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Psychiatry > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

4 classes of antidepressants

A

tricyclics, SSRIs, MAOIs and SNRIs

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2
Q

main problem with TCAs

A

many side effects

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3
Q

3 categories of TCA side effects

A

antihistaminic, anticholinergic and antiadrenergic

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4
Q

sedation and weight gain are what category of side effects

A

antihistaminic

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5
Q

a dry mouth, dry eyes, constipation, memory deficits and delirium are what category of side effet

A

anticholinergic

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6
Q

antiadrenergic side effects

A

orthostatic hypotension, sedation and sexual dysfunction

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7
Q

two causes of the sedation side effect in TCAs

A

antihistaminic and antiadrenergic

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8
Q

two types of TCAs

A

tertiary and secondary (secondaries are metabolite of tertiaries)

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9
Q

mechanism of tertiary TCAs

A

block reabsorption of serotonin

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10
Q

mechanism of secondary TCAs

A

block noradrenaline reabsorption

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11
Q

what type of drug is amitryptyline

A

a tertiary TCA

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12
Q

what type of drug is desipramine

A

a secondary TCA

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13
Q

which class of drugs affects the QT interval

A

TCAs - lengthen QT interval

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14
Q

which type of TCA has more severe side effects

A

tertiary

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15
Q

5 side effects of TCAs

A

weight gain, sedation, orthostatic hypotension, constipation, dry mouth

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16
Q

what does MAOI stand for

A

monoamine oxidase inhibitor

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17
Q

main indication for MAOI use in depression

A

treatment resistant depression

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18
Q

mechanism of MAOIs

A

binds to monoamine oxidase preventing its inactivation of the neurotransmitters NA, dopamine and serotonin

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19
Q

what type of drugs are isocarboxazid and selegiline

A

MAOIs

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20
Q

2 main side effects to look out for in MAOIs

A

cheese reaction and serotonin syndrom

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21
Q

what drugs do the “cheese reaction” occur in and what is it

A

MAOIs - a hypertensive crisis occuring when you eat tyramine rich foods like cheese or sympathomimetics

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22
Q

side effects of MAOIs aside from cheese reaction

A 
serotonin syndrome
weight gain
dry mouth
sedation
sexual dysfunction
sleep distrurbance
orthostatic hypotension
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23
Q

what happens in serotonic syndrome

A

drug that increases serotonin –> dangerously high serotonin –> abdominal pain, diarrhoea, sweats, tachycardia, HTN, myoclonus, irritability and delirium –> in severe CV shock and death

24
Q

how to prevent serotonin syndrome

A

wait 2 weeks before switching SSRI to MAOI or 5 weeks for fluoxetine to MAOI

25
Q

what does SSRI stand for

A

selective serotonin reuptake inhibitor

26
Q

mechanism of SSRIs

A

block presynaptic serotonin reuptake

27
Q

what is the most commonly prescribed type of antidepressant

A

SSRI

28
Q

paroxetine, sertaline and fluoxetine, citalopram, escitalopram and fluvoxamine are what type of antidepressant

A

SSRI

29
Q

what is activation syndrome

A

restlessness, agitation and anxiety during inital weeks of treatment, especially in under 25s

30
Q

what drug type do you get activation syndrome and discontinuation syndrome in

A

SSRIs

31
Q

what is discontinuation syndrome

A

agitation, nausea and dysphoria when you stop SSRIs. Not withdrawal because it’s not a craving for the drug

32
Q

which drug classes have the most risk of sexual dysfunction

A

SSRIs and SNRIs - in >30%

33
Q

which 2 SSRIs lengthens QT interval

A

citalopram and escitalopram (the prams)

34
Q

relationship between half-life and build-up of a drug

A

Longer half-life increases build-up. As does an active metabolite

35
Q

which SSRI has a long half-life making is less likely to induce discontinuation syndrome

A

fluoxetine

36
Q

what is the first line type of antidepressants

A

SSRI

37
Q

general side effects from SSRIs

A

gi upset, increased risk of gi bleed and agitation/anxiety

38
Q

fluoxetine and paroxetine has a high propensity for _______

A

DDIs

39
Q

given the gi risks of SSRIs what drug should be prescribed along side it if the patient takes NSAIDs

A

PPI

40
Q

mechanism of SNRIs

A

inhibit serotonin and NA reuptake

41
Q

main difference between TCAs and SNRIs

A

SNRIs don’t have the anticholinergic, antiadrenergic or antihistaminic side effects of TCAs

42
Q

two SNRIs

A

venlafaxine and duloxetine

43
Q

indications of SNRIs

A

anxiety, depression and neurpathic pain

44
Q

side effects of venlafaxine

A 
lengthens QT interval
raises diastolic BP
significan nausea
sexual dysfunction
bad discontinuation syndrome
45
Q

good things about venlafaxine

A

short half-life and fast renal clearance making it good in elderly
low DDIs

46
Q

which SNRI raises diastolic BP more, venlafaxine or duloxetine

A

venlafaxine

47
Q

pros of duloxetine

A

good for physical symptoms of depression

less effect on diastolic BP

48
Q

how much does mirtazapine raise cholesterol by

A

~20%

49
Q

what type of side effects make mirtazapine sedating and cause weight gain

A

antihistaminic

50
Q

which drug is also a 2nd line in ADHD

A

buproprion

51
Q

buproprion has an increased risk of ______ and can induce ______ and ______

A

seizures, anxiety and psychosis

52
Q

for a treatment naive patient what drug type should you start them on

A

an SSRI

53
Q

how to treat treatment resistant depression

A

combination of antidepressants
adjunct with lithium
adjunct with atypical antipsychotic
ECT

54
Q

how long do you continue antidepressant treatment for after a 1st episode

A

6-12 months

55
Q

how long do you continue antidepressant treatment after a 2nd episode

A

2 years

56
Q

how long do you continue antidepressant treatment after a 3rd episode

A

consider life-long

Psychiatry (7 decks)

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