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Chapter 4 > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

When are antidepressants used?

A

moderate-severe depression

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2
Q

What’s it used in combination with?

A

psychological therapy (CBT) + drug therapy

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3
Q

What are three main types of antidepressants? Name one property of each.

A 
Tricyclic antidepressants (TCA) - can be toxic in overdose 
Selective serotonin re-uptake inhibitors (SSRIs) - first line 
Monoamine oxidase inhibitors (MAOIs) - interact with different with foods and drugs
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4
Q

What else can be used in mild depression?

A

herbal therapy ex. St Johns Wort - not prescribed

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5
Q

What’s the main problem of St Johns Wort?

A

enzyme inducer - it interacts with a lot of different medication - must ask someone over the counter, are you on any medication? or you on any herbal medication?

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6
Q

Which conditions are TCA’s cautioned in?

A

patients with cardiovascular disease and those that have anti-muscarinic effects for example urinary retention - thats due to the S/E of TCA’s which are: muscarinic effects but also dizziness and anxiety

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7
Q

What are the withdrawal symptoms of TCA’s?

A

flu-like symptoms
insomnia
vivid dreams

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8
Q

Which TCA drugs are particularly dangerous in overdose?

A

Dosulepin

Amitriptylline

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9
Q

Which two main groups can TCA’s be classified in?

A
  1. Sedative properties (amitriptylline, dosulepin, doxepin, trazodone)
  2. Less sedative properties
    (Nortriptylline, imipramine, lofepramine (lower incidence of S/E and less dangerous in overdose))
    Not recommended for children
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10
Q

What dose MAOI’s react with?

A

Alcohol, tyramine rich foods (mature cheese, smoked meats or fish, overripe fruit, beans)

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11
Q

What are the main S/E of MAOI’s?

A

vivid dreams and irritability

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12
Q

If an antidepressant does not work for a pt what are the next steps you would take? Give an example.

A

they cant be changed straight away to another antidepressant
there needs to be a waiting period

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13
Q

Explain how long you would wait when switching between SSRI’s to MAOI’s to TCA’s etc?

A

If a patient is on an SSRI and it doesn’t work, and the pt is switched to a MAOI, they would usually have to wait ONE week then they’ll be started on the MAOI.

If a pt is on TCA, and they’re being switched to a MAOI - must wait 2 WEEKS!

If a patient is on a MAOI being switched to something else - they’d have to wait 2 weeks
but if its clomipramine and imipramine (must wait 3 weeks)

with fluoxetine - you’d wait 5 weeks and with Sertraline you must wait 2 weeks.

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14
Q

What are examples of SSRI’s?

A

Fluoxetine, paroxetine, citalopram, escitalopram

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15
Q

Which SSRI can be used in under 18 years olds?

A

Fluoxetine - must be carefully monitored in these patients

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16
Q

What have SSRI’s shown to cause?

A

suicidal thoughts and behaviours

17
Q

Which drug has a higher risk of withdrawal? Why?

A

Paroxetine because it has a short half-life

18
Q

What is an SNRI? Which SNRI has a higher risk of withdrawal and why?

A

Serotonin-norepinephrine reuptake inhibitor

Venlafaxine - short half life

19
Q

What conditions are SSRI’s cautioned in?

A

Diabetics
Epilepsy
those that have a history of mania

20
Q

What are general S/E of SSRI’s?

A

antimuscarinic effects

cardio toxic effects

21
Q

What is serotonin syndrome?

A

this is when a patient takes an NSAID and an SSRI

22
Q

What are symptoms of serotonin syndrome?

A 
Agitation 
Shivering 
Confusion
Diarrhoea 
Sweating
23
Q

If a pt is on an SSRI, and it doesn’t help them? What would the prescriber decide to do?

A
  • increase the dose
  • change them to a different SSRI
  • or change them to Mirtazapine which is taken at night
24
Q

Which drugs don’t fit into the three classes of SSRI’s?

A
  1. Venlafaxine (not sedative and no muscarinic effects but high risk of withdrawal)
  2. Duloxetine (used in major depressive episodes)
  3. Mirtazapine - fewer muscarinic side effects but does cause sedation
  4. Flupentixol
  5. Agomelatine
  6. Reboxetine

Chapter 4 (13 decks)

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