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Exam - M - Psychiatry (Meg) > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Which TCA is most likely to be useful in anxiety?

A

Clomipramine

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2
Q

What is TCA most often used for now?

A

Pain.

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3
Q

What is the first line medication used in generalised anxiety disorder?

A

Sertraline

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4
Q

What ECG changes are sometimes seen with tricyclic antidepressants? (in overdose)

A

Long QT
Wide QRS
Tachycardia

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5
Q

What are the 5 categories of antidepressants?

A 
SSRI 
SNRI 
MAOI
TCA 
novel/atypical
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6
Q

What are the 5 main SSRIs?

Famous five enjoy playing, chatting, speaking.

A 
Fluoxetine
Fluvoxamine 
Escitalopram
Paroxetine
Citalopram
Sertraline
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7
Q

How long should an antidepressant be trialled for before deeming as not working?

A

At least 2 months

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8
Q

What should you do if someone is on an antidepressant and its not working?

A

Titrate to the highest dose before switching or using adjuvant therapy.

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9
Q

What is the NNT for antidepressants to be successful?

A

3 (you need to treat 3 people to make one person better).

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10
Q

What does serotonin bind to?

A

5HT2 receptors

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11
Q

what are the 3 main neurotransmitters targeted by antidepressants?

A

serotonin
norepinephrine
Dopamine

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12
Q

What does serotonin do?

A

Regulates mood, feeding behaviour and emotions.

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13
Q

What causes the reuptake or serotonin?

A

Serotonin reuptake transporters.

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14
Q

When is SSRI used in depression?

A

As 1st line treatment.

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15
Q

How do SSRIs work?

A

Bind to serotonin reuptake transports and prevent them from removing serotonin from the synaptic cleft.

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16
Q

How long is it until improvements are seen with SSRI?

A

4-6 weeks

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17
Q

What can be treated with SSRI?

A

Depression
Eating disorders
Anxiety - PTSD, OCD

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18
Q

What are the side effects of SSRIs?

A 
Increased risk of GI, cerebral and uterine bleeding (especially if on NSAIDs, aspirin and warfarin)
Insomnia
fatigue
anxiety
GI distress
sexual dysfunction
suicidal ideations
serotonin syndrome
restlessness
nervousness
sedation
dizziness
Hyponatraemia
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19
Q

What is the symptoms of activation syndrome seem with starting an SSRI?

A

Nausea
Anxiety
Panic
agitation

Usually lasts 2-10 days.

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20
Q

What are the pros of sertraline?

A

Weak P450 interactions
Short half life
Less sedating

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21
Q

What are the cons of sertraline?

A

Max absorption requires a full stomach.

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22
Q

What is the doses of sertraline?

A

starts at 50mg and goes up to 200mg.

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23
Q

What are the pros of fluoxetine?

A 
Long half life (less chance of discontinuation syndrome + good for patients with compliance issues)
Initially activating (increased energy)
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24
Q

What are the cons of fluoxetine?

A

Long half life (not good in hepatic illness)
P450 interactions
Initial activation syndrome - anxiety and insomnia
More likely to induce mania than other SSRIs.

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25
Q

What is serotonin syndrome?

A

When there is too much serotonin causing overstimulation of the nervous system.

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26
Q

What are the signs and symptoms of serotonin syndrome?

A 
Skin flushing
Coma
Muscle rigidity
Restlessness
Nervousness
Insomnia
Fatigue 
Sedation
Dizziness
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27
Q

How long does activation syndrome usually last for?

A

2-10 days

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28
Q

What cardiac side effects can be seen with citalopram?

A

QT prolongation

Can lead to arrhythmias.

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29
Q

What congenital problems can paroxetine cause?

A

Congenital heart defects.

30
Q

Which SSRIs most commonly cause sedation and weight gain?

A

Paroxetine

31
Q

What are the main 5 SRNIs?

Dogs don’t like vegetarian meat

A 
Duloxetine 
Desvenlafaxine
Levomilnacipran
Venlafaxine
Milnacipran
32
Q

Which two neurotransmitters do SRNIs target?

A

Serotonin

Norepinephrine

33
Q

When is SRNI a go to medication?

A

When people haven’t responded to the SSRIs.

34
Q

What are the side effects of SRNIs?

A 
Insomnia
Nausea
Sexual dysfunction
Hypertension
Sweating
Headaches
35
Q

What are the pros of venlafaxine?

A 
Minimal drug interactions
No P450 activity
Short half life
Fast renal clearance 
(good for geriatrics)
36
Q

What are the cons of venlafaxine?

A

Increase in diastolic blood pressure of 10-15mmHg.

QT prolongation.

