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Psychiatry > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

5 groups?

A

TCAs, MAOIs, SSRIs, SNRIs, Novel therapies

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2
Q

name 4 indications for ADs?

A

depression, organic mood disorder, schizoaffective disorder, anxiety disorders

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3
Q

name 4 anxiety disorders?

A

PTSD, OCD, panic, social phobia

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4
Q

neurotransmitters in ADs?

A

serotonin and noradrenaline

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5
Q

action of ADs?

A

increase serotonin and noradrenaline, changing receptors in brain

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6
Q

3 criteria to decide which AD to choose as 1st line Tx?

A

past hx of response, side effects, other medical conditions

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7
Q

how long for ADs to take action?

A

2-4 weeks

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8
Q

2 types of TCA?

A

tertiary and 2y

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9
Q

action of TCAs?

A

increases serotonin, dopamine and noradrenaline

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10
Q

unacceptable side effects for TCAs?

A

antihistaminic, anticholinergic

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11
Q

toxicity of TCAs?

A

lethal in OD and causes QT lengthening @ therapeutic level

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12
Q

what are the 2 active metabolites in 3y TCAs and what are they an example of?

A

nortriptyline and desipramine - both 2y TCAs

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13
Q

action of 2y TCAs?

A

blocks noradrenaline

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14
Q

give 2 examples of 3y TCAs?

A

imipramine, amitriptyline

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15
Q

why do 3y TCAs have side effects?

A

amine side chains cross-react with other receptors

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16
Q

action of MAOIs?

A

bind irreversibly to monoamine oxidase - preventing inactivation of amines - therefore increases synaptic levels

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17
Q

when can MAOIs be particularly useful?

A

resistant depression

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18
Q

4 SEs of MAOIs?

A

orthostatic hypotension, weight gain, dry mouth, sedation

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19
Q

what is the cheese reaction?

A

hypertensive crisis due to taking MAOIs with tyramine-rich foods

20
Q

which foods are associated with increased risk of cheese reaction?

A

cheese (duh), red wine, flava beans, processed meats

21
Q

what is serotonin syndrome a result of?

A

MAOIs side effect - when taking MAOIs with other ADs (increases serotonin)

22
Q

give 4 sx of serotonin syndrome?

A

abdo pain, diarrhoea, sweats, tachycardia

23
Q

action of SSRIs?

A

blocks presynaptic serotonin reuptake

24
Q

indication - SSRIs?

A

anxiety and depressive symptoms

25
Q

name 4 SEs of SSRIs?

A

GI upset, sexual dysfunction, anxiety, restelessness

26
Q

define and describe sx of discontinuation syndrome?

A

when take pt off of ADs too quickly - agitation/ nausea, dysphoria/ unbalanced

27
Q

what should you do if pt presents with discontinuation syndrome?

A

switch AD to fluoxetine (longer 1/2 life)

28
Q

what is activation syndrome?

A

when pt starts AD and has anxiety/ nausea/ panic/ agitation for 2-10 days - caused by increased serotonin

29
Q

1st line SSRI (generally)?

A

sertraline

30
Q

when should sertraline be taken?

A

on full stomach (for full absorption)

31
Q

name 2 SSRIs?

A

fluoxetine and sertraline

32
Q

name 2 advantages of fluoxetine over sertraline?

A

good for patients with non-compliance, prevents discontinuation syndrome

33
Q

name 2 disadvantages of fluoxetine?

A

P450 interactions increased, can induce mania

34
Q

action of SNRIs?

A

inhibits serotonin and noradrenergic reuptake

35
Q

indication for SNRIs?

A

depression, anxiety, neuropathic pain

36
Q

name 2 SNRIs?

A

venlafaxine & duloxetine

37
Q

which pts is venlafaxine good for?

A

geriatric

38
Q

name 3 disadvantages to venlafaxine?

A

increases diastolic BP, discontinuation syndrome , QT prolongation

39
Q

which drug is good for treating physical sx of depression?

A

duloxetine

40
Q

disadvantage of duloxetine?

A

high drop out rates

41
Q

name a novel AD?

A

mirtazapine

42
Q

which type of drug is mirtazapine?

A

5HT2 and 5HT3 receptor agonist

43
Q

name 3 disadvantages to Mirtazapine?

A

weight gain, increases cholesterol, sedating

44
Q

what should we do if someone is treatment resistant?

A

1 - combine different ADs - SSRI/SNRI + mirtazapine
2 - augment with lithium
3 - augment with atypical antipsychotic - e.g. olanzapine
4 - ECT

45
Q

how long should ADs be taken for to prevent relapse?

A

at least 6 months

Psychiatry (8 decks)

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