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PSCYH PHARM > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Classes of antidepressants and examples

A

SSRI - sertraline, paroxetine, fluoxetine, citalopram, escitalopram,
Serotonin Noradrenaline Reuptake inhibitors - venlafaxine, duloxetine
Serotonin Antagonist and Reuptake Inhibitor - Trazodone
Noradrenaline Reuptake Inhibitor - Reboxetine
Noradrenaline Serotonin Specific Antidepressants - Mirtazapine
Tricyclic antidepressants - Amitriptyline, dosulepin, lofepramine
Monoamine Oxidase inhibitors - Isocarboxide, Phenelzine, Moclobemide

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2
Q

Side effects of citalopram

A 
GI side effects - nausea, dyspepsia, constipation, diarrhoea, flatulence, bloating
Sweating
Tremor
Rashes
Extrapyramidal
Sexual dysfunction
Somnolence
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3
Q

Symptoms when stopping sertraline

A

GI - dyspepsia, flatulence, constipation, diarrhoea, nausea, bloating
Hypomania
Chills
Insomnia

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4
Q

When should SSRIs be avoided?

A

mania

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5
Q

When should you be cautious with sertraline? What can you do for this?

A

Can increase risk of GI bleeding

Prescribe with PPI if at high risk e.g. on aspirin/warfarin/heparin/DOACs

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6
Q

Which SSRI for PTSD

A

sertraline, paroxetine

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7
Q

Which SSRI for post MI

A

sertraline

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8
Q

Which SSRI for adolescents/children?

A

fluoxetine

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9
Q

What are the side effects of venlafaxine?

A 
Dry mouth
nausea
headache
dizziness
sexual dysfunction
hypertension
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10
Q

When is fluoxetine contraindicated?

A

High risk of arrhythmia

Uncontrolled hypertension

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11
Q

What is the indication for mirtazapine

A

2nd line for depressed patients who would benefit from weight gain and sedation (suffer insomnia)

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12
Q

What are the side effects of mirtazapine?

A 
Increased appetite
Weight gain
Sleepiness
Dry mouth
Postural hypotension
Oedema
Drowsiness
Fatigue
Tremor
Dizziness
confusion
Anxiety
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13
Q

Indications for reboxetine

A

2nd/3rd line for major depression

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14
Q

Side effects of reboxetine?

A

Nausea, dry mouth, constipation, anorexia, tachycardia, palpitations, vasodilation, postural hypotension, headache, insomnia, dizziness, impotence, urinary retention, sweating

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15
Q

Indication for trazadone

A

Depressive illness where sedation is required

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16
Q

Side effects of trazadone

A

Dizziness
Sedation
GI symptoms

17
Q

Indication for lofepramine?

A

Depressive illness, noturnal enuresis, neuropathic pain

18
Q

Side effects of amitriptyline?

A

Anticholinergic - dry mouth, urinary retention, blurred vision, confusion
CVS - arrhythmias, postural hypotension, tachycardia, syncope, sweating
Uticaria/photosensitivity
Psych - hypomania, mania, confusion, delirium
Increased appetite and weight gain

19
Q

Contraindications for dosulepin?

A

Recent MI, arrhythmias, mania, severe liver disease, agranulocytosis

20
Q

Why should TCAs not be given in suicide risk patients?

A

Overdose causes cardiac dysfunction

21
Q

Give the indications for phenelzine

A

3rd line for depression (treatment resistant)

22
Q

Why is the use of isocarboxide limited? What can be used instead

A

Use is limited by toxicity and interaction with tyrosine rich foods
Moclobemide has no need for dietary restriction

23
Q

What are the side effects of phenelzine?

A

CVS - postural hypotension, arrhythmia
Psych - insomnia/headache
GI increased appetitie and weight gain
Hypertensive reaction with tyrosine rich foods.

24
Q

What are the clinical features of serotonin syndrome?

A

Headache, agitation hypomania, confusion, hallucination and coma
Shivering sweating, hyperthermia, hypertension,
Myoclonus, tremor, hyperreflexia

25
Q

When should sertraline be reviewed?

A

2 weeks after prescribing or 1 week in patients < 30 years old or with increased suicidal risk

26
Q

Why should citalopram not be prescribed with NSAIDs?

A

Increased risk of GI bleed - co-prescribe PPI

Also with warfarin, heparin and DOACs

27
Q

How should paroxetine be stopped?

A

Gradually over 4 weeks.

Fluoxetine is an exception

28
Q

What food should be avioded in MAOI use?

A

MAOIs strop metabolism of tyramine so eating tyramine rich for can cause a hypertensive crisis - cheese, liver, OXO, marmite, red wine

29
Q

What do MAOIs interact with?

A

Insulin, opioids, TCA, SSRI, anti-epileptics

PSCYH PHARM (4 decks)

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