidal thoughts/ self-harm risk

Depression can stop people performing ADLs due to extreme lethargy/ apathy: when antidepressant begins to work + enable people to do things again, they are also more able to act on thoughts of self-harm

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4
Q

Give 2 drugs that SSRIs interact with and the result

A

Triptans (ask about migraines)

Monoamine oxidase inhibitors

Interaction can cause serotonin syndrome

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5
Q

When prescribing an SSRI for anxiety, how long should you advise the patient it may take to work?

A

Anxiety may initially worsen (1-2w)
Will need 4-6w to work

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6
Q

How long should SSRI medications be continued for?

A

6m after remission of 1st episode
2y after remission if it’s a recurrence
Gradually stop over 4w

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7
Q

Recall one important side effect of citalopram

A

QT prolongation

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8
Q

What is the first line antidepressant used in children?

A

Fluoxetine

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9
Q

What should be prescriped if a patient on SSRIs needs NSAIDs?

A

Proton pump inhibitor
As increased risk GI bleeding with SSRI

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10
Q

When should patients be reviewed after starting an SSRI?

A

2w
1w if <25/ increased risk of suicide

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11
Q

What are the risks of SSRI use in pregnancy?

A

1st trim: small increased risk of congenital heart defects
3rd trim: can result in persistent pulmonary HTN of the newborn

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12
Q

Which SSRI is associated with congenital malformations if used in the first trimester?

A

Paroxetine

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13
Q

Recall 5 SE’s of SSRIs

A

The 5 ‘S’s:
Stomach (DNV= most common SE)
Suicidal idealisation
Sexual dysfunction
Sleep (insomnia)
Serotonin syndrome

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14
Q

What electrolyte abnormality can be caused by SSRIs?

A

Hyponatraemia

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15
Q

When switching anti-depressant, what does the term withdraw mean?

A

Gradually reduce dose, then stop + start new anti-depressant next day

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16
Q

Describe the switching from citalopram, escitalopram, sertraline or paroxetine to another SSRI

A

1st should be withdrawn before other is started

17
Q

Describe the switching from fluoxetine to another SSRI

A

Withdraw, then leave 4-7d (long half life) before starting a low dose of the new SSRI

18
Q

Describe the switching from SSRI to TCA

A

Cross tapering is recommended
Exception: Fluoxetine should be withdrawn before starting 4-7d later

19
Q

Describe the switching from citalopram, escitalopram, sertraline or paroxetine to venlafaxine

A

Cross taper cautiously + start low dose venlafaxine

20
Q

Describe the switching from fluoxetine to venlafaxine

A

Withdraw then start venlafaxine low + slow 4-7d later

21
Q

If a patient takes warfarin/ heparin, what antidepressant should be advised instead of an SSRI?

A

Mirtazipine

22
Q

What does SNRI stand for?

A

Serotonin noradrenaline reuptake inhibitor

23
Q

What is the main side effect of SNRIs?

A

Headache

24
Q

Recall 2 examples of SNRIs

A

Venlafaxine
Duloxetine

25
Q

Give 7 side effects of SNRIs

A

Headaches
Nausea
Constipation
HTN
Sweating
Insomnia
Sexual dysfunction

26
Q

What is the mechanism of action of TCAs?

A

Block serotonin + NA re-uptake

27
Q

What can TCAs be used for at low vs high doses?

A

Low dose: blocks H1 + 5HT + aids sleep

Higher doses: blocks all receptors- used in depression

28
Q

Why are TCAs not given if there is risk of suicide?

A

Can be fatal in OD

29
Q

What is one key contraindication for TCAs?

A

If patient also taking a monoamine oxidase inhibitor

30
Q

Recall the side effects of TCAs

A

TCA:
Thrombocytopaenia

Cardiac (QT prolongation, ST elevation, heart block, arrhythmias)

Anticholinergic (urinary retention, dry mouth, blurry vision, constipation)

Also:
Weight gain + sedation from histaminergic receptor blockade
Postural hypotension from alpha-adrenergic receptor blockade

31
Q

What are the anticholinergic side effects that are possible with all types of antidepressant?

A

“Can’t see, can’t pee, can’t spit, can’t shit”

32
Q

Give 2 examples of TCAs

A

Amitriptyline
Clomipramine

33
Q

What type of antidepressant is mirtazapine?

A

Noradrenergic and specific serotonin antidepressant (NaSsA)

34
Q

When is mirtazapine indicated?

A

Triad of depression + insomnia + loss of appetite

35
Q

What does MAOI stand for? Give 2 examples of MAOIs

A

MonoAmine Oxidase Inhibitor
Phenelzine
Selegiline

36
Q

What is the main risk of MAOI use?

A

Hypertensive cheese reaction

37
Q

What type of antidepressant is moclobemide?

A

Reversible Inhibitor of Monoamine oxidase A (RIMA)

38
Q

What is the MOA of benzodiazepines?

A

Enhance inhibitory GABA transmission at GABA-A receptor
MOA: Increase frequency of chloride channels

39
Q

What is the MOA of Barbituates?

A

Enhance inhibitory GABA transmission at GABA-A receptor
MOA: increase duration of cl- channel opening

YR5 Psychiatry (33 decks)

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