37
Q

What are the pros of duloxetine?

A

Less blood pressure changes than venlafaxine.

38
Q

Which SRNI would be used first?

A

Duloxetine

39
Q

What are the side effects of TCAs?

A 
Weight gain
Sleepy
Dry mouth
Blurred vision
Lethal in overdose (even 7 days worth)
Orthostatic hypotension
Sedation
Tachycardia
Hallucinations
Urinary retention
Confusion

^Because they target so many receptors.

40
Q

What is serotonin also known as?

A

5HT.

41
Q

What is SERT?

A

Serotonin transporter (For reuptake)

42
Q

What is NET?

A

Norepinephrine transporter (for reuptake).

43
Q

What are the two groups of tricyclics?

A

Tertiary

Secondary (usually metabolites of the tertiary ones)

44
Q

What does tertiary TCAs do?

A

Non-selective

Inhibit reuptake of serotonin AND norepinephrine

45
Q

What do secondary TCAs do?

A

Selective

only inhibit reuptake of norepinephrine

46
Q

How long is it before improvements are seen when using TCAs?

A

2-4 weeks

47
Q

When are TCAs used?

A

Depression - if no response to SSRI and SRNI
Phobic disorders
Chronic neuropathic pain
Migraine prophylaxis

48
Q

Which group of TCAs have more side effects?

A

Tertiary

Secondary has the same side effects but less severe.

49
Q

Which receptors do TCAs block?

A 
SERT
NET
Histamine - sedation
Alpha 1 - orthostatic hypotension
Muscarinic - dry mouth, tachycardia, hallucinations, urianry retention, confusion.
50
Q

What cardio effects can TCAs cause?

A

Prolonged QT

Arrhythmias

51
Q

What are the most common causes of death when using a TCA?

A

Convulsion
Coma
Cardio toxicity

52
Q

How long should you wait when switching from an SSRI to MAOI?

A

2 weeks

fluoxetine - wait 5 weeks

53
Q

When does TCA cause respiratory depression?

A

When taken with ethanol or sedative hypnotics

54
Q

How do monoamine oxidase inhibitors work MAOIs?

A

By irreversibly binding to monoamine oxidase enzymes. Stops these enzymes from breaking down the neurotransmitters when they had been reuptook from the synaptic cleft.

55
Q

Which type of depression responds well to MAOI?

A

Atypical depression

Resistant depression

56
Q

What are the signs of atypical depression?

A 
Able to improve their mood with positive events
Increased appetite
Weight gain
Sleepiness 
Fatigue
57
Q

What are the names of the non-selective MAOIs?

A

isocarboxazid
Phenelzine
Tranylcypromine

58
Q

What are the selective MAOIs?

A

Only increase the level of dopamine
Selegiline
Rasagiline

59
Q

What are selective MAOIs mostly used for?

A

Parkinsons.

60
Q

What are the side effects of MAOIs?

A 
Serotonin syndrome
Hypertensive crisis
Orthostatic hypertension
Weight gain
Dry mouth
Sedation
Sleep disturbance
Sexual dysfunction
61
Q

When are MAOIs used?

A

2nd or 3rd line.

62
Q

How long most MAOIs be stopped for before starting another antidepressant?

A

At least 2 weeks. Takes 2 weeks for monoamine oxidase enzyme to come back.

63
Q

Which category of MAOI is good for atypical depression?

A

Non selective MAOIs.

64
Q

What are 2 serious side effects of MAOIs?

A

Serotonin syndrome

Hypertensive crisis

65
Q

What are the signs and symptoms of hypertensive crisis?

A 
Hyperthermia
Hypertension
Tachycardia
agitation
arrhythmias
66
Q

What causes hypertensive crisis (cheese reaction) when taking MAOIs?

A

Eating tyrosine rich foods.

Wine
Cheese
Beer.

67
Q

What is a common atypical antidepressant?

A

Mirtazapine

68
Q

When is mirtazapine used?

A

Often in augmentation with SSRI

As a hypnotic at lower doses

69
Q

How is treatment resistant depression treated?

A

Combination of antidepressants
Adjunctive therapy with lithium
Adjunctive therapy with atypical antipsychotics
ECT

70
Q

Which type of antidepressants are best for anxiety?

A

More associated with serotonin:
SSRI
SRNI
(Antidepressants are 2nd line after psychological therapy).

71
Q

How long should antidepressant prophylaxis be taken by?

A

1st episode - 6 months - 1 yr
2nd episode - 2 years
3rd episode - discuss life long therapy

72
Q

Which antidepressant should not be used for panic disorder?

A

Fluoxetine

Exam - M - Psychiatry (Meg) (24 decks)

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