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Psychiatry SOH > Anti-depressants > Flashcards

Anti-depressants Flashcards

1
Q

Anti depressants work straight away. True or false?

A

False

- they take 2-6 weeks to work

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2
Q

Using anti-depressants prevents relapses. True or false?

A

True

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3
Q

Anti-depressants are associated with addiction. True or false?

A

False

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4
Q

Anti-depressants are more effective than talking therapies in the treatment of depression. True or false?

A

True

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5
Q

Some anti-depressants are better than others. True or false?

A

False

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6
Q

Which anti depressant is usually used first line?

A 
SSRI 
- if this doesn't work try another SSRI then try a different class of AD
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7
Q

Mechanism of action of most ADs

A

Most affect synaptic levels of the monoamine neurotransmitters (mainly 5-HT and NA).
They tend to reduce the b/d of neurotransmitters or inhibit their reuptake into the presynaptic terminal

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8
Q

What are the monoamine neurotransmitters

A

5-HT (serotonin)
Noradrenaline
Dopamine

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9
Q

Depression results from a deficit in which monoamine transmitters?

A

5-HT (serotonin)

Noradrenaline

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10
Q

What is 5-HT metabolised by?

A

Monoamine oxidase

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11
Q

What is noradrenaline metabolised by?

A

Monoamine oxidase

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12
Q

Name 4 classes of monoamine reuptake inhibitors

A

SSRI
SNRI
TCA
Atypicals

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13
Q

Monoamine reuptake inhibitors - mechanism of action

A

Block the neurotransmitter (serotonin, NA) either selectively or non-selectively back into the pre-synaptic terminal

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14
Q

Monoamine reuptake inhibitors - TCA - examples (4)

A

Impiramine
Dosulepin
Amitriptyline
Lofepramine

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15
Q

Monoamine reuptake inhibitors - TCA are selective/non selective?

A

Non-selective

- block the reuptake of serotonin and NA back into the pre-synaptic terminal

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16
Q

Monoamine reuptake inhibitors - TCAs - can be used in patients with suicidal intent. True or false?

A

False

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17
Q

Monoamine reuptake inhibitors - TCAs - overdose is dangerous. True or false?

A

True

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18
Q

Monoamine reuptake inhibitors - TCAs - side effects

A

Anticholinergic

  • blurred vision
  • dry mouth
  • constipation
  • urinary retention

Weight gain
Cardiovascular side effects
Sedation

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19
Q

If the patient has insomnia, which anti-depressant class might be beneficial?

A

TCA

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20
Q

Monoamine reuptake inhibitors - SSRI - mechanism of action

A

Selectively blocks the reuptake of serotonin back into the pre-synaptic terminal

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21
Q

Monoamine reuptake inhibitors - SSRI - example (4)

A

Fluoxetine
Escitalopram
Sertaline
Paroxatine

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22
Q

Monoamine reuptake inhibitors - SSRI - safe to use in adolescents. True or false?

A

False

- don’t use in adolescents due to increased self harm risk

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23
Q

Monoamine reuptake inhibitors - SSRI - Use if suicidal and at risk of overdose. True or false?

A

True

- relatively safe in overdose

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24
Q

Which SSRI is most commonly used in pregnancy ?

A

Sertaline

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25
Monoamine reuptake inhibitors - SSRI - side effects
Usually transient: - nausea - headache - sweating - worsened anxiety - sexual dysfunction - increased self harm - agitation - don't give with NSAIDS
26
Which SSRI has discontinuation effects as it leaves the system rapidly?
Paroxetine
27
Monoamine reuptake inhibitors - SNRI - mechanism of action
Non-selective | Blocks the repute of monoamines (NA + 5-HT) into presynaptic terminals
28
Monoamine reuptake inhibitors - SNRI - examples
Venlafaxine | Duloxetine
29
Monoamine reuptake inhibitors - SNRI - side effects
Transient side effects: - Nausea - Headache - sweating - worsened anxiety - sexual dysfunction
30
SNRI have a similar mechanism of action as which other class?
TCA
31
TCA has worse side effects than SNRI. True or false?
True | - so SNRI used more frequently
32
Monoamine reuptake inhibitors - atypical anti-depressants - mechanism of action
Similar to SSRI but also noradrenergic
33
Monoamine reuptake inhibitors - atypical anti-depressants - which receptors does it block
Blocks alpha 2, 5-Ht2, 5-HT3 receptors
34
Monoamine reuptake inhibitors - atypical anti-depressants - useful if patient has insomnia. True or false?
True
35
Monoamine reuptake inhibitors - atypical anti-depressants -side effects
Sedation | Weight gain
36
Monoamine reuptake inhibitors - atypical anti-depressants -examples (2)
Mirtazapine | Bupropion
37
Monoamine oxidase inhibitors - mechanism of action
Inhibit MAO Concentration of monoamines (NA, 5-HT) increases since there are more monoamines pre-synaptically and in the synaptic cleft.
38
Monoamine oxidase inhibitors - they are used routinely. True or false?
False | - held in reserve if nothing else works
39
Monoamine oxidase inhibitors - give an example of an irreversible inhibitor
Phenelzine - inhibits MAO which decreases the breakdown of the monoamine neurotransmitters leading to increased levels in the synapse
40
Monoamine oxidase inhibitors - phenelzine - side effects
Avoid foods with tyramine Insomnia Postural hypotension Peripheral oedema
41
List 2 foods that contain tyramine?
Cheese | Yeast based products
42
Monoamine oxidase inhibitors - give an example of a reversible inhibitor
Moclobemide | - if you get enough monoamines coming around then you get MAO functioning
43
Which has less side effects. Moclobemide or phenelzineu?
Moclobemide
44
Non-response to an AD can be defined as no response / inadequate response after ___ weeks?
6 weeks
45
After full resolution of symptoms of first episode of depression, AD medication should be continued for at least ___ ?
6-12 months
46
It is not advised to combine anti-depressants. True or false?
True
47
What is ECT ?
Proven effective treatment for depression | Induces a seizure lasting 15-20 seconds
48
Contraindications for ECT
Recent MI Recent stroke Intracranial mass Phaeochromocytoma
49
ECT can be used in pregnancy. True or false?
True
50
Side effects of ECT
Short lived headache Memory problems Muscle aches
51
ECT - who gets it
People who have severe depression (e.g. aren't eating or drinking)
52
What class is fluoxetine?
SSRI
53
What class is imipramine?
TCA
54
What class is mobeclamide?
(reversible) Monoamine oxidase inhibitor
55
What class is duloxetine?
SNRI
56
What class is sertaline?
SSRI
57
What class is Mirtazapine?
Atypical anti-depressant
58
What class is venlafaxine?
SNRI
59
Name a reversible MAOI
Moclobemide
60
Name an Irreversible MAOI
Phenelezine
61
First line anti-depressant
SSRI (6-8 weeks)
62
GP anti-depressant treatmetn plan
1st line: SSRI (6-8 weeks at therapeutic dose) 2nd line: try another SSRI (6-8 weeks at therapeutic dose) 3rd line: if the above doesn't work, refer to psychiatry

Psychiatry SOH (19 decks)

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