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CNS > antidepressant drugs > Flashcards

antidepressant drugs Flashcards

1
Q

what are the contraindications of TCAs? [4]

A
  • manic phase in bipolar
  • arrythmia
  • heart block
  • immediately after MI

baso CV` related

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2
Q

what are the cautions of TCA? [6]

A
  • hYPERthyroidism [leads to arrythmia]
  • glaucoma, urinary retention
  • diabetes
  • cv disease
  • epilepsy
  • chronic constipation
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3
Q

side effects of TCAs?

A 
TCA
toxic in overdose [more than SSRI[
cardiac side effects [QT prolongation/heart block/hypertension/arrythmia]
antimuscarinic s/e
seizures
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4
Q

what is the anticholinergic side effects that TCAS can cause?

A 
ABCDS
anorexia
blurred vision
constipation and confusion
dry mouth
static urine
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5
Q

what are the signs and symptoms of overdose of tricylic antidepressants? [8]

A

think…antimuscarinic, cardiac and hyponatraemia s/e

  • dry mouth
  • coma
  • hypotension
  • hypothermia
  • convulsions
  • arrythmia
  • dilated pupils
  • urinary retention
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6
Q

which 2 TCAs are NOT recommended to treat depression?

A

amitriptyline and dosulepin

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7
Q

which TCA is cautioned in mild-moderate liver impairment and avoided in severe?

A

L = lofepramine

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8
Q

when should the dose of TCAs be given and how many a day?

A

one at night due to long half life

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9
Q

what are the important drug interactions with TCAs? [think abt s/e]

A
  1. lithium [increased risk of neurotoxicity]
  2. increase antimuscarinic effects when given with antimuscarinic drugs, antipsychotics, antihistamines
  3. increased hypotension with BP tablets eg CCB, ACEI, Diureitcs, NSAIDs
  4. decreases effect of ephedrine [avoid]
  5. increases effect of phenylephedrine [avoid]
  6. increased risk of hyponatraemia with diuretics and carbamazepine
  7. increased risk of QT interval prolongation with antipsychotics, theophylline, amiodarone, sotalol
  8. increased risk of serotonin syndrome with SSRIs, sumatriptan, MAOI
  9. increased toxicity with MAOI
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10
Q

gives examples of IRREVERSIBLE maois?

give examples of reversible MAOI?

A

irreversible: tranylcypromine, isocarboxazid, phenelzine
reversible: moclobemide [RIMA]

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11
Q

which MAOI has increased hypertensive crisis?

isocarboxazid
phenelzine
tranylcypromine
moclobemide

A

tranylcypromine

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12
Q

Which MAOI is reserved for 2nd line treatment?

isocarboxazid
phenelzine
tranylcypromine
moclobemide

A

moclobemide

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13
Q

why should you not mix MAOI with other antidepressant medication?

A

risk of serotonin syndrome

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14
Q

what symptoms can occur when you abruptly stop MAOI?

risk of symptoms increased if you abruptly stop MAOI after regular treatment for more than...
5 weeks
3 months
5 years
8 weeks
A

Agitation, slurred speech, ataxia, insomnia, hallucinations

8 weeks

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15
Q

what symptom must occur for you to discontinue treating a pt with an MAOI

slurred speech
hepatic impairment
persistant headaches
rash

A

persistant headaches bc hypertensive crisis

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16
Q

what are the cautions of MAOI?

A

can cause hepatoxicity in pt with hepatic impairment

neonatal malformations in pregnancy

risk of postural hypotension

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17
Q

how long must you wait before switching a pt from clomipramine or imipramine to a MAOI?

A

3 weeks

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18
Q

how long must you wait before switching a pt from SSRI to an MAOI?

how long must you wait before switching a pt from fluoxetine to a MAOI?

A
  • SSRI: 1 week

- fluoxetine: 5 weeks

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19
Q

how long must you wait before switching a pt from TCA [other than clomipramine/imipramine] to a MAOI?

A

1-2 weeks

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20
Q

how long must you wait before switching a pt from one MAOI to another?

A

2 weeks

21
Q

how long must you wait before switching a pt from MAOI to clomipramine and imipramine?

