antidepressant drugs Flashcards
what are the contraindications of TCAs? [4]
- manic phase in bipolar
- arrythmia
- heart block
- immediately after MI
baso CV` related
what are the cautions of TCA? [6]
- hYPERthyroidism [leads to arrythmia]
- glaucoma, urinary retention
- diabetes
- cv disease
- epilepsy
- chronic constipation
side effects of TCAs?
TCA toxic in overdose [more than SSRI[ cardiac side effects [QT prolongation/heart block/hypertension/arrythmia] antimuscarinic s/e seizures
what is the anticholinergic side effects that TCAS can cause?
ABCDS anorexia blurred vision constipation and confusion dry mouth static urine
what are the signs and symptoms of overdose of tricylic antidepressants? [8]
think…antimuscarinic, cardiac and hyponatraemia s/e
- dry mouth
- coma
- hypotension
- hypothermia
- convulsions
- arrythmia
- dilated pupils
- urinary retention
which 2 TCAs are NOT recommended to treat depression?
amitriptyline and dosulepin
which TCA is cautioned in mild-moderate liver impairment and avoided in severe?
L = lofepramine
when should the dose of TCAs be given and how many a day?
one at night due to long half life
what are the important drug interactions with TCAs? [think abt s/e]
- lithium [increased risk of neurotoxicity]
- increase antimuscarinic effects when given with antimuscarinic drugs, antipsychotics, antihistamines
- increased hypotension with BP tablets eg CCB, ACEI, Diureitcs, NSAIDs
- decreases effect of ephedrine [avoid]
- increases effect of phenylephedrine [avoid]
- increased risk of hyponatraemia with diuretics and carbamazepine
- increased risk of QT interval prolongation with antipsychotics, theophylline, amiodarone, sotalol
- increased risk of serotonin syndrome with SSRIs, sumatriptan, MAOI
- increased toxicity with MAOI
gives examples of IRREVERSIBLE maois?
give examples of reversible MAOI?
irreversible: tranylcypromine, isocarboxazid, phenelzine
reversible: moclobemide [RIMA]
which MAOI has increased hypertensive crisis?
isocarboxazid
phenelzine
tranylcypromine
moclobemide
tranylcypromine
Which MAOI is reserved for 2nd line treatment?
isocarboxazid
phenelzine
tranylcypromine
moclobemide
moclobemide
why should you not mix MAOI with other antidepressant medication?
risk of serotonin syndrome
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
Agitation, slurred speech, ataxia, insomnia, hallucinations
8 weeks
what symptom must occur for you to discontinue treating a pt with an MAOI
slurred speech
hepatic impairment
persistant headaches
rash
persistant headaches bc hypertensive crisis
what are the cautions of MAOI?
can cause hepatoxicity in pt with hepatic impairment
neonatal malformations in pregnancy
risk of postural hypotension
how long must you wait before switching a pt from clomipramine or imipramine to a MAOI?
3 weeks
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?
- SSRI: 1 week
- fluoxetine: 5 weeks
how long must you wait before switching a pt from TCA [other than clomipramine/imipramine] to a MAOI?
1-2 weeks
how long must you wait before switching a pt from one MAOI to another?
2 weeks
how long must you wait before switching a pt from MAOI to clomipramine and imipramine?
3 weeks
how long must you wait before switching a pt from MAOI to another antidepressant?
2 weeks
how long must you wait before switching a pt from MAOI to another MAOI?
2 weeks
MAOIs can induce a hypertensive crisis with…
insulins
ace inhibitors
sympathomimetics
SSRIs
and give examples
sympathomimetics
eg ephedrine, pseudoephedrine [cold and flu remedies]
noradrenaline and adrenaline
MAOIs can induce a hypertensive crisis with.... antibiotics anti-epileptics thiazide diuretics TCAs
and give examples
TCAs
clomipramine and tranylcypromine
MAOIs can induce hypertensive crisis with…
digoxin
warfarin
dopaminergic drugs
amoxicillin
and give examples
dopaminergic drugs eg
levodopa, MAO-B inhibitors
which types of foods can interact with MAOI and how?
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
what is the pt and carer advice of MAOI?
- 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
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
2 weeks
when are reversible MAOI [RIMA] considered?
give an example of one
2nd line treatment
moclobemide
which 2 SSRIs can cause QT interval prolongation?
escitalopram
citalopram
which ssri is better for someone with angina and MI?
sertraline
what is the drug action of SSRI?
selectively inhibit reuptake of serotonin [5-HT]
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
from 8yrs old and over
what are the 2 contra indications of SSRIs?
poorly controlled epilepsy
manic phase
what are the cautions of SSRIs?
CVD, diabetes epilepsy history of bleeding [esp gi] history of mania susceptibility of angle glaucoma
which SSRI has the highest withdrawal symptoms out of all SSRIs?
fluoextine
sertraline
paroxetine
escitalopram
paroxetine
give some examples of withdrawal symptoms that you get from SSRIs?
GI disturbance electical shock sensation in the head, neck and spine tinnitus sleep disturbance palpitation sweating
what is the MHRA warning of SSRIs and SNRIs?
small risk of postpartum haemorrhage when used in the month before delivery
what electrolyte imbalance occurs as a s/e of SSRIs?
hyponatraemia
what are the s/e of ssris?
arrythmia qt interval prolongation anxiety confusion drowsiness and constipation
what are the risks of SSRIs in early and late pregnancy?
early: risk of congenital heart defects
late: risk of neonate withdrawal symptoms and hypertension
avoid in pregnancy unless benefits outweigh risks
which drug interactions with SSRIs can increase the risk of bleeding?
NSAIDs antiplatelets anticoagulants thrombolytics [eg alteplase] phenindione
which antipsychotic when given with an SSRI can increase the risk of toxicity?
phenytoin
which drugs when given with SSRIs can increase the risk of QT interval prolongation?
antipsychotics
antimalarials
sotalol
amiodarone
QT interval prolongation occurs because of what electrolyte imbalance?
hypokalaemia
which drugs when given with SSRIs can increase risk of hyponatraemia?
NSAIDs
diuretics
carbamazepine
which drugs when given with SSRIs can increase the risk of serotonin syndrome?
tramadol
sumatriptan
ondansetron
