Antidepressant drugs Flashcards
Tricyclic and related antidepressant drugs can be divided into those with additional sedative properties and those that are less sedating.
1) which patients benefit from the sedative properties?
2) who are the less sedating ones more suitable for?
1) Agitated and anxious patients tend to respond best to the sedative compounds
2) withdrawn and apathetic patients will often obtain most benefit from the less sedating ones
List the tricyclic and related antidepressant drugs that have sedative properties (6)
1) Amitriptyline
2) Clomipramine
3) Dosulepin (specialist)
4) Doxepin
5) Trazodone
6) Trimipramine
List the tricyclic and related antidepressant drugs that are non-sedative (3)
1) Imipramine
2) iofepramine
3) nortriptyline.
Tricyclic and related antidepressants have varying degrees of antimuscarinic side-effects and cardiotoxicity in overdosage. which one has the lower incidence of side-effects and is less dangerous in overdosage ?
Lofepramine has a lower incidence of side-effects and is less dangerous in overdosage but is infrequently associated with hepatic toxicity
Imipramine hydrochloride is also well established antidepressant. what side effects is it more likely to cause?
More marked antimuscarinic side-effects than other tricyclic and related antidepressants
Amitriptyline and dosulepin (specialist) are effective drugs. Explain why they are not recommended for the treatment of depression
They are particularly dangerous in overdosage
About 10 to 20% of patients fail to respond to tricyclic and related antidepressant drugs, Explain why
Inadequate dosage- Important to use doses that are sufficiently high for effective treatment but not so high as to cause toxic effects
who would normally be prescribed lower doses of tricyclic and related antidepressant drugs initially?
Elderly
when should tricyclic antidepressant drugs be taken during the day?
The long half-life allows once-daily administration, usually at night
studies have shown that TCA’s are not effective for treating depression in which patient group?
Not effective for treating depression in children
Tranylcypromine, phenelzine and isocarboxazid are MAOIs.
1) which one of the above is most likely to cause a hypertensive crisis?
2) which two likely to cause hepatotoxicity?
1) Tranylcypromine has a greater stimulant and is more likely to cause a hypertensive crisis
2) Isocarboxazid and phenelzine are more likely to cause hepatotoxicity than tranylcypromine
MAOIs are used less frequently due to the dangers of dietary and drug interactions. Patients with which conditions respond best to MAOIs?
1) Phobic patients and depressed patients with atypical, hypochondriacal, or hysterical features
2) MAOIs should be tried when other antidepressants are ineffective, as there might be a dramatic response
How long does it take for MAOIs to start working and after what period of time is maximal benefit seen?
1) Response may be delayed for 3 weeks or more
2) may take an additional 1 or 2 weeks to become maximal
1) Other antidepressants should not be started for how many weeks after a MAOI have been stopped?
2) is this different for clomipramine or imipramine?
1) 2 weeks after treatment with MAOIs has been stopped
2) 3 weeks if starting clomipramine or imipramine
For the following classes of antidepressant drugs, what wash out period is required, before it is safe to start a MAOI:
1) After a previous MAOI has been stopped
2) After a tricyclic or related, has been stopped
3) SSRI has been stopped
1) Previous MAOI: At least 2 weeks after previous MAOI
2) Tricyclic: at least 7–14 days (3 weeks in the case of clomipramine or imipramine)
3) SSRI: At least a week after an SSRI has been stopped (at least 5 weeks for fluoxetine)
