antidepressants Flashcards
preferred SSRIs for depression
citalopram and fluoexetine
SSRI post MI
sertraline
SSRI in children and adolescents
fluoxetine
SE SSRIs
GI, bleeding, increased anxiety and agitation after starting
biggest SE citalopram
prolonged QT syndrome + torsades de pointes
SSRI interactions
NSAIDs or aspirin (cover with NSAIDs) // warfarin or heparin (use mirtazapine) // triptans // MAOi
when should a patient on an SSRI be reviewed
after 2 weeks, or after 1 if under 25
how long should a patient continue on an SSRI
6 months
how long should an SSRI be gradually reduced for and what is the exception
4 weeks (not fluoxetine)
which SSRI has higher risk of discontinuation symptoms
paroxetine
discontinuation symptoms
mood change, restless, difficulty sleeping, unsteady, sweating, GI: pain, cramp, D+V
Risk using SSRI in 1st trimester
congenital heart defect
risk using SSRI last trimesert
persistent pulm hypertension
which SSRI has biggest risk of congenital malformations
paroxetine
metabolic SE from SSRI
hyponatraemia
indication SNRI
major depression, GAD, social anxiety, panic disorder
example SNRI
vanlaxafine + duloxetine
action mirtazapine
blocks alpha2-andrenergic receptor
SE mirtazapine
sedatory (good for insomnia) and increased appetite (good for weight loss)
when should mirtazapine be taken
evening
action MAO inhibitors
prevent serotonin and Na metabolisation
examples MAO inhibitors
tranylcypromine + phenelzine
indication MAOi
atypical depression (increased eating)
SE MAOi
anticholinergic - dry mouth, vision, urinary retention
foods to be avoided in MAOi
containing tyramine eg cheese, herring, bovril
NICE advice st john wort
may be beneficial in mild or moderate prescription but should not be advised
SE st johns wort
serotonin syndrome // induce P450 (decrease levels of warfarin, ciclosporin, the COCP)
drugs that causes serotonin syndrome
SSRIs // st johns wort // extasy // amphetamine
what painkiller coprescribed with an SSRI can cause serotonin syndrome
tramadol
symptoms serotonin syndrome
NM excitation - hypereflexia, monoclous, rigidity // automonic - raised temp, sweating // confused
mx serotonin syndrome
IV fluids // benzos // severe - serotonin antagonist eg cyrpohepatdine, chlorpromazine
indication TCA
neuropathic pain
SE TCA
anticholingeric: drowsy, dry mouth, blurred vision, urinary retention, long QT
more sedating TCA
amitrip, clomipramine, dosulepin
less sedating TCA
Imipramine, Lofepramine, Nortriptyline
which TCA are most dangerous in overdose
amitriptyline and dosulepin
early TCA overdose symptom
dry mouth // dilated pupil // agitation // sinus tachucardia // blurred vision
severe TCA overdose symptom
arrhytmia, seizure, met acidosis, coma
ECG changes TCA overdose
sinus tachycardia, widened QRS, prolonged QT
mx TCA overdose
IV bicarbonate (widened QRS)
which drugs should be aboided in TCA overdose
quinidine, flecainide, amiodarone
