Antidepressants

Question 1

Antidepressant associated with higher risk of withdrawal symptoms

Answer 1

Venlafaxine

Question 2

First line antidepressant class

Answer 2

SSRIs

Question 3

Only licensed reversible MAOI

Answer 3

Meclobemide

Question 4

Interactions of MAOIs

Answer 4

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

Question 5

How long after MAOI can cheese reaction occur?

Answer 5

2 weeks

Question 6

What are the symptoms of the MAOI interaction

Answer 6

throbbing headache due to dangerously high rise in BP

Question 7

Can you give MAOIs with other antidepressants

Answer 7

this is considered very dangerous except in experienced hands

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

Question 8

Can you drink with MAOIs

Answer 8

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

Question 9

Can the cheese reaction still occur if the MAOI is reversible

Answer 9

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

Question 10

Antidepressant action can begin …. weeks after begining

Answer 10

2 weeks

Question 11

Before symptoms of depression improve what symptoms might be experienced

Answer 11

aggitation
anxiety
suicide risk

Question 12

Why is the first line class for depression first line?

Answer 12

less dangerous in overdose and better tolerated

Question 13

TCAs have what side effect profile compared to SSRIs?

Answer 13

more antimuscurinic, more sedating and less cardiotoxic

Question 14

following remission how long should antidepressant treatment be continued for?

Answer 14

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

Question 15

All types of antidepressant are associated with what electrolyte change?

Answer 15

Hypernatraemia (most common with SSRIs)

Question 16

Symptoms of hyponatramia

Answer 16

drowsiness, confusion, convulsions

Question 17

Symptoms of serotonin syndrome (3 main areas)

Answer 17

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

Question 18

What is the cause of serotonin syndrome?

Answer 18

excessive central and peripheral serotonergic activity

Question 19

Second line options and

…….. is reserved for more severe depression

Answer 19

Other SSRI or dose increase or mirtazepine

Venlafaxine

Question 20

What class is reboxetine and what line is it?

Answer 20

NRI

2nd/3rd line

Question 21

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

Answer 21

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

convulsions on abrupt withdrawl
amnesia
ataxia
confusion
paradoxical excitment

Question 22

All TCAs are considered sedating appart from (3)

Answer 22

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

Question 23

2 main s/e of the TCA class

Answer 23

cardiotoxicity in overdose and antimuscurinic effects

Question 24

which two TCAs are particularly dangerous in overdosage

Answer 24

amitryptiline

dolsupin

Question 25

Why is there no point in MR preps of TCAs

Answer 25

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

Question 26

Can you treat children with TCAs?

Answer 26

no - not efficatious

Question 27

what patients are said to respond best to MAOIs?

Answer 27

phobic and depressed pt with atypical hypocondriachal or hysterical features

Question 28

what antipsychotic has antidepressant properties at low doses

Answer 28

fluclupenthixol

Question 29

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

Answer 29

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

Question 30

is reversible or irriversible MAOI second line

Answer 30

weirdly - reversible MAOI meclobide is second line

Question 31

only SSRI proven to work in adolescents

Answer 31

fluoxetine

Question 32

Symptoms of - SSRI overdose - Serotinin syndrome:

Answer 32

Nausea, vomiting, agitation, drowsiness, tremour, nystagmus, sinus tachycardia, convulsions Serotonin syndrom: neuropsychiatric effects, neurmuscular hyperactivity, autonomic instability, hyperthermia, rahbdomyolysis, renal failure, coagulopathies

Question 33

citalopram and ecitalopram are contraindicated in what caridac condition

Answer 33

QT prolongation

Question 34

Duloxtetine is what drug class

Answer 34

SNRI

Question 35

``` What class of drug is mirtazepine and mianserin? What are the monitoring requirements of mianserin? ```

Answer 35

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

Question 36

``` Trazadone is what class and is used to treat what ```

Answer 36

triazolopyridine antidepressant | used to treat depression where sedation is required