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Psychiatry > Anti-Depressants > Flashcards

Anti-Depressants Flashcards

1
Q

What are the indications for anti-depressants

A 
Unipolar and bipolar depression 
Organic mood disorders 
Schizoaffective disorder 
Anxiety disorders including OCD
Panic
Social phobia
PTSD
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2
Q

What are the different classifications of antidepressants

A 
SSRIs
SNRIs
TCA 
Monoamine Oxidase Inhibitors (MAOIs)
Novel antidepressants
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3
Q

What is generally the first line antidepressant class used

A

SSRI

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4
Q

Action of SSRIs

A

Block pre-synaptic serotonin reuptake

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5
Q

Most common SE of SSRIs

A 
GI upset
Sexual dysfunction 
Anxiety 
Restlessness 
Sedation
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6
Q

Name 3 types of SRRIs

A

Sertraline
Fluoxetine
Citalopram
Paroxetine

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7
Q

What is the action of SNRIs

A

Inhibit both serotonin and noradrenergic reuptake like the TCAS but without the antihistamine, antiadrenergic or anticholinergic side effects

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8
Q

Which antidepressant is no longer recommended 1st line

A

TCAs

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9
Q

What is the major issue with TCAs

A

They are lethal in overdose

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10
Q

Which 2 types of anti-depressants are rarely used nowadays and if they are it is in secondary care

A

Monoamine Oxidase Inhibitors

TCAs

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11
Q

What can TCAs be very good to treat

A

Neuropathic pain

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12
Q

What is generally 2nd line treatment for depression

A

Try another SSRI

Then SNRI

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13
Q

Prophylaxis with antidepressants after 1 episode

A

Continue for 6mnths-1yr

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14
Q

Prophylaxis with antidepressants after 2 episodes

A

Continue for 2yrs

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15
Q

Prophylaxis with anti-depressants after 3 episodes

A

Discuss lifelong

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16
Q

Rx for treatment resistance depression

A

Combination of antidepressants e.g SSRI or SNRi with Mirtazepine

Adjunctive treatment with Lithium

Adjunctive treatment with atypical antipsychotic eg Quetipaine, Olanzapine or Aripiprazole

ECT!!

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17
Q

What does ECT stand for

A

Electroconvulsive therapy

18
Q

What are the 2 novel antidepressant drugs

A

Mirtazapine

Buproprion

19
Q

What class of drug is amitryptiline

A

TCA

20
Q

Pros of Sertraline

A

Weak P450 interactions
Short half-life (low build up)
Less sedating than paroxetine

21
Q

Cons of Sertraline

A

Max. absorption requires a full stomach

no. GI side adverse reactions

22
Q

Pros of paroxetine

A

Short half life
No build up
Sedating properties offers relief from insomnia and anxiety

23
Q

Cons of paroxetine

A

Sedating
Weight gain
Likely cause of discontinuation syndrome

24
Q

Which patients is fluoxetine not good for

A

Patients with hepatic illness

25
Q

Give 2 drug examples of SNRIs

A

Venlafaxine

Duloxetine

26
Q

Pros of venlafaxine (SNRI)

A 
Minimal drug interactions 
Almost no P450 activity 
Short ½ life 
Fast renal clearance 
Avoids build up
27
Q

Cons of venlafaxine

A

Can cause increased in diastolic BP
Can cause bad discontinuation syndrome

Sexual side effects >30%

28
Q

Pros of duloxetine (SNRI)

A

Some data to suggest efficacy for physical depression symptoms of depression

29
Q

Cons of duloxetine (SNRI)

A

Strong inhibtors:
CYP2D^ and CYP1A2
Higher dorp out rate

30
Q

Drug examples of monoamine oxidase inhibitors

A

Tranylcypromine
Phenelzine
Isocarboxazid

31
Q

What is the cheese reaction

A

Hypertensive crisis can develop when monoamine oxidase inhibitor is taken with tyramine rich foods or sympathomimetics

32
Q

Action of monoamine oxidase inhibitors

A

Bind irreversible to monoamine oxidase thereby preventing inactivation of amines such as
Norepinephrine
Dopamine
Serotonin

Leading to increased synaptic levels

33
Q

Side effects of monoamine oxidase inhibitors

A 
Orthostatic hypotension 
Weight gain 
Dry mouth 
Sedation 
Sexual dysfunction 
Sleep disturbance
34
Q

What are the cons of TCAs

A

Lethal in overdose
Can cause QT lengthening syndromes

potentially unacceptable side effect profile:
Antihistaminic
Anticholinergic
Antiadrenergic

35
Q

Which has the most effect on BP Venlafaxine or Duloxetine

A

Venlafaxine

36
Q

Action of mirtazapine (novel)

A

5HT2 and 5HT3 receptor antagonist

37
Q

What else is Buproprion (novel) used to treat

A

2nd line agents for ADHD

38
Q

cons of bupropion (novel)

A 
May increase seizure risk at high doses 
Avoid in:
Brain injury
Bulimia 
Anorexia

Does not treat anxiety

39
Q

Drugs examples of tertiary TCAs

A

Amitriptyline
Doxepin
Clomipramine

40
Q

Drug examples of secondary TCAs

A

Desipramine

Nortriptyline

Psychiatry (15 decks)

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