anti-depressants (TCA,MAOIs) Flashcards
Flashcard 1:
Question: What are the major classes of antidepressant drugs?
Answer: The major classes include tricyclic and related antidepressants, selective serotonin re-uptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and some antidepressants that don’t fit easily into these categories.
Flashcard 2:
Question: How does one choose between different classes of antidepressants?
Answer: Choice should be based on individual patient requirements, including concomitant diseases, existing therapies, suicide risk, and previous responses to antidepressant therapy, as efficacy across classes is similar.
Flashcard 3:
Question: What potential side effects might arise during the first few weeks of antidepressant treatment?
Answer: There’s an increased potential for agitation, anxiety, and suicidal ideation during the initial weeks of treatment.
Flashcard 4:
Question: How do SSRIs compare to other classes of antidepressants in terms of safety and tolerability?
Answer: SSRIs are better tolerated, safer in overdose situations, less sedating, and have fewer antimuscarinic and cardiotoxic effects compared to tricyclic antidepressants.
Flashcard 5:
Question: What should be considered when prescribing MAOIs?
Answer: MAOIs have dangerous interactions with certain foods and drugs, so their use should be reserved for specialists due to the risk of interactions.
Flashcard 1:
Question: What are the major classes of antidepressant drugs?
Answer: The major classes include tricyclic and related antidepressants, selective serotonin re-uptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and some antidepressants that don’t fit easily into these categories.
Flashcard 2:
Question: How does one choose between different classes of antidepressants?
Answer: Choice should be based on individual patient requirements, including concomitant diseases, existing therapies, suicide risk, and previous responses to antidepressant therapy, as efficacy across classes is similar.
Flashcard 3:
Question: What potential side effects might arise during the first few weeks of antidepressant treatment?
Answer: There’s an increased potential for agitation, anxiety, and suicidal ideation during the initial weeks of treatment.
Flashcard 4:
Question: How do SSRIs compare to other classes of antidepressants in terms of safety and tolerability?
Answer: SSRIs are better tolerated, safer in overdose situations, less sedating, and have fewer antimuscarinic and cardiotoxic effects compared to tricyclic antidepressants.
Flashcard 5:
Question: What should be considered when prescribing MAOIs?
Answer: MAOIs have dangerous interactions with certain foods and drugs, so their use should be reserved for specialists due to the risk of interactions.
Flashcard 1:
Question: How often should patients be reviewed at the beginning of antidepressant treatment?
Answer: Patients should be reviewed every 1–2 weeks initially when starting antidepressant treatment.
Flashcard 2:
Question: How long should antidepressant treatment be continued before considering a switch due to lack of efficacy?
Answer: Antidepressant treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering a switch due to lack of efficacy.
Flashcard 3:
Question: What should be done in cases of partial response to antidepressant treatment?
Answer: In cases of partial response, treatment should be continued for a further 2–4 weeks, though elderly patients may require a longer duration to respond.
Flashcard 4:
Question: After achieving remission, how long should antidepressant treatment be continued?
Answer: After achieving remission, antidepressant treatment should be continued at the same dose for at least 6 months (around 12 months in the elderly). For generalized anxiety disorder, treatment should be continued for at least 12 months due to a higher risk of relapse.
Flashcard 1:
Question: How often should patients be reviewed at the beginning of antidepressant treatment?
Answer: Patients should be reviewed every 1–2 weeks initially when starting antidepressant treatment.
Flashcard 2:
Question: How long should antidepressant treatment be continued before considering a switch due to lack of efficacy?
Answer: Antidepressant treatment should be continued for at least 4 weeks (6 weeks in the elderly) before considering a switch due to lack of efficacy.
Flashcard 3:
Question: What should be done in cases of partial response to antidepressant treatment?
Answer: In cases of partial response, treatment should be continued for a further 2–4 weeks, though elderly patients may require a longer duration to respond.
Flashcard 4:
Question: After achieving remission, how long should antidepressant treatment be continued?
Answer: After achieving remission, antidepressant treatment should be continued at the same dose for at least 6 months (around 12 months in the elderly). For generalized anxiety disorder, treatment should be continued for at least 12 months due to a higher risk of relapse.
Flashcard 1:
Question: What condition has been associated with various types of antidepressants, particularly SSRIs?
Answer: Hyponatremia, often due to inappropriate secretion of antidiuretic hormone, has been linked to antidepressants, with SSRIs showing a higher frequency of reports.
Flashcard 2:
Question: What symptoms should raise suspicion of hyponatremia in patients taking antidepressants?
