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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
Q

Monoamine reuptake inhibitors - SSRI - side effects

A

Usually transient:

  • nausea
  • headache
  • sweating
  • worsened anxiety
  • sexual dysfunction
  • increased self harm
  • agitation
  • don’t give with NSAIDS
26
Q

Which SSRI has discontinuation effects as it leaves the system rapidly?

A

Paroxetine

27
Q

Monoamine reuptake inhibitors - SNRI - mechanism of action

A

Non-selective

Blocks the repute of monoamines (NA + 5-HT) into presynaptic terminals

28
Q

Monoamine reuptake inhibitors - SNRI - examples

A

Venlafaxine

Duloxetine

29
Q

Monoamine reuptake inhibitors - SNRI - side effects

A

Transient side effects:

  • Nausea
  • Headache
  • sweating
  • worsened anxiety
  • sexual dysfunction
30
Q

SNRI have a similar mechanism of action as which other class?

A

TCA

31
Q

TCA has worse side effects than SNRI. True or false?

A

True

- so SNRI used more frequently

32
Q

Monoamine reuptake inhibitors - atypical anti-depressants - mechanism of action

A

Similar to SSRI but also noradrenergic

33
Q

Monoamine reuptake inhibitors - atypical anti-depressants - which receptors does it block

A

Blocks alpha 2, 5-Ht2, 5-HT3 receptors

34
Q

Monoamine reuptake inhibitors - atypical anti-depressants - useful if patient has insomnia. True or false?

A

True

35
Q

Monoamine reuptake inhibitors - atypical anti-depressants -side effects

A

Sedation

Weight gain

36
Q

Monoamine reuptake inhibitors - atypical anti-depressants -examples (2)

A

Mirtazapine

Bupropion

37
Q

Monoamine oxidase inhibitors - mechanism of action

A

Inhibit MAO
Concentration of monoamines (NA, 5-HT) increases since there are more monoamines pre-synaptically and in the synaptic cleft.

38
Q

Monoamine oxidase inhibitors - they are used routinely. True or false?

A

False

- held in reserve if nothing else works

39
Q

Monoamine oxidase inhibitors - give an example of an irreversible inhibitor

A

Phenelzine
- inhibits MAO which decreases the breakdown of the monoamine neurotransmitters leading to increased levels in the synapse

40
Q

Monoamine oxidase inhibitors - phenelzine - side effects

A

Avoid foods with tyramine
Insomnia
Postural hypotension
Peripheral oedema

41
Q

List 2 foods that contain tyramine?

A

Cheese

Yeast based products

42
Q

Monoamine oxidase inhibitors - give an example of a reversible inhibitor

A

Moclobemide

- if you get enough monoamines coming around then you get MAO functioning

43
Q

Which has less side effects. Moclobemide or phenelzineu?

A

Moclobemide

44
Q

Non-response to an AD can be defined as no response / inadequate response after ___ weeks?

A

6 weeks

45
Q

After full resolution of symptoms of first episode of depression, AD medication should be continued for at least ___ ?

A

6-12 months

46
Q

It is not advised to combine anti-depressants. True or false?

A

True

47
Q

What is ECT ?

A

Proven effective treatment for depression

Induces a seizure lasting 15-20 seconds

48
Q

Contraindications for ECT

A

Recent MI
Recent stroke
Intracranial mass
Phaeochromocytoma

49
Q

ECT can be used in pregnancy. True or false?

A

True

50
Q

Side effects of ECT

A

Short lived headache
Memory problems
Muscle aches

51
Q

ECT - who gets it

A

People who have severe depression (e.g. aren’t eating or drinking)

52
Q

What class is fluoxetine?

A

SSRI

53
Q

What class is imipramine?

A

TCA

54
Q

What class is mobeclamide?

A

(reversible) Monoamine oxidase inhibitor

55
Q

What class is duloxetine?

A

SNRI

56
Q

What class is sertaline?

A

SSRI

57
Q

What class is Mirtazapine?

A

Atypical anti-depressant

58
Q

What class is venlafaxine?

A

SNRI

59
Q

Name a reversible MAOI

A

Moclobemide

60
Q

Name an Irreversible MAOI

A

Phenelezine

61
Q

First line anti-depressant

A

SSRI (6-8 weeks)

62
Q

GP anti-depressant treatmetn plan

A

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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