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Chapter 18 Psychotropic > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Phenelzine (Nardil)

Tranylcypromine (Parnate)

A

A) Non-selective Irreversible MAO Inhibitors

B)
1. Major Depression
PHENELZINE:
2. Panic Disorder

C)
PHENELZINE:
45-90 mg daily (in 2 or 3 doses)
TRANYLCYPROMINE:
20-60 mg daily (in 2 or 3 doses)

D)
1. SEROTONIN TOXICITY
2. SEIZURE risk
3. HYPERTENSIVE CRISIS (severe occipital headache)
4. FOOD (tyramine)
5. CAFFEINE intake (jittery or headaches)
6. Drug INTERACTIONS
7. MOOD and BEHAVIOUR
8. HEPATIC (raised serum aminotransferase)
NO renal

E)
Labels: 1, 5, 9, 16, I
PHENELZINE (6)
TRANYLCYPROMINE (A)
#Take your LAST DOSE before 3 pm (trouble sleeping)
#Avoid foods containing TYRAMINE and for 2 weeks after stopping (mature cheese, aged meat products, yeast extracts)
#Reduce amount of CAFFEINE intake (feel jittery or headaches)
**DR - frequent or severe HEADACHES or PALPITATIONS (hypertensive crisis)

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2
Q 
Citalopram (Cipramil)
Escitalopram (Lexapro)
Fluoxetine (Lovan / Prozac)
Fluvoxamine (Luvox)
Paroxetine (Aropax)
Sertraline (Zoloft)
A

A) SSRI

B)
ALL (only cit)
1. Major depression
ESI, FLO, FLV, PAROX, SERT (except cit)
2. Obsessive Compulsive Disorder
FLO, FLV, PAROX, SERT (except cit, esi)
3. Panic disorder
ESI, PAROX, SERT (except cit, flo, flv)
4. Social phobia
ESI, PAROX
5. General Anxiety Disorder
FLO, PAROX
6. Post-Traumatic Stress Disorder
FLO, SERT
7. Premenstrual Dysphoric Disorder
FLO
8. Bulimia Nervosa

PAR - MD - OCD - PANIC - SOCIAL - PTSD - GAD - ———
FLO - MD - OCD - PANIC - ———– - PTSD - ——- - PMDD
SER - MD - OCD - PANIC - SOCIAL - ——– - ——- - PMDD
FLV - MD - OCD - PANIC - ———– - ——– - ——- - ———
ESI - MD - OCD - ——— - SOCIAL - ——– - GAD - ———
CIT - MD - —— - ——— - ———– - ——– - ——- - ———

C)
PAR - 10-50 mg ONCE daily
FLO - 10-80 mg ONCE daily
SER - 25-200 mg ONCE daily
FLV - 25-300 mg daily (2 or 3 doses)
ESI  - 5-20 mg ONCE daily
CIT  - 10-40 mg ONCE daily

D)

  1. SEROTONIN TOXICITY
  2. MOOD or behaviour
  3. BLEEDING (increased risk)
  4. SODIUM (hyponatraemia or SIADH)
  5. Compliance
  6. WITHDRAWAL symptoms
  7. QT interval (FLO, ESI, CIT)
  8. HEPATIC (all)
  9. Renal (PAR)

E)
Labels: 5, 9, 12
(A) swallow whole - FLV and PAR
(B) with FOOD to minimise stomach upset - FLV and PAR
#Takes time to work. 1-2 weeks before noticing a difference
#Usually taken in the MORNING, however can move to night if drowsy
S/E:
*GIT (nausea, diarrhoea)
*CNS (agitation, insomnia, drowsiness, dizziness, headache, anxiety)
*MOTOR (tremor, sweating, weakness, weight gain or loss, sexual dysfunction)

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3
Q 
Amitriptyline (Endep)
Clomipramine (Placil)
Dothiepin (Dothep)
Doxepin (Deptran)
Imipramine (Tofranil)
Nortriptyline (Allegron)
A