Answer: Drowsiness, confusion, or convulsions developing while taking an antidepressant should prompt consideration of hyponatremia in patients.
Use these flashcards to reinforce and remember the key information about the association between antidepressants and hyponatremia, including the symptoms that should raise suspicion of this condition in individuals taking antidepressants, especially SSRIs.
Flashcard 1:
Question: What condition has been associated with various types of antidepressants, particularly SSRIs?
Answer: Hyponatremia, often due to inappropriate secretion of antidiuretic hormone, has been linked to antidepressants, with SSRIs showing a higher frequency of reports.
Flashcard 2:
Question: What symptoms should raise suspicion of hyponatremia in patients taking antidepressants?
Answer: Drowsiness, confusion, or convulsions developing while taking an antidepressant should prompt consideration of hyponatremia in patients.
Use these flashcards to reinforce and remember the key information about the association between antidepressants and hyponatremia, including the symptoms that should raise suspicion of this condition in individuals taking antidepressants, especially SSRIs.
Flashcard 1:
Question: Who is particularly at risk of experiencing suicidal thoughts or behaviors linked to antidepressant use?
Answer: Children, young adults, and patients with a history of suicidal behavior are particularly at risk when using antidepressants.
Flashcard 2:
Question: When should patients be monitored for suicidal behavior, self-harm, or hostility during antidepressant treatment?
Answer: Monitoring should occur, especially at the beginning of treatment or if the dosage is changed, to observe for signs of suicidal behavior, self-harm, or increased hostility.
Use these flashcards to reinforce and remember the key information about the association between antidepressants and the risk of suicidal thoughts or behaviors in specific patient groups, as well as the importance of monitoring during treatment initiation or dosage changes.
Flashcard 1:
Question: Who is particularly at risk of experiencing suicidal thoughts or behaviors linked to antidepressant use?
Answer: Children, young adults, and patients with a history of suicidal behavior are particularly at risk when using antidepressants.
Flashcard 2:
Question: When should patients be monitored for suicidal behavior, self-harm, or hostility during antidepressant treatment?
Answer: Monitoring should occur, especially at the beginning of treatment or if the dosage is changed, to observe for signs of suicidal behavior, self-harm, or increased hostility.
Use these flashcards to reinforce and remember the key information about the association between antidepressants and the risk of suicidal thoughts or behaviors in specific patient groups, as well as the importance of monitoring during treatment initiation or dosage changes.
Flashcard 1:
Question: What is serotonin syndrome or serotonin toxicity?
Answer: Serotonin syndrome is an uncommon adverse drug reaction caused by excessive central and peripheral serotonergic activity.
Flashcard 2:
Question: When can symptoms of serotonin syndrome occur?
Answer: Symptoms can arise within hours or days after initiating, escalating the dose, overdosing, adding a new serotonergic drug, or replacing one serotonergic drug with another without a proper washout period—especially if the initial drug is an irreversible MAOI or a long half-life drug.
Flashcard 3:
Question: What are the characteristic symptoms of serotonin syndrome?
Answer: Symptoms include neuromuscular hyperactivity (tremor, hyperreflexia, clonus, myoclonus, rigidity), autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhea), and altered mental state (agitation, confusion, mania).
Flashcard 4:
Question: What is the recommended treatment for serotonin syndrome?
Answer: Treatment involves withdrawing the serotonergic medication and providing supportive care. Seeking specialist advice is crucial.
Flashcard 1:
Question: What is serotonin syndrome or serotonin toxicity?
Answer: Serotonin syndrome is an uncommon adverse drug reaction caused by excessive central and peripheral serotonergic activity.
Flashcard 2:
Question: When can symptoms of serotonin syndrome occur?
Answer: Symptoms can arise within hours or days after initiating, escalating the dose, overdosing, adding a new serotonergic drug, or replacing one serotonergic drug with another without a proper washout period—especially if the initial drug is an irreversible MAOI or a long half-life drug.
Flashcard 3:
Question: What are the characteristic symptoms of serotonin syndrome?
Answer: Symptoms include neuromuscular hyperactivity (tremor, hyperreflexia, clonus, myoclonus, rigidity), autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhea), and altered mental state (agitation, confusion, mania).
Flashcard 4:
Question: What is the recommended treatment for serotonin syndrome?
Answer: Treatment involves withdrawing the serotonergic medication and providing supportive care. Seeking specialist advice is crucial.
Flashcard 1:
Question: What medications are typically used for managing acute anxiety?
Answer: Benzodiazepines or buspirone hydrochloride are commonly used for acute anxiety management.
Flashcard 2:
Question: What type of medication might be suitable for chronic anxiety lasting longer than 4 weeks?
