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Phase 3a Psych > Antidepressants > Flashcards

Antidepressants Flashcards

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1
Q

How long do they take to start working?

A

4-6 weeks to start working

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2
Q

how do we monitor them?
how often?

A

baseline monitor weekly for 4 weeks, then after, 2 weekly

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3
Q

what is a common side effect of starting antidepressants and in which age group?

A

30 and under
high suicidality risk when first starting

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4
Q

How long do they need to be taken for and when can they be stopped and how?

A

need to take for 6 months after Sx improve and wean over 4 weeks

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5
Q

why do we wean Px off antidepressants?

A

To prevent SSRI/Serotonin discontinuation syndrome

Sx = Flu Sx, N+V, Agitation, insomnia, parasthesia

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6
Q

name some antidepressant classes?

A

SSRI
SNRI
MAOI
TCA
MIRTAZIPINE

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7
Q

What does SSRI stand for?
what is it?

A

selective serotonin reuptake inhibitor

5HT (Serotonin) presynaptic reuptake inhibitor

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8
Q

what are 4 examples of SSRIs?

A

sertraline
fluoxetine
paroxetine
citalopram

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9
Q

Sertraline
good in which conditions?

Fluoxetine
used in which age group and good in what group?

A

good for generalised anxiety disorder and depression

CAMHS + breast feeding

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10
Q

paroxetine
good in what group? high risk of what?

Citalopram
can cause?

A

good for breastfeeding
high discontinuation Sx

QTc prolongation

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11
Q

Side effects for SSRIs?

A

GI (enteric NS) - N+V, pain, High GI bleed risk, if lots of NSAID use

Impotence + low libido

Serotonin syndrome

QTc prolongation (>450 ms)

HyPO natremia (low Na)

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12
Q

what interactions can SSRIs have with which 2 meds?

A

triptans
reduces efficacy of triptans and low seizure threshold

NSAIDS
co prescribe PPI

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13
Q

What is paroxetine associated with?

A

high associated congenital defects

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14
Q

what cong defects in 1/3 and 3/3?

A

1/3 = CHD + Cleft palate

3/3 = persistent pul htn of newborn (PPHN)

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15
Q

which 2 SSRIs are good for breast feeding?

A

sertraline and paroxetine

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16
Q

What are SNRI’s?
what are they also used in?

A

Serotonin + norepinephrine reuptake inhibitor
NA reuptake-i presynaptically (+ 5HT Reuptake inhibitor)

used in stress incontinence

17
Q

what are 2 examples of SNRI’s?

A

venlafaxine
Duloxetine

18
Q

SE of SNRI’s?

A

N+V
Dry mouth
Rhabdomyolysis
SIADH

19
Q

What is MAOI?
how do they work?

A

Monoamine oxidase inhibitor

Prevent NAd, Adr, serotonin breakdown in CNS

20
Q

examples of MAOI?

A

Isocaboxaid
phenoxybenzamine
sellegilline

21
Q

What are TCA?
how do they word?
what is it also used for?

A

tricyclic antidepressants

serotonin + NAd reuptake inhibitor
+ Antagonises Ach + alpha 1+2 + histamine

neuropathic pain

22
Q

what are 2 examples of TCAs and types?

A

amitryptiline (sedative)
Imipramine (non sedative)

23
Q

SE of TCAs?

A

Ach (can’t see, pee, spit and shit), impotence, sedation

24
Q

what symptoms do you get in a TCA overdose?

A

confused, dry hot skin, high Ach Sx

25
Q

Dx and Tx of TCA overdose?

A

Wide QRS >100ms
QTx prolongation >480ms

IV Bicarb

26
Q

what is mirtazipine?

A

NaSSA
Noradrenergic + specific serotonin antidepressant

27
Q

SE of mirtazipine?

A

Weight gain and sedation

28
Q

what does NICE recommend mirtazipine for?

A

a Px on warfarin or lmwh

29
Q

what is a major SE of antidepressants?

A

Serotonin syndrome

30
Q

what is serotonin syndrome?
what drugs cause it?

A

high serotonin
SSRI, MAOI, Tramadol, metoclopramide, ondansetron, MDMA, amphetamines, LSD, Cocaine, st Jons wort

31
Q

Sx of serotonin syndrome?
How long it occurs for?

A

Over hours
hypER reflexia, clonus, DILATED pupils, autonomic Sx (htn, tachy, flushing eg) + AMS
May have high CK (Do u+e, toxicology)

32
Q

Tx for serotonin syndrome?

A

ABCDE
Supportive
stop SSRI + Give chlorpromazine
(typical antipsychotic which reduces serotonin)

33
Q

what toxicity criteria is used for serotonin syndrome?

A

Hunter serotonin toxicity criteria
used in serotonin syndrome diagnosis (severity)

Phase 3a Psych (11 decks)

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