antidepressants

Question 1

tricyclic antidepressants - used for

Answer 1

used less commonly for depression

used widely for neuropathic pain

Question 2

TCAs- side effects

Answer 2

drowsiness
dry mouth 
blurred vision 
constipation 
urinary retention 
lengthening QT

Question 3

MAOIs - MOA

Answer 3

bind to monoamine oxidase, inhibiting it from metabolising serotinin and noradranline

Question 4

MAOIs - hypertensive reaction

Answer 4

htn reaction wiht tyramine rich foods

e.g. cheese, marmite

Question 5

MAOIs - side effects

Answer 5

hypertensive reaction

anticholinergic effects

Question 6

first line treatment majority depression

Answer 6

SSRI

Question 7

SSRI - best for post MI

Answer 7

sertraline

Question 8

SSRI - best for kids

Answer 8

fluoxetine

Question 9

SSRI - adverse effectd

Answer 9

GI upset
risk GI bleed
inc anxiety, agitation at start

Question 10

SSRI - citalopram and QT

Answer 10

dose dependent QT lengthening

don’t use if pt has long QT
max dose 40mg adults, 20mg >65yrs

Question 11

SSRI - NSAIDs

Answer 11

prescribe PPI

Question 12

SSRI - warfarin, aspirin and heparin

Answer 12

avoid offering SSRI, consider mirtazepine

Question 13

SSRI - MAOIs

Answer 13

risk serotonin syndromme

Question 14

reviewing patients on SSRI

Answer 14

• review after 2wks
• if <30 or suicidal risk review 1wk

if good repsonse continue for 6mo

Question 15

stopping SSRI

Answer 15

dose should be gradually reduced over 4wks

Question 16

SSRI - discontinuation symptoms

Answer 16

inc mood change 
restlessness
sleeping difficulty 
unsteadiness
sweating 
GI upset
paraesthesia

Question 17

SNRIs

Answer 17

serotonin and noradrenaline reuptake inhibitors

ex/ venlafaxine and duloxetine

Question 18

Mirtazapine - MOA

Answer 18

blocks alpha2-adrenergic receptors

which increases release of neurotransmitters

Question 19

Mirtazapine - useful in

Answer 19

odler patients

Question 20

Mirtazapine - side effects

Answer 20

sedation

increased appetite

Question 21

Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI

Answer 21

first SSRI should be withdrawn before alternative SSRI started

Question 22

Switching from fluoxetine to another SSRI

Answer 22

withdraw then leave gap of 4-7days before starting low-dose of the alternative SSRI

Question 23

Switching from a SSRI to a tricyclic antidepressant (TCA)

Answer 23

crosstaper

except fluoxetine which should be withdrawn prior to TCA being started

Question 24

Switching from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine

Answer 24

cross taper cautiously

start venlafaxine 37.5mg daily and increase slowly

Question 25

Switching from fluoxetine to venlafaxine

Answer 25

withdraw and then start venlafaxine at 37.5mg daily and increase slowly