Answer: Antidepressants may be appropriate for chronic anxiety. For patients with generalized anxiety disorder (GAD), psychological treatment is offered before initiating an antidepressant.
Flashcard 3:
Question: Which medications are recommended for treating generalized anxiety disorder (GAD)?
Answer: SSRIs such as escitalopram, paroxetine, sertraline (unlicensed), duloxetine, and venlafaxine (SNRIs) are recommended. Pregabalin can be considered if SSRIs or SNRIs are not tolerated or if previous treatment failed.
Flashcard 4:
Question: How are panic disorders usually treated?
Answer: Panic disorders are typically treated with SSRIs as first-line. Clomipramine hydrochloride or imipramine hydrochloride (both unlicensed) can be used as second-line treatments. Venlafaxine, an SNRI, is also licensed for panic disorder.
Flashcard 5:
Question: What medications are used for obsessive-compulsive disorder, post-traumatic stress disorder, and certain phobic states?
Answer: SSRIs are commonly used for these conditions. Clomipramine hydrochloride is a second-line option for obsessive-compulsive disorder. Moclobemide is licensed for social anxiety disorder.
Flashcard 1:
Question: What medications are typically used for managing acute anxiety?
Answer: Benzodiazepines or buspirone hydrochloride are commonly used for acute anxiety management.
Flashcard 2:
Question: What type of medication might be suitable for chronic anxiety lasting longer than 4 weeks?
Answer: Antidepressants may be appropriate for chronic anxiety. For patients with generalized anxiety disorder (GAD), psychological treatment is offered before initiating an antidepressant.
Flashcard 3:
Question: Which medications are recommended for treating generalized anxiety disorder (GAD)?
Answer: SSRIs such as escitalopram, paroxetine, sertraline (unlicensed), duloxetine, and venlafaxine (SNRIs) are recommended. Pregabalin can be considered if SSRIs or SNRIs are not tolerated or if previous treatment failed.
Flashcard 4:
Question: How are panic disorders usually treated?
Answer: Panic disorders are typically treated with SSRIs as first-line. Clomipramine hydrochloride or imipramine hydrochloride (both unlicensed) can be used as second-line treatments. Venlafaxine, an SNRI, is also licensed for panic disorder.
Flashcard 5:
Question: What medications are used for obsessive-compulsive disorder, post-traumatic stress disorder, and certain phobic states?
Answer: SSRIs are commonly used for these conditions. Clomipramine hydrochloride is a second-line option for obsessive-compulsive disorder. Moclobemide is licensed for social anxiety disorder.
Flashcard 1:
Question: What neurotransmitters are affected by tricyclic and related antidepressants?
Answer: These antidepressants block the re-uptake of both serotonin and noradrenaline to varying degrees.
Flashcard 2:
Question: How do different tricyclic and related antidepressants vary in their selectivity for serotonin or noradrenaline?
Answer: For instance, clomipramine hydrochloride is more selective for serotonergic transmission, while imipramine hydrochloride is more selective for noradrenergic transmission.
Flashcard 3:
Question: What are the characteristics of tricyclic antidepressants with additional sedative properties?
Answer: They include drugs like amitriptyline hydrochloride, clomipramine hydrochloride, dosulepin hydrochloride, doxepin, mianserin hydrochloride, trazodone hydrochloride, and trimipramine. These tend to be suitable for agitated and anxious patients.
Flashcard 4:
Question: Which tricyclic antidepressants have less sedative properties?
Answer: Drugs like imipramine hydrochloride, lofepramine, and nortriptyline have fewer sedative properties and might be more appropriate for withdrawn and apathetic patients.
Flashcard 1:
Question: What neurotransmitters are affected by tricyclic and related antidepressants?
Answer: These antidepressants block the re-uptake of both serotonin and noradrenaline to varying degrees.
Flashcard 2:
Question: How do different tricyclic and related antidepressants vary in their selectivity for serotonin or noradrenaline?
Answer: For instance, clomipramine hydrochloride is more selective for serotonergic transmission, while imipramine hydrochloride is more selective for noradrenergic transmission.
Flashcard 3:
Question: What are the characteristics of tricyclic antidepressants with additional sedative properties?
Answer: They include drugs like amitriptyline hydrochloride, clomipramine hydrochloride, dosulepin hydrochloride, doxepin, mianserin hydrochloride, trazodone hydrochloride, and trimipramine. These tend to be suitable for agitated and anxious patients.
Flashcard 4:
Question: Which tricyclic antidepressants have less sedative properties?
