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1. 4th year > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Sertraline
fluoxetine
paroxetine
citalopram

are examples of what

A

selective serotonin re-uptake inhibitors (SSRI)

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2
Q

when starting an antidepressant what must you discuss with a patient

A 
side effects
therapeutic effects
time taken to respond 
discontinuation symptoms 
safety net re suicide
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3
Q

what is the mechanism of action of an SSRI

A

selectively block serotonin (5-HT) reuptake from the synaptic cleft

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4
Q

what is the SSRI of choice in young people

A

fluoxetine

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5
Q

what are SSRIs used in

A

1st line in depression

also GAD, panic disorder, phobia, OCD

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6
Q

are SSRIs safe in overdose

A

yes

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7
Q

SSRIs are associated with withdrawal symptoms, how long should the dose be tapered off

A

4 weeks and taper more slowly towards the end

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8
Q

Can NSAIDs be given with an SSRI

A

advised against but can be, if they are need to co-prescribe a PPI

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9
Q

what drugs used in cardiology should be avoided with SSRIs

A

warfarin
heparin
aspirin
- consider mirtazapine instead

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10
Q

if an SSRI is used with a triptan or mono-oxidase inhibitor there is an increased risk of what

A

serotonin syndrome

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11
Q

what are the main side effects of SSRIs

A

GI upset - abdominal pain, constipation, nausea
GI bleeds
sexual dysfunction
headaches
mood: agitation/anxiety, increased suicidality in young people
hyponatraemia
insomnia

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12
Q

what is the concern with using SSRIs in the elderly

A

hyponatraemia and falls

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13
Q

what specific side effects do paroxetine cause

A

more weight gain and sexual dysfunction

increased withdrawal effect

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14
Q

what specific side effects do fluoxetine cause

A

insomnia
agitation
rash

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15
Q

what specific side effects do sertraline cause

A

diarrhoea

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16
Q

what specific side effects do citalopram cause

A

QT prolongation

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17
Q

which SSRI is cardioprotective and therefore useful after an MI

A

sertraline

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18
Q

what are the discontinuation symptoms of an SSRI

A 
increased mood change
restlessness
difficulty sleeping/increased dreaming
unsteadiness
sweating
paraesthesia
GI symptoms
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19
Q

if someone is starting an SSRI what can you advise them about the side effects of GI upset e.g. cramping, constipation, nausea

A

normally settle within a few weeks

20
Q

Amitriptyline, Norytrptiline, Lofepramine, Clomipramine imipramine, dosulepin, doxepin

are examples of what

A

tricyclic antidepressants

21
Q

what is the mechanism of action of TCAs

A

Block the reuptake of noradrenaline and serotonin from the synapse (non-selectively, also block dopamine, histamine and muscarinic ACh receptors)

22
Q

why do TCAs have an extensive side effect profile

A

also block dopamine, histamine and muscarinic ACh receptors

23
Q

why might a TCA impact a patients ability to drive/operate machinery

A

sedative

24
Q

are TCAs dangerous in overdose

A

yes - cardiotoxic

25
Q

what are TCAs used for

A

depression (less commonly now due to side effect profile and toxicity in overdose)
neuropathic pain
anxiety
migraine prophylaxis

26
Q

what are the side effects of TCAs

A
  • sedation, weight gain
  • dry mouth, constipation, blurred vision, urinary retention, sexual dysfunction
  • QT prolongation, tachycardia, hypotension
27
Q

venlafaxine and duloxetine are examples of what

A

serotonin and noradrenaline re-uptake inhibitors (SNRI)

28
Q

what is the mechanism of action of SNRIs

A

selectively block noradrenaline and serotonin reuptake (weak dopamine blockade)

29
Q

why are SNRIs preferable to TCAs

A

block major receptor blockade so reduced side effects

30
Q

when are SNRIs used

A

second line to SNRI in depression

anxiety disorders

31
Q

what are the side effects of SNRIs

A

GI upset

cardio - hypertension, palpitations, dizziness

32
Q

what kind of drug is mirtazapine

A

noradrenaline and serotonin specific antidepressant - atypical

33
Q

how does mirtazapine work

A

antagonises pre-synaptic noradrenaline, serotonin and histamine receptors
(a-2, 5ht2 and 5ht3 receptors)

34
Q

why might mirtazapine be used and why

A

if patient experiencing weight loss and sleep disturbance - side effects include sedation and weight gain

35
Q

when should mirtazapine be taken

A

evening

36
Q

what are the side effects of mirtazapine

A

weight gain

sedation

37
Q

what kind of drug is moclobemide

A

reversible monoamine oxidase inhibitor (MAOI)

38
Q

what kind of drug is phenelzine

A

non-reversible mono-amine oxidase inhibitor

39
Q

how do monoamine oxidase inhibitors (MAOI) work

A

block monoamine oxidase (MOA-A and MOA-B) which prevents the breakdown of serotonin and noradrenaline (along with other neurotransmitters)

40
Q

what is a major adverse effect of monoamine oxidase inhibitors (MAOI) and how can it be avoided

A

hypertensive crisis (cheese reaction)

non-reversible MAOI prevents breakdown of dietary tyramine. Tyramine is a substrate of MAO. Accumulation of tyramine causes noradrenaline release causing BP to sky rocket

  • avoid cheese, red wine and soy (food that contains dietary tyramine)
  • patients must be off TCA/SSRI for several weeks before starting MAOI
41
Q

what are the side effects of monoamine oxidase inhibitors (MAOI)

A

dizziness
postural hypotension
peripheral oedema
anticholinergic - dry mouth, constipation, blurred vision, urinary retention and sexual dysfunction

42
Q

monoamine oxidase inhibitors (MAOI) are particularly good in what kind of depression

A

atypical depression

43
Q

what kind of drug is trazadone

A

serotonin antagonist and reuptake inhibitor (SARI)

44
Q

what is the mechanism of action of trazadone

A

potent serotonin and noradrenaline receptor antagonist

45
Q

is trazadone addictive

A

no

46
Q

what is the treatment of mild depression

A 
active monitoring
exercise
guided self help
CBT
- antidepressants not generally recommended
47
Q

what would a general treatment plan of depression look like

A

SSRI unless reason it cannot be given
if unsuccessful - increase dose or try a different SSRI
if unsuccessful can augment with other drug

1. 4th year (23 decks)

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