antidepressants

Question 1

What are the different classes of antidepressants

Answer 1

SSRI
SNRI
TCA
NaSSA
MAOI

Question 2

name 5 SSRIs

Answer 2

Sertraline
Citalopram
Escitalopram
Fluoxetine
Paroxetine

Question 3

most common side effect ssris

Answer 3

GI disturbance

Question 4

Complications of SSRIs

Answer 4

• QT prolongation / ventricular arrhythmias including torsade de pointes in citalopram
• Hyponatremia
• SSRI discontinuation syndrome

Question 5

Interactions SSRIs

Answer 5

NSAIDs/aspirin: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor

warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine

triptans - increased risk of serotonin syndrome

monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

Question 6

SSRI in first trimester can cause?

Answer 6

congenital heart defects

Question 7

SSRI in third trimester can cause?

Answer 7

persistent pulmonary hypertension of the newborn

Question 8

worst SSRI pregnancy

Answer 8

Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

Question 9

SSRIs of choice in breastfeeding women

Answer 9

Sertraline or paroxetine

Question 10

SSRI of choice post MI

Answer 10

Sertraline

Question 11

SSRI of choice children

Answer 11

fluoxetine

Question 12

Name 2 SNRIs

Answer 12

Venlafaxine
Duloxetine

Question 13

Side effects SNRIs

Answer 13

include nausea/vomiting, sweating, loss of appetite, dizziness, headache, increase in suicidal thoughts, and sexual dysfunction.

Question 14

Complication SNRI

Answer 14

HTN

(Elevation of norepinephrine levels can sometimes cause anxiety, mildly elevated pulse, and elevated blood pressure. )(monitor before initiation and after titration)

Question 15

Name 3 TCAs

Answer 15

Imipramine
Clomipramine
Amitriptyline

Question 16

Mechanism TCAs

Answer 16

inhibit the reuptake of serotonin and noradrenaline.

Question 17

Side effects TCAs?

Answer 17

anticholinergic effects:
Can’t see (blurred vision)
Can’t pee (urinary retention)
Can’t spit (dry mouth)
Can’t shit (constipation)
Can’t sit for too long - postural hypotension

TCAs can cause overflow incontinence due to chronic urinary retention
Drowsiness
Postural hypotension

lengthening of QT interval

Question 18

Name 1 NaSSA

Answer 18

Mirtazapine

Question 19

Mechanism NaSSA

Answer 19

Blocking alpha2-adrenergic receptors, which increases the release of neurotransmitters. Blocking α2-adrenergic autoreceptors and heteroreceptors, NaSSAs enhance adrenergic and serotonergic neurotransmission in the brain involved in mood regulation,[1] notably 5-HT1A-mediated transmission.

Question 20

Side effects mirtazapine?

Answer 20

Sedative
Increases appetite

risk of bone marrow suppression including agranulocytosis

Question 21

Name 3 MAOIs

Answer 21

Isocarboxazid
Phenelzine
Tranylcypromine

Question 22

Complication MAOI

Answer 22

The tyramine cheese reaction is a classic side effect of MAOI (monoamine oxidase inhibitor) antidepressants, such as phenelzine. Consumption of foods high in tyramine (such as cheese) can result in a hypertensive crisis. Symptom: Throbbing headache at bottom of skull

Question 23

Presentation SSRI discontinuation syndrome

Answer 23

Dizziness, electric shock sensations and anxiety

Question 24

how to prevent SSRI discontinuation syndrome?

Answer 24

reduce gradually over 4 weeks

Question 25

Presentation seretonin syndrome

Answer 25

Neuromuscular excitation
- hyperreflexia
- myoclonus
- rigidity

autonomic nervous system excitation
- hyperthermia
- sweating

altered mental state
- Confusion

Question 26

management seretonin syndrome

Answer 26

supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

Question 27

what should pts taking MAOIs be advised in regards to food and drink

Answer 27

diet low in tyramine-containing foods, alongside cheese, patients should avoid cured meats, fermented foods, and alcohol consumption - the BNF states that patients should ‘be advised to avoid alcoholic drinks’.