Answer: Drugs like imipramine hydrochloride, lofepramine, and nortriptyline have fewer sedative properties and might be more appropriate for withdrawn and apathetic patients.
Flashcard 1:
Question: What side effects vary among tricyclic and related antidepressants?
Answer: Antimuscarinic side effects and cardiotoxicity in overdosage vary among these antidepressants, which can be important considerations for individual patients.
Flashcard 2:
Question: What is notable about lofepramine concerning side effects and overdosage?
Answer: Lofepramine has a lower incidence of side effects and is less dangerous in overdosage but may infrequently be associated with hepatic toxicity.
Flashcard 3:
Question: What distinguishes imipramine hydrochloride among tricyclic antidepressants?
Answer: Imipramine hydrochloride is well established but has more pronounced antimuscarinic side effects compared to other tricyclic and related antidepressants.
Flashcard 4:
Question: Which tricyclic antidepressants are effective but particularly dangerous in overdosage?
Answer: Amitriptyline hydrochloride and dosulepin hydrochloride are effective but carry higher risks in overdosage situations. Dosulepin hydrochloride should be initiated by a specialist.
Flashcard 1:
Question: What side effects vary among tricyclic and related antidepressants?
Answer: Antimuscarinic side effects and cardiotoxicity in overdosage vary among these antidepressants, which can be important considerations for individual patients.
Flashcard 2:
Question: What is notable about lofepramine concerning side effects and overdosage?
Answer: Lofepramine has a lower incidence of side effects and is less dangerous in overdosage but may infrequently be associated with hepatic toxicity.
Flashcard 3:
Question: What distinguishes imipramine hydrochloride among tricyclic antidepressants?
Answer: Imipramine hydrochloride is well established but has more pronounced antimuscarinic side effects compared to other tricyclic and related antidepressants.
Flashcard 4:
Question: Which tricyclic antidepressants are effective but particularly dangerous in overdosage?
Answer: Amitriptyline hydrochloride and dosulepin hydrochloride are effective but carry higher risks in overdosage situations. Dosulepin hydrochloride should be initiated by a specialist.
Flashcard 1:
Question: What percentage of patients may not respond to tricyclic and related antidepressants, and what might contribute to this lack of response?
Answer: Approximately 10 to 20% of patients fail to respond to these antidepressants. Inadequate dosage might account for some of these failures.
Flashcard 2:
Question: What is crucial regarding dosage when using tricyclic antidepressants?
Answer: It’s important to use doses that are sufficiently high for effective treatment but not so high as to cause toxic effects. Lower initial doses are recommended for the elderly.
Flashcard 3:
Question: How often can tricyclic antidepressants be administered due to their long half-life?
Answer: Tricyclic antidepressants usually have a long half-life, allowing once-daily administration, often at night. Therefore, modified-release preparations are typically unnecessary.
Flashcard 4:
Question: Besides depression, for what other conditions might tricyclic antidepressants be used?
Answer: Some tricyclic antidepressants are used in the management of panic and other anxiety disorders. Additionally, they may have a role in certain types of neuralgia and in treating nocturnal enuresis in children.
Flashcard 1:
Question: What percentage of patients may not respond to tricyclic and related antidepressants, and what might contribute to this lack of response?
Answer: Approximately 10 to 20% of patients fail to respond to these antidepressants. Inadequate dosage might account for some of these failures.
Flashcard 2:
Question: What is crucial regarding dosage when using tricyclic antidepressants?
Answer: It’s important to use doses that are sufficiently high for effective treatment but not so high as to cause toxic effects. Lower initial doses are recommended for the elderly.
Flashcard 3:
Question: How often can tricyclic antidepressants be administered due to their long half-life?
Answer: Tricyclic antidepressants usually have a long half-life, allowing once-daily administration, often at night. Therefore, modified-release preparations are typically unnecessary.
Flashcard 4:
Question: Besides depression, for what other conditions might tricyclic antidepressants be used?
Answer: Some tricyclic antidepressants are used in the management of panic and other anxiety disorders. Additionally, they may have a role in certain types of neuralgia and in treating nocturnal enuresis in children.
Flashcard 1:
Question: Are tricyclic antidepressants effective for treating depression in children and adolescents?
Answer: Studies have shown that tricyclic antidepressants are not effective for treating depression in children.
Flashcard 2:
Question: What considerations should be kept in mind regarding the use of tricyclic antidepressants in elderly patients?
Answer: The use of tricyclic antidepressants in the elderly may be potentially inappropriate based on the STOPP criteria:
Avoid in those with dementia, narrow-angle glaucoma, cardiac conduction abnormalities, prostatism, or history of urinary retention due to the risk of worsening these conditions.
