Antidepressants

Question 1

5 groups?

Answer 1

TCAs, MAOIs, SSRIs, SNRIs, Novel therapies

Question 2

name 4 indications for ADs?

Answer 2

depression, organic mood disorder, schizoaffective disorder, anxiety disorders

Question 3

name 4 anxiety disorders?

Answer 3

PTSD, OCD, panic, social phobia

Question 4

neurotransmitters in ADs?

Answer 4

serotonin and noradrenaline

Question 5

action of ADs?

Answer 5

increase serotonin and noradrenaline, changing receptors in brain

Question 6

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

Answer 6

past hx of response, side effects, other medical conditions

Question 7

how long for ADs to take action?

Answer 7

2-4 weeks

Question 8

2 types of TCA?

Answer 8

tertiary and 2y

Question 9

action of TCAs?

Answer 9

increases serotonin, dopamine and noradrenaline

Question 10

unacceptable side effects for TCAs?

Answer 10

antihistaminic, anticholinergic

Question 11

toxicity of TCAs?

Answer 11

lethal in OD and causes QT lengthening @ therapeutic level

Question 12

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

Answer 12

nortriptyline and desipramine - both 2y TCAs

Question 13

action of 2y TCAs?

Answer 13

blocks noradrenaline

Question 14

give 2 examples of 3y TCAs?

Answer 14

imipramine, amitriptyline

Question 15

why do 3y TCAs have side effects?

Answer 15

amine side chains cross-react with other receptors

Question 16

action of MAOIs?

Answer 16

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

Question 17

when can MAOIs be particularly useful?

Answer 17

resistant depression

Question 18

4 SEs of MAOIs?

Answer 18

orthostatic hypotension, weight gain, dry mouth, sedation

Question 19

what is the cheese reaction?

Answer 19

hypertensive crisis due to taking MAOIs with tyramine-rich foods

Question 20

which foods are associated with increased risk of cheese reaction?

Answer 20

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

Question 21

what is serotonin syndrome a result of?

Answer 21

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

Question 22

give 4 sx of serotonin syndrome?

Answer 22

abdo pain, diarrhoea, sweats, tachycardia

Question 23

action of SSRIs?

Answer 23

blocks presynaptic serotonin reuptake

Question 24

indication - SSRIs?

Answer 24

anxiety and depressive symptoms

Question 25

name 4 SEs of SSRIs?

Answer 25

GI upset, sexual dysfunction, anxiety, restelessness

Question 26

define and describe sx of discontinuation syndrome?

Answer 26

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

Question 27

what should you do if pt presents with discontinuation syndrome?

Answer 27

switch AD to fluoxetine (longer 1/2 life)

Question 28

what is activation syndrome?

Answer 28

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

Question 29

1st line SSRI (generally)?

Answer 29

sertraline

Question 30

when should sertraline be taken?

Answer 30

on full stomach (for full absorption)

Question 31

name 2 SSRIs?

Answer 31

fluoxetine and sertraline

Question 32

name 2 advantages of fluoxetine over sertraline?

Answer 32

good for patients with non-compliance, prevents discontinuation syndrome

Question 33

name 2 disadvantages of fluoxetine?

Answer 33

P450 interactions increased, can induce mania

Question 34

action of SNRIs?

Answer 34

inhibits serotonin and noradrenergic reuptake

Question 35

indication for SNRIs?

Answer 35

depression, anxiety, neuropathic pain

Question 36

name 2 SNRIs?

Answer 36

venlafaxine & duloxetine

Question 37

which pts is venlafaxine good for?

Answer 37

geriatric

Question 38

name 3 disadvantages to venlafaxine?

Answer 38

increases diastolic BP, discontinuation syndrome , QT prolongation

Question 39

which drug is good for treating physical sx of depression?

Answer 39

duloxetine

Question 40

disadvantage of duloxetine?

Answer 40

high drop out rates

Question 41

name a novel AD?

Answer 41

mirtazapine

Question 42

which type of drug is mirtazapine?

Answer 42

5HT2 and 5HT3 receptor agonist

Question 43

name 3 disadvantages to Mirtazapine?

Answer 43

weight gain, increases cholesterol, sedating

Question 44

what should we do if someone is treatment resistant?

Answer 44

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

Question 45

how long should ADs be taken for to prevent relapse?

Answer 45

at least 6 months