A

3 weeks

22
Q

how long must you wait before switching a pt from MAOI to another antidepressant?

A

2 weeks

23
Q

how long must you wait before switching a pt from MAOI to another MAOI?

A

2 weeks

24
Q

MAOIs can induce a hypertensive crisis with…

insulins
ace inhibitors
sympathomimetics
SSRIs

and give examples

A

sympathomimetics
eg ephedrine, pseudoephedrine [cold and flu remedies]
noradrenaline and adrenaline

25
Q 
MAOIs can induce a hypertensive crisis with....
antibiotics
anti-epileptics
thiazide diuretics
TCAs

and give examples

A

TCAs

clomipramine and tranylcypromine

26
Q

MAOIs can induce hypertensive crisis with…

digoxin
warfarin
dopaminergic drugs
amoxicillin

and give examples

A

dopaminergic drugs eg

levodopa, MAO-B inhibitors

27
Q

which types of foods can interact with MAOI and how?

A

tyramine containing foods such as mature cheese, fermented beans, meat etc

bc they can release noradrenaline which increases bp leading to hypertensive crisis and throbbing headache

28
Q

what is the pt and carer advice of MAOI?

A
  • drowsiness can affect performance of skilled tasks
  • avoid eating stale food, ‘going off’ foods esp meat, eat only fresh food
  • avoid alcoholic drinks or drinks with low alochol
29
Q 
a person stops taking an MAOI, how long after he has stopped can an interaction with food still occur?
3 months
2 weeks
1 week
3 days
22 days
A

2 weeks

30
Q

when are reversible MAOI [RIMA] considered?

give an example of one

A

2nd line treatment

moclobemide

31
Q

which 2 SSRIs can cause QT interval prolongation?

A

escitalopram

citalopram

32
Q

which ssri is better for someone with angina and MI?

A

sertraline

33
Q

what is the drug action of SSRI?

A

selectively inhibit reuptake of serotonin [5-HT]

34
Q

what age is fluoextine licensed for?

from 9 years old
5 years old and over
from 8 years old
from 12 years old and over

A

from 8yrs old and over

35
Q

what are the 2 contra indications of SSRIs?

A

poorly controlled epilepsy

manic phase

36
Q

what are the cautions of SSRIs?

A 
CVD, diabetes
epilepsy 
history of bleeding [esp gi]
history of mania
susceptibility of angle glaucoma
37
Q

which SSRI has the highest withdrawal symptoms out of all SSRIs?

fluoextine
sertraline
paroxetine
escitalopram

A

paroxetine

38
Q

give some examples of withdrawal symptoms that you get from SSRIs?

A 
GI disturbance
electical shock sensation in the head, neck and spine
tinnitus
sleep disturbance
palpitation
sweating
39
Q

what is the MHRA warning of SSRIs and SNRIs?

A

small risk of postpartum haemorrhage when used in the month before delivery

40
Q

what electrolyte imbalance occurs as a s/e of SSRIs?

A

hyponatraemia

41
Q

what are the s/e of ssris?

A 
arrythmia
qt interval prolongation
anxiety
confusion
drowsiness and constipation
42
Q

what are the risks of SSRIs in early and late pregnancy?

A

early: risk of congenital heart defects
late: risk of neonate withdrawal symptoms and hypertension

avoid in pregnancy unless benefits outweigh risks

43
Q

which drug interactions with SSRIs can increase the risk of bleeding?

A 
NSAIDs
antiplatelets
anticoagulants
thrombolytics [eg alteplase]
phenindione
44
Q

which antipsychotic when given with an SSRI can increase the risk of toxicity?

A

phenytoin

45
Q

which drugs when given with SSRIs can increase the risk of QT interval prolongation?

A

antipsychotics
antimalarials
sotalol
amiodarone

46
Q

QT interval prolongation occurs because of what electrolyte imbalance?

A

hypokalaemia

47
Q

which drugs when given with SSRIs can increase risk of hyponatraemia?

A

NSAIDs
diuretics
carbamazepine

48
Q

which drugs when given with SSRIs can increase the risk of serotonin syndrome?

A

tramadol
sumatriptan
ondansetron

CNS (11 decks)

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