antidepressants

Question 1

preferred SSRIs for depression

Answer 1

citalopram and fluoexetine

Question 2

SSRI post MI

Answer 2

sertraline

Question 3

SSRI in children and adolescents

Answer 3

fluoxetine

Question 4

SE SSRIs

Answer 4

GI, bleeding, increased anxiety and agitation after starting

Question 5

biggest SE citalopram

Answer 5

prolonged QT syndrome + torsades de pointes

Question 6

SSRI interactions

Answer 6

NSAIDs or aspirin (cover with NSAIDs) // warfarin or heparin (use mirtazapine) // triptans // MAOi

Question 7

when should a patient on an SSRI be reviewed

Answer 7

after 2 weeks, or after 1 if under 25

Question 8

how long should a patient continue on an SSRI

Answer 8

6 months

Question 9

how long should an SSRI be gradually reduced for and what is the exception

Answer 9

4 weeks (not fluoxetine)

Question 10

which SSRI has higher risk of discontinuation symptoms

Answer 10

paroxetine

Question 11

discontinuation symptoms

Answer 11

mood change, restless, difficulty sleeping, unsteady, sweating, GI: pain, cramp, D+V

Question 12

Risk using SSRI in 1st trimester

Answer 12

congenital heart defect

Question 13

risk using SSRI last trimesert

Answer 13

persistent pulm hypertension

Question 14

which SSRI has biggest risk of congenital malformations

Answer 14

paroxetine

Question 15

metabolic SE from SSRI

Answer 15

hyponatraemia

Question 16

indication SNRI

Answer 16

major depression, GAD, social anxiety, panic disorder

Question 17

example SNRI

Answer 17

vanlaxafine + duloxetine

Question 18

action mirtazapine

Answer 18

blocks alpha2-andrenergic receptor

Question 19

SE mirtazapine

Answer 19

sedatory (good for insomnia) and increased appetite (good for weight loss)

Question 20

when should mirtazapine be taken

Answer 20

evening

Question 21

action MAO inhibitors

Answer 21

prevent serotonin and Na metabolisation

Question 22

examples MAO inhibitors

Answer 22

tranylcypromine + phenelzine

Question 23

indication MAOi

Answer 23

atypical depression (increased eating)

Question 24

SE MAOi

Answer 24

anticholinergic - dry mouth, vision, urinary retention

Question 25

foods to be avoided in MAOi

Answer 25

containing tyramine eg cheese, herring, bovril

Question 26

NICE advice st john wort

Answer 26

may be beneficial in mild or moderate prescription but should not be advised

Question 27

SE st johns wort

Answer 27

serotonin syndrome // induce P450 (decrease levels of warfarin, ciclosporin, the COCP)

Question 28

drugs that causes serotonin syndrome

Answer 28

SSRIs // st johns wort // extasy // amphetamine

Question 29

what painkiller coprescribed with an SSRI can cause serotonin syndrome

Answer 29

tramadol

Question 30

symptoms serotonin syndrome

Answer 30

NM excitation - hypereflexia, monoclous, rigidity // automonic - raised temp, sweating // confused

Question 31

mx serotonin syndrome

Answer 31

IV fluids // benzos // severe - serotonin antagonist eg cyrpohepatdine, chlorpromazine

Question 32

indication TCA

Answer 32

neuropathic pain

Question 33

SE TCA

Answer 33

anticholingeric: drowsy, dry mouth, blurred vision, urinary retention, long QT

Question 34

more sedating TCA

Answer 34

amitrip, clomipramine, dosulepin

Question 35

less sedating TCA

Answer 35

Imipramine, Lofepramine, Nortriptyline

Question 36

which TCA are most dangerous in overdose

Answer 36

amitriptyline and dosulepin

Question 37

early TCA overdose symptom

Answer 37

dry mouth // dilated pupil // agitation // sinus tachucardia // blurred vision

Question 38

severe TCA overdose symptom

Answer 38

arrhytmia, seizure, met acidosis, coma

Question 39

ECG changes TCA overdose

Answer 39

sinus tachycardia, widened QRS, prolonged QT

Question 40

mx TCA overdose

Answer 40

IV bicarbonate (widened QRS)

Question 41

which drugs should be aboided in TCA overdose

Answer 41

quinidine, flecainide, amiodarone