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Notes > Anti-depressants > Flashcards

Anti-depressants Flashcards

1
Q
  1. What are the 4 classes of antidepressants?
A

SSRI, SNRI, TCA, MAO-I

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2
Q 
2.	Which class is preferred? 
and why
A

SSRI

Least side effects, most safe in overdose

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3
Q
  1. Which class is most efficacious?
A

None

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4
Q
  1. What is the first choice anti-depressant and why? (over 18)
A

Sertraline.

No Cardiac S/e Like TAC and safer in OD

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5
Q
  1. Why do we not use sertraline in under 18’s?
A

Suicide risk increased

we tend to use fluoxetine

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6
Q
  1. How long does it take to have full effect?
A

roughly 4 weeks, but effect should be seen in 1 -2weeks

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7
Q
  1. How often do we monitor when initiating therapy and when do we asses if treatment change needed?
A

Monitor every 1-2 weeks and judge at 4 weeks (6 weeks in elderly)

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8
Q
  1. How long should it be continued for after remission? How long for ppl with anxiety?
A

Carry on for at least 6 months after remission, 12 months for people with anxiety/ elderly as they have a higher chance of relapse.
2 years for people with history of relapse

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9
Q
  1. Which electrolyte disturbance is likely to happen and why?
A

Hyponatremia due to inappropriate secretion of antidiuretic hormone

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10
Q
  1. Signs of serotonin syndrome
A

The characteristic symptoms of serotonin syndrome fall into 3 main areas, although features from each group may not be seen in all patients—neuromuscular hyperactivity (such as tremor, hyperreflexia, clonus, myoclonus, rigidity), autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhoea), and altered mental state (agitation, confusion, mania).

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11
Q
  1. What drug do you consider if treatment failure?
A

Mirtazapine

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12
Q
  1. Which TCA’s are less sedating
A

Less sedating; Imipramine hydrochloride, lofepramine, and nortriptyline.

More sedating: Amitriptyline hydrochloride, clomipramine hydrochloride, dosulepin hydrochloride, doxepin, mianserin hydrochloride, trazodone hydrochloride, and trimipramine.

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13
Q
  1. Why are MAO-I not used?
A

Interactions with food and medicines.

Hypertensive crisis with cheese

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14
Q
  1. Name 4 MAO-I’s which is reversible, which is likely to cause hypertensive crisis?
A

Tranylcypromine- irrivesible and likely to cause hypertensive crisis.

Phenelzine +Isocarboxazid- irreversible likely to cause hepatoxicity

Moclobemide- reversible (Second line) multiple day dosing and S/E

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15
Q
  1. How long do you have to wait to start an MAO-I
A

Other antidepressants should not be started for 2 weeks after treatment with MAOIs has been stopped (3 weeks if starting clomipramine or imipramine). Conversely, an MAOI should not be started until:

at least 2 weeks after a previous MAOI has been stopped (then started at a reduced dose)
at least 7–14 days after a tricyclic or related antidepressant (3 weeks in the case of clomipramine or imipramine) has been stopped
at least a week after an SSRI or related antidepressant (at least 5 weeks in the case of fluoxetine) has been stopped

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16
Q

Name SSRI’s

A 
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
17
Q

Name SNRI’s

A 
Venlafaxine
Sibutramine
Duloxetine
Desvenlafaxine
Milnacipran
Levomilnacipran
18
Q

Name MAO-I’s for depression

A

Tranylcypromine
Phenelzine
Isocarboxazid
Moclobemide-

19
Q

Name TCA’s

A 
Clomipramine 
Imipramine
Nortriptyline 
Amitriptyline 
Dosulepin
Doxepin
20
Q

MOA of SSRI

A

Increasing the extracellular level of the neurotransmitter serotonin by limiting its reabsorption (reuptake) into the presynaptic cell, increasing the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor.

21
Q

MOA of SNRI

A

inhibit the reuptake of serotonin and norepinephrine. These neurotransmitters are thought to play an important role in mood regulation

22
Q

MOA of MAO-I

A

MAOIs act by inhibiting the activity of monoamine oxidase, thus preventing the breakdown of monoamine neurotransmitters and thereby increasing their availability. There are two isoforms of monoamine oxidase, MAO-A and MAO-B. MAO-A preferentially deaminates serotonin, melatonin, epinephrine, and norepinephrine. MAO-B preferentially deaminates phenethylamine and certain other trace amines; in contrast,

23
Q

MOA of TCA

A

The majority of the TCAs act primarily as SNRIs by blocking the serotonin transporter (SERT) and the norepinephrine transporter (NET), which results in an elevation of the synaptic concentrations of these neurotransmitters, and therefore an enhancement of neurotransmission

24
Q

Half life of SSRI’s

A 
Citalopram 35h
Escitalopram 27-32h
Fluoxetine 1-3 days
Fluvoxamine 22 hours
Paroxetine 21 hours
Sertraline  23-26h
25
Q

Half life of SNRI’s

A

Venlafaxine 5h 15h(M/R)

Duloxetine 12 hours

26
Q

Half life of TCA

A 
Clomipramine 19-37h
Imipramine 20h
Nortriptyline 30h (18-44)
Amitriptyline 10-50 h
Dosulepin 14.4 -23.9h
Doxepin 17h (8-24)
27
Q

Half life of MAO-I

A

Tranylcypromine 2.5h
Phenelzine 11.6h
Isocarboxazid 1.5-4h
Moclobemide- 1-2h (4h in elderly)

28
Q

Dosing of SSRI

A

Citalopram 20-40mg OD (10-20mg in elderly)
Escitalopram 10-20mg OD (5-10mg elderly)
Fluoxetine 20-60mg OD
Fluvoxamine 50-300mg OD
Paroxetine 20-50mg OD (upto 40mg elderly)
Sertraline 50-200mg OD

29
Q

Dosing of SNRI

A

Venlafaxine 75-375mg in 2 doses

Duloxetine 60mgOD

30
Q

Dosing of TCA

A

Clomipramine 10-250mg/day (elderly upto75mg)
Imipramine 75-200mg/day (elderly upto 50mg)
Nortriptyline 75-150mg OD (upto 50mg elderly)
Amitriptyline 50-150mg in 2 doses (upto 100mg in elderly)
Dosulepin 75-225mg OD
Doxepin 75-100mg in 3 doses

31
Q

Dosing of MAO-I

A

Tranylcypromine 10mg BD intially before 3pm upto 30mg/ day maintenance 10mg OD

Phenelzine intially 15mg TDS upto 30mg TDS. can be reduced to 15mg alternate days

Isocarboxazid 30mg - 40mg OD(10-20 for maintenance)
5-10mg in elderly

Moclobemide- 150-600mg TDS-QDS

32
Q

Contraindications and side effects of SSRI

A

Poorly controlled epilepsy

Mania

33
Q

Contraindications and side effects of SNRI

A

Uncontrolled hypertension

34
Q

Contraindications and side effects of TCA

A 
Arrythmia
Mania in bipolar
Heart block
Immediately after MI
Acute porphoria
35
Q

Contraindications and side effects of MAO-I

A 
Acute confusion
Pheochromocytoma (adrenal tumor)
Sever cardiovascular diesease
Hepatic disease,
Hyperthyroidism
Mania
36
Q

Which classes of depressants need cross-tapering

A

https://www.sps.nhs.uk/wp-content/uploads/2019/10/UKMI_QA_How-do-you-switch-between-TCA-SSRI-related-antidepressants_update_Oct-2019.pdf

Notes (12 decks)

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