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4th year Psychiatry > Antidepressant drugs > Flashcards

Antidepressant drugs Flashcards

1
Q

Antidepressants

A

1st line - SSRI
2nd line- another SSRI
3rd line- mirtazipine, SNRI
4th- consider tricyclics, monoamine oxidase inhibitors

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2
Q

Egs of SSRIs

A

Fluoxetine, sertraline, citalopram/escitalopram, paroxetine

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3
Q

Antidepressant of choice for children/ adolescents

A

Fluoxetine- only one licensed

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4
Q

which antidepressant drug increases risk of congenital malformations, particularly in 1st trimester

A

paroxetine

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5
Q

SSRIs and pregnancy- safe?

A

weigh up risks and benefit
1st trimester- small increased risk of congenital heart defects
3rd- persistent pulmonary hypertension of newborn

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6
Q

which antidepressant is favoured post MI

A

sertraline

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7
Q

Interations of SSRI

A

NSAIDs- PPI should be given if patients taking both
warfarin/heparin- avoid SSRI
Triptans- avoid SSRI

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8
Q

How long should you continue SSRIs for after remission

A

6 weeks

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9
Q

how to stop SSRIs

A

gradually over 4wks (except fluoxetine)

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10
Q

Common side effects of SSRIs

A

nausea, headache, sweating/vivid dreams, worsened anxiety, sexual dysfunction, hyponatraemia (in elderly). transient increase in self harm and suicidal ideation in <25yrs

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11
Q

What is citalopram/escitalopram associated with

A

dose dependent QT prolongation

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12
Q

eggs of tricyclics

A

imipramine, dosulepin, amitriptyline, lofepramine, clomipramine

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13
Q

how do tricyclics work

A

block reuptake of monoamines into presynaptic terminals- mainly noradrenaline and 5HT

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14
Q

Common side effects of TCAs

A

anticholinergic- blurred vision, dry mouth, sedation, weight gain, constipation, urinary retention, postural hypotension, tachycardia, arrhythmia, cardiotoxic in overdose

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15
Q

Why are TCAs used less often now

A

dangerous in overdose

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16
Q

Monoamine oxidase inhibitors eg

A

irreversible- phenelzine

reversible- moclobemide

17
Q

side effects of monoamine oxidase inhibitors

A

cheese reaction/hypertensive crisis, increase metabolism of other drugs, postural hypotension, peripheral oedema

18
Q

SNRIs eg

A

venlafaxine, duloxetine

block reuptake of monoamines into presynaptic terminals

19
Q

Mirtazipine

A

blocks alpha 2- increases release of neurotransmitters

20
Q

mirtazipine side effects

A

fewer side effects than other ADs, main ones are weight gain and sedation- useful for people that are suffering from insomnia and poor appetite

4th year Psychiatry (18 decks)

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