A) Tricyclic Antidepressant

B)
ALL
1. Major Depression
AMI, IMI, NOR
2. Urinary Urge Incontinence
AMI, IMI
3. Nocturnal Enuresis
AMITRIPTYLINE ONLY
4. Adjuvant in Pain Management
5. Migraine Prophylaxis
CLOMIPRAMINE ONLY
2. Obsessive Compulsive Disorder
3. Cataplexy
IMIPRAMINE ONLY
4. Panic Disorder
C)
NOR - 10-150 mg daily
AMI  - 10-300 mg daily
IMI   - 10-300 mg daily
CLO - 25-300 mg daily
DOT - 25-300 mg daily
DOX - 25-300 mg daily
D)
1. ECG (prolong QT)
2. BP (orthostatic hypotension)
3. MOOD changes (initial suicidal thoughts)
4. SEIZURE risk (increases)
5. Compliance (overdose risk)
6. WITHDRAWAL (cholinergic rebound - hypersalivation, runny nose, abdo cramp, diarrhoea)
7. Drug interactions
8. Serotonin toxicity (CLO and IMI)
9. HEPATIC
NO renal

E)
Labels: 1, 5, 9, 16
#Takes 1-2 weeks before noticing a difference. Up to a month to know if it works effectively
#If DAYTIME DROWSINESS is a problem, take single dose at night
#For temporary relief of DRY MOUTH, use sugarless gum or sweets, or a saliva substitute
S/E
*You may get side effects such as BLURRED VISION, DROWSINESS and DRY MOUTH. These lessen or disappear after about 7 days

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4
Q

Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Venlafaxine (Efexor)

A

A) Serotonin and Noradrenaline Reuptake Inhibitors (SNRI)

B)
ALL (Desven only)
1. Major Depression
DULOXETINE and VENLAFAXINE
2. General Anxiety Disorder
DULOXETINE only
3. Painful diabetic peripheral neuropathy
VENLAFAXINE only
3. Panic Disorder
4. Social Phobia

C)
DESVEN 50-200 mg ONCE daily
DULOX 30-120 mg ONCE daily
VENLA 37.5 - 225 mg ONCE daily

D)

  1. BP (increase and orthostatic hypotension)
  2. SODIUM (hyponatraemia)
  3. MOOD changes (increased suicidal thoughts initially)
  4. SEROTONIN TOXICITY (dizziness, nausea, paraesthesia, anxiety, sweating, confusion)
  5. BLEEDING (Dulox and Venla increase risk)
  6. SEIZURE risk
  7. Drug INTERACTIONS
  8. WITHDRAWAL
  9. RENAL (all)
  10. HEPATIC (Dulox and Venla)

E)
Labels: 5, 9, 12, A (swallow whole)
(1) - Duloxetine
(B) - Duloxetine and Venlafaxine (with food to minimise stomach upset)
#Taken in the MORNING - however if it makes you drowsy, take at night
#Takes 1-2 weeks before noticing a difference, and up to a month before working effectively
S/E
*ANTICHOL (dry mouth, constipation, dizziness, blurred vision)
*MOTOR (yawning, sweating, weakness, sexual dysfunction and decreased libido)
*CNS (somnolence, insomnia, headache, decreased appetite)

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5
Q

Agomelatine (Valdoxan)

A

A) Melatonergic Antidepressant

B)
1. Major Depression

C)
25 - 50 mg NOCTE

D)
1. LIVER function tests (aminotransferase increase)
2. AGE (avoid in people >75)
3. MOOD changes (initial suicidal thoughts)
4. Drug INTERACTIONS (CYP1A2 substrate)
NO renal, withdrawal or abuse

E)
Labels: 5, 12
#Best taken at BEDTIME
#Takes 1-2 weeks before noticing a difference, and up to 4-6 weeks to know if it’s working effectively
**DR - (hepatoxicity) dark urine, pale stools or yellow skin or eyes
S/E
*initially causes DIZZINESS, NAUSEA and HEADACHES. These should decrease or disappear within 1-2 weeks.

