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BNF Chapter 4 - CNS > Antidepressant Drugs > Flashcards

Antidepressant Drugs Flashcards

1
Q

What are the three main classes of antidepressant drugs?

A

Tricyclic and related antidepressants, SSRIs, monoamine-oxidase inhibitors.

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2
Q

Which class of antidepressant drugs are first line? Why?

A

The SSRIs as they are better tolerated and safer.

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3
Q

Which class of antibiotics is less effective at treating depression in children?

A

The tricyclic antidepressants.

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4
Q

Which class of antidepressant drugs has the greatest risk of interactions?

A

The monoamine-oxidase inhibitors.

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5
Q

Which common herbal medicine is sometimes used for the treatment of depression?

A

St John’s Wort.

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6
Q

Why should St. John’s Wort not be recommended for the treatment of depression?

A

There is very limited evidence to its efficacy as well as the fact it is an enzyme inducer, thus it has many interactions with other drugs.

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7
Q

What electrolyte imbalance is occasionally seen with antidepressant use? In what patient group is there a greater risk?

A

Hyponatraemia, especially in the elderly.

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8
Q

Which class of antidepressants comes with the greatest risk of causing hyponatraemia?

A

The SSRIs.

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9
Q

What symptoms may suggest hyponatraemia in patients taking antidepressants?

A

Drowsiness, confusion, convulsions.

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10
Q

Antidepressants have been linked with suicidal thoughts and behaviour in which patient groups?

A

Children, young adults, and patients with a history of suicidal behaviour.

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11
Q

With regards to suicidal thoughts and behaviour, what should patients be monitored for when taking antidepressants? When should this be done?

A

Suicidal behaviour, self-harm or hostility. Particularly at the beginning of treatment or if there is a dose change.

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12
Q

What is serotonin syndrome?

A

Accumulation of high levels of serotonin in the body.

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13
Q

What three groups can the symptoms of serotonin syndrome be separated into?

A

Neuromuscular hyperactivity, autonomic dysfunction, altered mental state.

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14
Q

What are the symptoms of neuromuscular hyperactivity associated with serotonin syndrome?

A

Tremor, hyperreflexia, clonus, myoclonus, rigidity.

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15
Q

What are the symptoms of autonomic dysfunction associated with serotonin syndrome?

A

Tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhoea.

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16
Q

What are the symptoms of the altered mental state associated with serotonin syndrome?

A

Agitation, confusion, mania.

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17
Q

Monoamine-oxidase inhibitors inhibit the metabolism of which drug commonly seen in OTC cough and decongestant preparations?

A

Pseudoephedrine.

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18
Q

The hypertensive effects of tyramine may be dangerously potentiated by monoamine-oxidase inhibitors. Give some examples of where tyramine may be found.

A

Mature cheese, pickled herrings, broad bean pods, meat or yeast extracts (Bovril, Marmite) and fermented soy bean extract.

19
Q

What symptom may be an early warning sign of the hypertensive effect of monoamine-oxidase inhibitors and tyramine-rich foods?

A

A throbbing headache.

20
Q

Patients taking monoamine-oxidase inhibitors should be warned against eating food which may have gone off or is stale. With which food products is this especially important?

A

Meat, fish, poultry, offal. Game should be avoided.

21
Q

What drinks should patients on monoamine-oxidase inhibitors be advised against drinking?

A

Alcoholic and low-alcohol drinks.

22
Q

How long after treatment with monoamine-oxidase inhibitors can treatment with other antidepressants be started?

A

2 weeks.

23
Q

Give some examples of monoamine-oxidase inhibitors used in the treatment of depression.

A

Phenelzine, isocarboxazid, moclobemide.

24
Q

Monoamine-oxidase inhibitor use is potentially lethal when used with which other class of antidepressants?

A

Tricyclic antidepressants.

25
Q

The risk of serotonergic adverse effects is increased when monoamine-oxidase inhibitors are used with this other class of antidepressants?

A

SSRIs.

26
Q

How should treatment with monoamine-oxidase inhibitors be withdrawn?

A

Slowly if possible. Dose tapered over at least 4 weeks to avoid withdrawal effects.

27
Q

What are the symptoms of monoamine-oxidase inhibitor withdrawal?

A

Agitation, irritability, ataxia, movement disorders, insomnia, drowsiness, vivid dreams, cognitive impairment, slowed speech. Occasionally patients experience hallucinations and paranoid delusions.

28
Q

Give some examples of SSRIs.

A

Citalopram, escitalopram, paroxetine, sertraline, mirtazapine, venlafaxine.

29
Q

Why are SSRIs not recommended for the treatment of depression in patients under the age of 19?

A

There is an increased risk of suicidal behaviour, self-harm, or hostility, particularly at the beginning of treatment.

30
Q

Which SSRI has been shown to be effective for use in children and adolescents?

A

Fluoxetine.

31
Q

In what conditions should SSRIs be used with caution?

A

Epilepsy (avoid if poorly controlled, discontinue if convulsions develop), cardiac disease, diabetes, susceptibility to angle-closure glaucoma, history of mania, history of bleeding disorders (especially GI bleeding), if used with other drugs which increase the risk of bleeding.

32
Q

What are the symptoms of an SSRI overdose?

A

Nausea, vomiting, agitation, tremor, nystagmus, drowsiness, sinus tachycardia, convulsions. Rarely, severe poisoning can lead to serotonin syndrome. Hyperthermia, rhabdomyolysis, renal failure, and coagulopathies may develop.

33
Q

What are the symptoms of SSRI withdrawal?

A

GI disturbances, headache, anxiety, dizziness, paraesthesia, electric shock sensation in the head, neck and spine, tinnitus, sleep disturbances, fatigue, flu-like symptoms, sweating. Palpitation and visual disturbances occur less commonly.

34
Q

How should SSRIs be withdrawn?

A

Slowly tapered over four weeks.

35
Q

Which SSRIs are associated with an increased risk of withdrawal symptoms?

A

Paroxetine and venlafaxine.

36
Q

Give some examples of tricyclic antidepressants.

A

Clomipramine, imipramine, amitriptyline, dosulepin, doxepin, mianserin, trazodone, trimipramine, lofepramine, nortriptyline.

37
Q

Tricyclic antidepressants should be used in caution in patients with which conditions?

A

Cardiovascular disease, hyperthyroidism, prostatic hypertrophy, chronic constipation, urinary retention, glaucoma.

38
Q

Which patient group are more susceptible to the adverse effects associated with tricyclic antidepressants?

A

The elderly.

39
Q

What are the symptoms of tricyclic antidepressant withdrawal?

A

Flu-like symptoms (chills, nausea, myalgia, sweating, headache), insomnia, vivid dreams, occasionally movement disorders and mania.

40
Q

How should tricyclic antidepressants be withdrawn to reduce the risk of withdrawal symptoms?

A

Gradually over at least four weeks.

41
Q

Are tricyclic antidepressants effective for the treatment of depression in children?

A

No.

42
Q

What risks are associated with the use of agomelatine?

A

Suicidal thoughts & behaviours and hepatotoxicity.

43
Q

Due to the associated risk of hepatotoxicity, what monitoring is required when a patient is treated with agomelatine?

A

Liver function tests.

44
Q

What are the symptoms of hepatotoxicity associated with agomelatine use? What should the patient do if they experience these symptoms?

A

Dark urine, pale stools, jaundice, bruising, fatigue, abdominal pain, itchiness. Seek immediate medical attention.

BNF Chapter 4 - CNS (13 decks)

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