Anti-depressants

Question 1

List the types of anti-depressants

Answer 1

Selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors, serotonin and noradrenaline reuptake inhibitors (SNRIs), atypical anti-depressants and serotonin 2 antagonists/reuptake inhibitors (SARI)

Question 2

Examples of SSRIs

Answer 2

Fluoxetine, citalopram, escitalopram, sertraline

Question 3

Mechanism of SSRIs

Answer 3

Block uptake of serotonin from the synaptic cleft

Question 4

What is 1st line in depression

Answer 4

SSRIs

Question 5

What else are SSRIs used for

Answer 5

Panic disorders, OCD, PTSD, phobias, GAD (escitalopram and paroxetine)

Question 6

What usually happens with nausea in SSRIs

Answer 6

Usually improves after the first week

Question 7

What are the discontinuation effects of SSRIs, how do you avoid this and which drug is the worst for these symptoms

Answer 7

GI upset, anxiety, agitation, insomnia, myoclonus, taper the drugs over weeks to avoid this and paroxetine is the worst

Question 8

What increases in risk when SSRIs are used with NSAIDs

Answer 8

GI bleeding

Question 9

What SSRI is safest in cardiac problems

Answer 9

Sertraline

Question 10

What SSRI is safest in epilepsy

Answer 10

Citalopram

Question 11

Why is paroxetine rarely used

Answer 11

Discontinuation syndrome and anticholinergic effects

Question 12

Give examples of tricyclic antidepressants

Answer 12

Imipramine, dosulepin, amitriptyline and lofepramine

Question 13

Mechanism of tricyclic antidepressants

Answer 13

Block the reuptake of monoamines (mainly noradrenaline and 5-HT) into presynaptic terminals

Question 14

Why are tricyclic antidepressants not first line?

Answer 14

Cardiac side effects and dangerous in OD

Question 15

What is 2nd line in panic disorder

Answer 15

tricyclic antidepressants

Question 16

Examples of monoamine oxidase inhibitors

Answer 16

Phenelzine and moclobemide

Question 17

Which monoamine oxidase inhibitors is reversible and which is irreversible

Answer 17

Phenelzine is irreversible and moclobemide is reversible

Question 18

When to use monoamine oxidase inhibitors

Answer 18

Treatment resistent depression (3rd or 4th line)

Question 19

What is used in social anxiety disorder

Answer 19

Moclobemide

Question 20

What is the cheese reaction (hypertensive crisis) in monoamine oxidase inhibitors

Answer 20

Inhibition of MOA-A in gut and liver preventing breakdown of dietary tyramine. No high tyramine foods

Question 21

Why are monoamine oxidase inhibitors not used in bipolar

Answer 21

High risk of switching to mania

Question 22

How to treat hypertensive crisis

Answer 22

Phentolamine infusion

Question 23

Examples of SNRIs

Answer 23

Venlafaxine and duloxetine

Question 24

Mechanism of SNRIs

Answer 24

Block the reuptake of monoamines (noradrenaline and serotonin) into presynaptic terminals

Question 25

What is used in GAD

Answer 25

Venlafaxine

Question 26

How to use venlafaxine

Answer 26

Excellent in combination with mirtazapine and monotherapy doesnt work

Question 27

What can duloexetine be used for

Answer 27

Neuropathic pain or bladder instability

Question 28

Examples of atypical antidepressants

Answer 28

Mitrazapine and bupropion

Question 29

What is bupropion used for

Answer 29

Smoking cessation

Question 30

Mechanism of atypical antidepressants

Answer 30

Blocks alpha2 and serotonin

Question 31

Side effects of atypical antidepressants

Answer 31

weight gain, sedation, constipation

Question 32

Example of SARI

Answer 32

Trazodone

Question 33

Mechanism of SARI

Answer 33

Serotonin antagonist and reuptake inhibitor

Question 34

When are SARIs used

Answer 34

When sedation is needed and/or to augment other antidepressants