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6
Q

Mianserin (Lumin)

Mirtazapine (Avanza)

A

A) Tetracyclic antidepressants

B)
1. Major depression

C)
MIANSERIN 30-120 mg NOCTE
MIRTAZAPINE 15-60 mg NOCTE

D)

  1. MOOD changes (initial suicidal thoughts)
  2. SEIZURE risk
  3. Drug INTERACTIONS
    * *MIRTAZAPINE only
  4. Weight
  5. Withdrawal symptoms
  6. Peripheral Oedema
    * *MIANSERTIN only
  7. QT interval (prolonged)
  8. Complete BLOOD count (blood dyscrasias - neutropenia and agranulocytosis)
  9. HEPATIC (disturbances of liver function; jaundice)
  10. RENAL (increase dose slower)

E)
Labels: 1, 9
(16) - MIANSERIN
(5) and (A* oral disintegrate) - MIRTAZAPINE
#Takes 1-2 weeks before noticing a difference, and up to a month to know if it’s working effectively
#Best taken at NIGHT

MIANSERIN
**DR - signs of INFECTION (fever, sore throat) or MOUTH ULCERS - blood dyscrasias (i.e. neutropenia and agranulocytosis)
S/E
*DRY MOUTH, TIREDNESS, DIZZINESS, CONSTIPATION and HEADACHES disappear/decrease within 1-2 weeks.

MIRTAZAPINE
S/E
*increased APPETITE, WEIGHT gain, NAUSEA, DIARRHOEA, DRY MOUTH, DIZZINESS and HEADACHES

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7
Q

Moclobemide (Aurorix)

A

A) Reversible, Competitive, Selective MAO-A Inhibitor

B)

  1. Major Depression
  2. Panic disorder
  3. Social phobia

C)
150-600 mg daily (1 or 2 doses)

D)
1. MOOD changes (increased suicidal thoughts initially)
2. Acute CONFUSIONAL states (avoid use)
3. SEROTONIN toxicity
4. Drug INTERACTIONS
5. HEPATIC (reduce dose)
NO renal

E)
Labels: 5, 9, 12+, B (with food - best taken)
#Take doses NO LATER THAN EARLY AFTERNOON - trouble sleeping at night (restlessness and insomnia)
#Takes 1-2 weeks to notice a difference. Up to a month to know if it’s effective
S/E
NA (nausea, dry mouth, constipation, insomnia) - decrease or disappear with continued use

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8
Q

Reboxetine (Edronax)

A

A) Selective Noradrenaline Reuptake Inhibitor
(weakly inhibits serotonin reuptake)

B)
1. Major Depression

C)
2 - 6 mg BD
Max 12 mg daily

D)

  1. MOOD changes (initial suicidal thoughts)
  2. BP (increase diastolic and orthostatic hypotension)
  3. HR (tachycardia)
  4. SEIZURE (increase associated)
  5. RENAL (reduce dose)
  6. HEPATIC (reduce dose)

E)
Labels: 9, 12+, 16
#Takes 1-2 weeks to notice a difference. UP to a month to work effectively
**DR - Difficulty URINATING (urinary retention, dysuria, urinary frequency)
S/E
*ANTICHOL (urinary retention, dry mouth, sweating, constipation, orthostatic hypotension)
*CARDIAC (increase diastolic BP, tachycardia)
*GIT (nausea, decreased appetite)
*CNS (headache, dizziness, insomnia)

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9
Q

Vortioxetine (Brintellix)

A

A) Selective Serotonin Reuptake Inhibitor

B)
1. Major Depression

C)
5 - 20 mg ONCE daily

D)
1. SEROTONIN toxicity
2. Drug INTERACTIONS
3. MOOD changes (initial suicidal thoughts)
NO renal, hepatic or withdrawal (can be stopped without tapering)

E)
Labels: 5, 9
#Taken once daily around the SAME TIME each day
#Might take 2 weeks before noticing a difference, and up to a month to know its effectiveness
**DR - hypersenstivity (new drug) - rash; swelling of face, lips, tongue; difficulty breathing
S/E:
*Decreases with time: NAUSEA and VOMITING, CONSTIPATION, DRY MOUTH

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Chapter 18 Psychotropic (8 decks)

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