Avoid initiating them as first-line antidepressant treatment due to a higher risk of adverse drug reactions compared to SSRIs or SNRIs.
Flashcard 1:
Question: Are tricyclic antidepressants effective for treating depression in children and adolescents?
Answer: Studies have shown that tricyclic antidepressants are not effective for treating depression in children.
Flashcard 2:
Question: What considerations should be kept in mind regarding the use of tricyclic antidepressants in elderly patients?
Answer: The use of tricyclic antidepressants in the elderly may be potentially inappropriate based on the STOPP criteria:
Avoid in those with dementia, narrow-angle glaucoma, cardiac conduction abnormalities, prostatism, or history of urinary retention due to the risk of worsening these conditions.
Avoid initiating them as first-line antidepressant treatment due to a higher risk of adverse drug reactions compared to SSRIs or SNRIs.
Flashcard 1:
Question: Why are monoamine-oxidase inhibitors (MAOIs) used less frequently compared to tricyclic antidepressants or SSRIs?
Answer: MAOIs are less commonly used due to the dangers of dietary and drug interactions. However, they might be prescribed when tricyclic antidepressants have been unsuccessful, as it’s easier to switch to MAOIs from tricyclics than vice versa.
Flashcard 2:
Question: How do different MAOIs vary in terms of their effects and risks?
Answer: Tranylcypromine has a greater stimulant action and is more likely to cause a hypertensive crisis. Isocarboxazid and phenelzine are more likely to cause hepatotoxicity than tranylcypromine.
Flashcard 3:
Question: What is the suggested position for moclobemide in treatment?
Answer: Moclobemide is recommended as a second-line treatment for depression.
Flashcard 4:
Question: Which types of patients are reported to respond best to MAOIs?
Answer: Phobic patients and those with atypical, hypochondriacal, or hysterical features in depression are said to respond best to MAOIs. However, MAOIs should be tried in patients refractory to other antidepressants, as some might have a dramatic response. Treatment response may be delayed for several weeks.
Use these flashcards to reinforce and remember the key info
Flashcard 1:
Question: Why are monoamine-oxidase inhibitors (MAOIs) used less frequently compared to tricyclic antidepressants or SSRIs?
Answer: MAOIs are less commonly used due to the dangers of dietary and drug interactions. However, they might be prescribed when tricyclic antidepressants have been unsuccessful, as it’s easier to switch to MAOIs from tricyclics than vice versa.
Flashcard 2:
Question: How do different MAOIs vary in terms of their effects and risks?
Answer: Tranylcypromine has a greater stimulant action and is more likely to cause a hypertensive crisis. Isocarboxazid and phenelzine are more likely to cause hepatotoxicity than tranylcypromine.
Flashcard 3:
Question: What is the suggested position for moclobemide in treatment?
Answer: Moclobemide is recommended as a second-line treatment for depression.
Flashcard 4:
Question: Which types of patients are reported to respond best to MAOIs?
Answer: Phobic patients and those with atypical, hypochondriacal, or hysterical features in depression are said to respond best to MAOIs. However, MAOIs should be tried in patients refractory to other antidepressants, as some might have a dramatic response. Treatment response may be delayed for several weeks.
Use these flashcards to reinforce and remember the key info
Flashcard 1:
Question: What are the guidelines regarding starting other antidepressants after discontinuing MAOIs?
Answer: Other antidepressants should not be initiated for 2 weeks after stopping MAOIs (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 stopping a tricyclic or related antidepressant (3 weeks for clomipramine or imipramine).
At least a week after stopping an SSRI or related antidepressant (at least 5 weeks for fluoxetine).
Flashcard 2:
Question: Are there alternative antidepressants beyond the usual classes?
Answer: Flupentixol (Fluanxol ®), a thioxanthene, has antidepressant properties when given orally in low doses. It’s also used for treating psychoses.
Use these flashcard
Flashcard 1:
Question: What are the guidelines regarding starting other antidepressants after discontinuing MAOIs?
Answer: Other antidepressants should not be initiated for 2 weeks after stopping MAOIs (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 stopping a tricyclic or related antidepressant (3 weeks for clomipramine or imipramine).
At least a week after stopping an SSRI or related antidepressant (at least 5 weeks for fluoxetine).
Flashcard 2:
Question: Are there alternative antidepressants beyond the usual classes?
Answer: Flupentixol (Fluanxol ®), a thioxanthene, has antidepressant properties when given orally in low doses. It’s also used for treating psychoses.
Use these flashcard
