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Week 123 - Depression > Antidepressants > Flashcards

Antidepressants Flashcards

0
Q

What is the mechanism of action for TCAs?

A

Inhibition of neurotransmitter reuptake (serotonin and noradrenaline) by binding competitively to pre-synaptic neurone receptors (also act on muscarinic, acetylcholine and histamine receptors)

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1
Q

Name 3 classes of antidepressant

A
  • Tricyclics (TCAs)
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Selective Serotonin Reuptake Inhibitors
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2
Q

List the adverse side effects of TCAs

A

Sedation
Confusion
Motor inco-ordination
Weight gain

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3
Q

How do you minimise the adverse effects of TCAs when starting a patient on them?

A

Titration them up slowly to build a tolerance

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4
Q

What are the anti-muscarinic side effects of TCAs?

A

Blurred vision (dilated pupils)
Dry mouth
Constipation
Urinary retention

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5
Q

How would someone present having overdosed on TCAs?

A

Tachycardic
SOB
Dry mouth
Dilated pupils

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6
Q

How do TCAs cause postural hypotension?

A

Alpha 1 adrenoceptor blocking

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7
Q

How do TCAs cause tachycardia (ventricular dysrhythmias and prolongation of the QT interval)?

A

Through vagal blockade

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8
Q

What are the main contraindications for TCAs?

A 
Prostatism
Recent MI
Narrow angle glaucoma
Heart Block
(Cautions inc. ischaemic heart disease; epilepsy)
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9
Q

Name 3 drug types that TCAs interact with.

A

Other sedative agents (e.g. Opioids, anxiolytics, alcohol, sedative antihistamines)
Drugs the prolong the QT interval (e.g. Amiodarone)
Catecholamines and other sympathomimetics (e.g. Nor-/Adrenaline)

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10
Q

Name 3 MAOIs

A

Phenelzine
Isocarboxazid
Tranylcypromine

Moclobemide (more preferable these days - safer)

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11
Q

What is the mechanism of action for MAOIs?

A

Inhibit the Monoamine oxidase enzyme

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12
Q

What are the 2 subtypes of MAOI and the substrate preference(s) for each?

A

MAO-A : preference for serotonin

MAO-B: preference for dopamine and phenylethylamine

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13
Q

What are the main adverse effects if MAOIs?

A

Postural hypotension (sympathetic block)
Atropine-like effects (but less so than TCAs)
Weight gain
CNS stimulation (restlessness; insomnia; hallucinations)

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14
Q

What must you advise patients to avoid when taking MAOIs?

A

Mature cheese Ephedrine-containing products (e.g. sudafed)
Beer. Pethidine
Game. Antidepressants (need dose titration)
Yeast/soy extracts
Pickled Herring

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15
Q

Give 3 examples of Selective Serotonin Reuptake Inhibitors (SSRIs)

A

Fluoxetine
Paroxetine
Citalopram
Sertraline

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16
Q

What are the most common side effects of SSRIs?

A 
Nausea
Anorexia
Insomnia
GI disturbance
Loss of libido / failure to orgasm
17
Q

List some less common side effects of SSRIs

A

Hyponatraemia
GI bleeding
Serotonin syndrome (tremor, hyperthermia)
QT prolongation

18
Q

In which group of patients are SSRIs contraindicated? Why?

A

Under 18s. Risk of self harm and suicidal thoughts.

19
Q

SSRIs can cause hyponatraemia via SIADH (syndrome of inappropriate antidiuretic hormone).
What are the signs of hyponatraemia?

A 
Dizziness
Lethargy 
Nausea
Confusion
Cramps.           Seizures
20
Q

What are the risk factors for hyponatraemia?

A

Old age. Reduced renal function
Female sex. Co-morbidity (diabetes, COPD, hypertension)
Low body weight
Low baseline sodium conc.
Concurrent drug treatment (e.g. NSAIDs, diuretics)

21
Q

What interactions can occur with SSRIs?

A

Drugs with increased GI bleed risk (antiplatelet, NSAIDs, corticosteroids)
Other antidepressants (particularly MAOIs)
Lowers seizure threshold

22
Q

Which antidepressant is considered most effective for the treatment of severe depression?

A

Venlafaxine (serotonin reuptake inhibitor with some noradrenaline reuptake at higher doses)

23
Q

In what way is Mirtazapine different to SSRIs?

A

No action on serotonin or noradrenaline reuptake. Enhance release of them from synapse.
Antagonist for presynaptic alpha-2 adrenoceptors

24
Q

With which antidepressant is there the greatest risk of suicide?

A

Venlafaxine

25
Q

Which particular antidepressant is being actively phased out? Why?

A

Dosulepin. Window between therapeutic benefit and fatal dose is narrow

26
Q

What is the average length of time it takes a prescribed antidepressant to start taking effect?

A

2-3 weeks

27
Q

A patient comes to see you, they are clearly suffering with depression, struggle to sit still and mention trouble sleeping. What would you prescribe.

A

Anxiolytic sedative antidepressants e.g. Amytriptyline or Mirtazapine

28
Q

A depressed patient comes to ask for some treatment for their depression. On examination she tells you she is always tired and has noticed a real reduction in her reaction time lately. What antidepressant would you prescribe?

A

SSRI or Imipramine (less sedative effect)

29
Q

A 65 year old gentleman is having difficultly following the death of his brother and recent split with his wife. In his history he tells you he suffering a heart attack 2 years ago. What antidepressant do you prescribe him?

A

Sertraline

30
Q

What is considered first-line treatment for depression?

A

SSRIs

31
Q

Can Fluoxetine be stopped abruptly?

A

Yes

32
Q

List some discontinuation symptoms

A

Flu-like. GI disturbances (SSRIs)
Insomnia. Cardiac arrhythmia (TCAs)
Vivid dreams. Mania
Agitation
Irritability

33
Q

Why can Paroxetine and Venlafaxine not be withdrawn abruptly?

A

Shorter half-life than other antidepressants

34
Q

What are the 2 types of benzodiazepines?

A

Hypnotics and Anxiolytics

35
Q

List some hypnotic benzodiazepines

A

Temazepam
Nitrazepam (hangover effect)
Z-related compounds (Zopiclone, Zopidem, Zaleplon)

36
Q

List some Anxiolytic benzodiazepines

A

Diazepam
Lorazepam
Oxazepam

37
Q

What is the mechanism of action for Benzodiazepines?

A

Benzodiazepine agonists
Enhances inhibitory effect of GABA by opening chloride channels
Binds to benzodiazepine sites on GABA (a) receptor
Inhibition of neurotransmitters leads to sedation and reduction in anxiety

38
Q

In guidelines what is the only true indication for use of benzodiazepines?

A

Severe, disabling or distressing anxiety or insomnia

Short-term relief; 2-4weeks

39
Q

What are the major adverse effects of benzodiazepine?

A

Drowsiness and falls
Impaired dexterity and judgement
Forgetfulness, confusion, irritability, aggression, paradoxical dis-inhibition
Dependence / Highly Addictive (withdraw cautiously)

Week 123 - Depression (1 decks)

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