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Year 3 - Psychiatry > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

Antidepressants increase what levels in the brain?

A

noradrenaline and serotonin which changes receptors in the brain

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2
Q

Typical delay before symptoms improve?

A

2-4 weeks

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3
Q

If not improvement is seen after 2 months.. what should you do?

A

switch to another antidepressant or augment with another agent

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4
Q

Different classes of antidepressants

A

Tricyclics (TCA’S)
monoamine oxidate inhibitors (MAOI’S)
Selective Serotonin Reuptake inhibitors (SSRI’S)
Novel antidepressants

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5
Q

Tricyclic side effects?

A

antihistaminic - weight gain, sleepy

anticholinergic - dry mouth, blurred vision

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6
Q

What do TCA’s increase?

A

serotonin, dopamine and noradrenaline

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7
Q

TCA’s can be lethal with?

A

overdose - week supply can cause death

- think if the patient is suicidal

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8
Q

TCA’s cause lengthening of?

A

QT interval

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9
Q

Tertiary TCA’s have what side chains?

A

amine

- cross react with other type of receptor

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10
Q

give examples of tertiary TCA’S (4)

A

Amitriptyline
Clomipramine
Doxepin
Imipramine

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11
Q

What are the active metabolites in Tertiary TCA’S?

A

Desipramine and Nortriptyline

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12
Q

Secdonary TCA’S block?

A

noradrenaline

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13
Q

MAOI’S work by?

A

preventing inactivation of amines such a norepinephrine, dopamine and serotonin = increased synaptic levels

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14
Q

MAOI’S are effective for?

A

resistant depression

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15
Q

Side effects of MAOI’S

A

orthostatic hypotension, weight gain, dry mouth, sedation, sexual dysfunction and sleep disturbance

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16
Q

When can a hypertensive crisis develop?

A

When MAOI’s are taken with tyramine- rich foods or sympathomimetics

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17
Q

MAOI’S require a restricted diet, what can’t you eat?

A

cheese
red wine
Fala beans
processed meats

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18
Q

When can serotonin syndrome develop?

A

taking MAOI’s with other medications that increase serotonin or have sympathomimetic actions (+ combo of antidepressants)

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19
Q

Serotonin syndrome symptoms can include?

A

abdo pain, diarrhoea, sweats, tachycardia, HTN, myoclonus, irritability, delirium

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20
Q

Serotonin syndrome can ultimately lead to?

A

hyperpyrexia, cardiovascular shock and death

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21
Q

how do SSRI’S work?

A

block presynaptic serotonin reuptake

22
Q

SSRI’S can treat both?

A

anxiety and depressive symptoms

23
Q

most common side effects of SSRI’S?

A

GI upset, sexual dysfunction!!!!, anxiety, insomnia, fatigue, dizziness

24
Q

The discontinuation syndrome from SSRI’S can? (4)

A

agitation, nauseam disequilibrium and dysphoria

25
Q

Activation syndrome is caused by?

How long does it last?

A

increase in serotonin

2-10 days

nauseas, increased anxiety, panic and agitation

26
Q

Discontinuation syndrome means that the SSRI’S have a?

A

shorter half life , consider switching them to fluoxetine

27
Q

Pro’s of sertraline?

A

very weak interactions with other drugs (P450)

  • short half life
  • less sedating
  • can start at 50mg and move up to 200mg etc
28
Q

Con’s of sertraline?

A
  • max absorption when stomach is full

- GI adverse drug reactions

29
Q

Fluoxetine (Prozac) is good for?

A
  • decreasing discontinuation syndrome
  • helping with non-compliance issues
  • can provide increased energy
  • can give 20mg tab to tier soon off SSRI’S when trying to prevent discontinuation syndrome
30
Q

Fluoxetine (Prozac) is not as good for?

A
  • patients with hepatic illness
  • may not be good for someone already on lots of medication
  • increased anxiety and insomnia initially
  • more likely to cause mania
31
Q

SNRI’S function?

A

inhibit both serotonin and noradrenergic reuptake but without the TCA’s side effects

32
Q

SNRI’S are used for?

A

depression

anxiety and neuropathic pain

33
Q

SNRI’S example?

A

Venlafaxine

Duloxetine

34
Q

Venlafaxine pros?

A

doesn’t interact with other drugs

- short half life so good for those with renal problems

35
Q

Venlafaxine cons? (6)

A
  • increases in BP - 10-15 mmHG
  • significant nausea
  • can cause bad discontinuation syndrome
  • taper recommended after 2 weeks of administration
  • QT prolongation
  • sexual dysfunction
36
Q

Duloxetine pros and cons?

A

can treat physical symptoms of depression

  • doesn’t increase BP
  • neuropathic pain treatment
  • anxiety and depression symptoms can be treated
  • CYP2D6 and CYP1A2 inhibitor
37
Q

Switching from SSRI to SNRI but patient has cardio symptoms - what do you prescribe?

A

Duloxetine

38
Q

Novel antidepressants example?

A

Mirtazapine (sedative medication)

39
Q

Cons of Mirtazapine?

A
  • increases serum cholesterol
  • weight gain
  • very sedating at lower doses
40
Q

Hyperphagia is?

A

eating too much

41
Q

hypersomnolence is?

A

excessive sleeping

42
Q

Examples of SSRI’S you would prescribe on first episode?

A

Citalopram, sertraline, fluoxetine

43
Q

drugs which can cause sedation and weight gain?

A

paroxetine and mirtrazapine

44
Q

Treatment resistance - start with what?

  • what else can be used
A

SSRI - SNRI - mirtazepine

  • Lithium
  • ECT
45
Q

treatment with atypical antipsychotics - give 3 examples?

A

Quetipaine , Olanzapine, Aripiprazole

46
Q

Prophylaxis - first episode, send episode and 3rd episode?

A

1st = 6 month -1 year

2nd - 2 years

3rd - life long

47
Q

Anxiety treatment?

A

Serotonergic anti-depressant agents

- SSRI’S, SNRI’S

48
Q

TCA for anxiety ?

A

Chlomipramine

49
Q

Anxiety with adjunctive treatment?

A

antipsychotics - risperidone or quetiapine

50
Q

Avoid symptomatic relief in anxiety - what drug?

A

diazepam

Year 3 - Psychiatry (7 decks)

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