Antidepressants

Question 1

SSRIs:

What does it stand for?

Name some? - F, C, S, P

What is the only one licensed in children?

What is the most cost-effective?

MOA?

How long does it take to work?

Answer 1

Selective Serotonin Reuptake Inhibitors

Fluoxetine, citalopram, sertraline, paroxetine

Fluoxetine

Sertraline

MOA?

How long does it take to work?

Question 2

SSRIs:

Side effects:

• GI - 3
• Sex - 2

Why is paroxetine not recommended?

What monitoring does citalopram need and why?

Advantages of using these

Interactions:
- Which 2 SSRIs can be used for patients with physical health problems requiring multiple medications?

What is a major complication of SSRI’s?

Answer 2

Nausea and vomiting, dyspepsia, GI bleeds

Low libido, erectile dysfunction

Had withdrawal syndrome on cessation (e.g. N+V, headache)

ECG monitoring due to it causing long QT syndrome

Less sedating
No anticholinergic side effects

Citalopram
Sertraline

Serotonin syndrome

Question 3

SNRIs:

What does it stand for?

2 names - V and D?

Side effects:

• Why is it bad in overdose?
• What may it cause at high doses which will also require monitoring?
• Sex

Advantage of SNRI?

Answer 3

Serotonin and noradrenaline reuptake inhibitor

Venlafaxine - noradrenaline effects only comes at higher doses
Duloxetine

Toxic in overdose
HTN - due to more adrenaline being available - BP monitoring
Sexual dysfunction

Non-sedating

Question 4

NaSSAs:

What does it stand for?

Name of the only drug? - M

Side effects due to anti-histamine effects? - 2

Answer 4

Noradrenergic and specific serotonergic antidepressants

Mirtazapine

Weight gain
Sedation which is worse at LOWER doses

Question 5

TCAs:

What does it stand for?

What is the main one that you should know? - A

Name of drugs - L, C, D

How long does it take to work?

MOA?

Answer 5

Tricyclic Antidepressants

Amitriptyline****

Lofepramine
Clomipramine
Dosulepin

2 wks

Blocks noradrenaline and 5-HT reuptake

Question 6

TCAs:

Contraindications:

• Type of patient
• Age
• Why is it not given to suicidal patients?
• Why is it not given to drivers?

Side effects:

• Anticholinergic effects?
• Antihistamine effects?

Answer 6

Cardiac patients

Elderly or young

Easy to overdose on

Causes sedation 
/////////

Dry mouth, blurred vision, constipation, retention, cognitive impairment

Sedation and weight gain

Question 7

MAOIs:

What does it stand for?

Example - P

MOA

Answer 7

Monoamine oxidase inhibitors

Phenelzine

Increases availability of monoamines (serotonin and noradrenaline) by preventing break down

Question 8

Serotonin Syndrome:

What is it?

What drugs can cause it?

The clinical triad is:

Neuromuscular excitabiiity
Autonomic dysfunction
Altered mental status

What are some general systemic effects? - 2

CV effects? - 2

GI - 3?

Psych - 2

Neuro - list?

Answer 8

A life-threatening condition caused by serotonergic overactivity

SSRI’s
MAOI’s
SNRI’s
TCA’s

Hyperthermia
Excessive sweating - diaphoresis

HTN
Tachycardia

N&V + Diarrhoea

Delirium
Psychomotor agitation

Hypertonia 
Hyperreflexia 
Myoclonus 
Tremor 
Ataxia etc.

Question 9

Serotonin Syndrome:

What are some differentials?

Rx is obviously discontinuing drugs

What needs to be done knowing the effects?

Answer 9

Meningitis
Encephalitis

Antihypertensives - HTN
Fluid replacement - N&V, Diarrhoea
Benzos - for sedation - they are agitated