antidepressants Flashcards
Which AD would you choose in pt with unstable angina or who have had recent MI
sertraline
…. are better tolerated and safer in overdose than other classes of AD
SSRIs
These two AD classes have similar efficacy, but one if more likely to be discontinued because of SE; toxicity in overdosage is also a problem
SSRIs and TCAs have similar efficacy
but TCAs more likely to be discontinued because of SE and toxicity in OD is also a problem
Which one is more sedating SSRI or TCA
TCA
This drug class has dangerous interactions with some food and drugs, and should be reserved for use by specialists
MAOIs
This electrolyte imbalance has been associated with ALL types of AD, but more freq with SSRIs
hyponatraemia
Hyponatraemia occurs with all ADs but is more frequent with this class
SSRIs
Consider this SE in all pt who take AD and develop drowsiness, confusions and convulsions while taking an antidepressant
hyponatraemia
A patient who is on AD treatment develops confusion, drowsiness and convulsions. What do you suspect
hyponatraemia
The use of antidepressants has been linked with suicidal thoughts and behaviour. Who is particularly at risk?
children
young adults
pt with history of suicidal behaviour
where necessary monitor pt for suicidal behaviour, self harm, or hostility esp at beginning or treatment or if dose is changed
serotonin syndrome is a relatively uncommon adverse drug reaction which is caused by
excessive central and peripheral serotonergic activity
serotonin syndrome - onset of symptoms which range from mild to life threatening can occur within ..
hours or days following initiation, dose escalation or OD of a serotonergic drug, addition of a new serotonergic drug, or replacement on one serotinergic drug by another without allowing a long enough washout period in between, esp when first drug is an irreversible MAOI or a drug with a long half life
Severe toxicity, which is a medical emergency, usually occurs with a combination of serotonergic drugs, one of which is generally an …
MAOI
The characteristic symptoms of serotonin syndrome fall into 3 main areas, although features from each group may not be seen in all patients
neuromuscular hyperactivity (such as tremor, hyperreflexia, clonus, myoclonus, rigidity)
autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhoea)
altered mental state (agitation, confusion, mania)
A patient has tremor, tachycardia, shivering, diarrhoea and confusion. What do you suspect they are suffering from
serotonin syndrome
Treatment of serotonin syndrome
withdrawal of serotonergic med and supportive care
seek specialist advice
Management of acute anxiety generally involves the use of … (2)
BZDPN or buspirone
for chronic anxiety (>4 weeks), what would you consider
may be appropriate to use AD
combined therapy with BZDPN may be required until AD takes effect
generalised anxiety disorder (form of chronic anxiety) management
offer psychological treatment BEFORE initiating AD
if drug treatment needed, SSRI (escital, parox, sertraline (unlicensed)
SNRIs also licensed
if none of the above can be tolerated or fail to control symptoms, consider pregabalin
treatment of panic disorder - 1st and 2nd line and another
SSRIs
2nd line clompramine or imipramine
SNRI Venlafaxine is also licensed
Obsessive-compulsive disorder, post-traumatic stress disorder, and phobic states such as social anxiety disorder are treated with…
SSRIs
OCD 1st line and 2nd line
1st line SSRIs
2nd line clomipramine
Moclobemide is licensed for this anxiety disorder
social anxiety disorder
