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4 CNS > Antidepressants > Flashcards

Antidepressants Flashcards

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1
Q

Antidepressant associated with higher risk of withdrawal symptoms

A

Venlafaxine

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2
Q

First line antidepressant class

A

SSRIs

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3
Q

Only licensed reversible MAOI

A

Meclobemide

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4
Q

Interactions of MAOIs

A
  • tyramine (cheese, pickled herring, broad bean pods, marmite, yeast)
  • indirect acting sympathomimetics (in some cough/decongestants)
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5
Q

How long after MAOI can cheese reaction occur?

A

2 weeks

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6
Q

What are the symptoms of the MAOI interaction

A

throbbing headache due to dangerously high rise in BP

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7
Q

Can you give MAOIs with other antidepressants

A

this is considered very dangerous except in experienced hands

2 weeks between SSRI and starting MAOI (5 weeks for fluoxetine)

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8
Q

Can you drink with MAOIs

A

pt should be advised not to drink or to drink de-alcoholised drinks

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9
Q

Can the cheese reaction still occur if the MAOI is reversible

A

Yes - avoid large amounts. Risk is less than traditional.

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10
Q

Antidepressant action can begin …. weeks after begining

A

2 weeks

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11
Q

Before symptoms of depression improve what symptoms might be experienced

A

aggitation
anxiety
suicide risk

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12
Q

Why is the first line class for depression first line?

A

less dangerous in overdose and better tolerated

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13
Q

TCAs have what side effect profile compared to SSRIs?

A

more antimuscurinic, more sedating and less cardiotoxic

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14
Q

following remission how long should antidepressant treatment be continued for?

A

6 months
12 months in the elderly
12 months with anxiety disorder as relapse risk is higher

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15
Q

All types of antidepressant are associated with what electrolyte change?

A

Hypernatraemia (most common with SSRIs)

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16
Q

Symptoms of hyponatramia

A

drowsiness, confusion, convulsions

17
Q

Symptoms of serotonin syndrome (3 main areas)

A

neuromuscular hyperactivity - tremour, rigidity
autonomic dysfunction - diarrhoea, hyperthermia, BP change
altered mental state - agitation, confusion, mania

18
Q

What is the cause of serotonin syndrome?

A

excessive central and peripheral serotonergic activity

19
Q

Second line options and

…….. is reserved for more severe depression

A

Other SSRI or dose increase or mirtazepine

Venlafaxine

20
Q

What class is reboxetine and what line is it?

A

NRI

2nd/3rd line

21
Q
  • Class of drug for treatment of anxiety with EMA warning that side-effect risks outweigh potential benefit….
  • example of this ….
  • e.g. of sideffects
A

Carbamates
e.g. meprobamate (the only licensed med)

convulsions on abrupt withdrawl
amnesia
ataxia
confusion
paradoxical excitment
22
Q

All TCAs are considered sedating appart from (3)

A

imipramine - more antimuscurinic s/e
lofepramine - fewer s/e, less dangerous in OD, potential hepatic s/e
nortriptyline

23
Q

2 main s/e of the TCA class

A

cardiotoxicity in overdose and antimuscurinic effects

24
Q

which two TCAs are particularly dangerous in overdosage

A

amitryptiline

dolsupin

25
Q

Why is there no point in MR preps of TCAs

A

they have long half lives allowing once daily (at night) admin

26
Q

Can you treat children with TCAs?

A

no - not efficatious

27
Q

what patients are said to respond best to MAOIs?

A

phobic and depressed pt with atypical hypocondriachal or hysterical features

28
Q

what antipsychotic has antidepressant properties at low doses

A

fluclupenthixol

29
Q

Name the three irriverible MAOIs
Which is most stimulating
which is mot likely to cause hepatotox

A

tranycypromine - stimulating & hepatotox, more likely to cause hypertensive crisis
isocarboxid
phenelzine

30
Q

is reversible or irriversible MAOI second line

A

weirdly - reversible MAOI meclobide is second line

31
Q

only SSRI proven to work in adolescents

A

fluoxetine

32
Q

Symptoms of

  • SSRI overdose
  • Serotinin syndrome:
A

Nausea, vomiting, agitation, drowsiness, tremour, nystagmus, sinus tachycardia, convulsions

Serotonin syndrom: neuropsychiatric effects, neurmuscular hyperactivity, autonomic instability, hyperthermia, rahbdomyolysis, renal failure, coagulopathies

33
Q

citalopram and ecitalopram are contraindicated in what caridac condition

A

QT prolongation

34
Q

Duloxtetine is what drug class

A

SNRI

35
Q 
What class of drug is mirtazepine and mianserin?
What are the monitoring requirements of mianserin?
A

Tertracyclic

FBC - report signs of sore throat, stomatitis or other signs of infection

36
Q 
Trazadone is what class
and is used to treat what
A

triazolopyridine antidepressant

used to treat depression where sedation is required

4 CNS (10 decks)

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