Antidepressants and Antipsychotics Flashcards
What are the three characteristic groups of serotonin syndrome?
Autonomic dysfunction
Neuromuscular hyperactivity
Altered mental state
What are the the symptoms if autonomic dysfunction in serotonin syndrome? (5)
Tachycardia BP changes Hyperthermia Shivering Diarrhoea
What are the the symptoms of an alter mental state in serotonin syndrome? (3)
Mania,
Confusion
Agitation
What are the the symptoms of neuromuscular hyperactivity in serotonin syndrome? (5)
Tremor Hyperreflexia Clonus Myoclonus Rigidity
How many weeks after starting an antidepressant therapy should a patient be followed up?
1-2 weeks
How long must you continue an antidepressant for until swapping or stopping due to lack off effect?
4 weeks (6 weeks for the elderly)
What receptors do tricyclic antidepressants block to cause their side effects
Histamine, muscarinic, alpha receptors and dopamine
What are the side effects of tricyclic antidepressants?
Sedation Constipation Sexual disfunction and breast changes Arrhythmia/ QT prolongation Dry mouth blurred vision Hypotension
How long does it take for antidepressants to work?
2 weeks
What SSRI are safest in patients with angina or had an MI?
Sertraline
What hypo can SSRIs cause?
Hyponaturaemia
What is the antidepressant of choice in anxiety disorder? (3)
Escitalopram
Paroxetine
Sertraline (unlicensed)
For a patient with chronic anxiety who has not responded to an SSRI what drugs can be offered next?
Venlafaxine
Duloxetine
What are the sedating tricyclic? (7)
Amitriptyline Clomiprame Dosulepin Mianserin Trazodone Trimipramine
What are the non sedating tricyclic? (3)
Imipramine
Lofeptamine
Nortriptyline
What tricyclic has the least side effects but is Hepatotoxicity?
Lofepramine
What tricyclic has more pronounced antimucarinic effects?
Imipramine
What conditions can tricyclic antidepressants worsen?
Dementia Narrow angle glaucoma Cardiac conditions Prostatism Urinary retention
What are the MOA’s?
Isocarboxazid
Phenelzine
Tranycypromine
Moclobemide
What MOA has the greatest risk of a hypertension crisis?
Tranylcypromine
What MOA are more hepatoxic?
Isocarboxazid
Phenelzine
What antidepressants are best for panic/ depression with atypical, hypochondriacal or hysterical features?
MOAs
How long must you wait to start an alternative antidepressant after trying (and now stopping) treatment with MOA. Also what are the exceptions?
2 weeks
But 3 weeks if you’re starting imipramine or clomipramine
If you are changing treatment and starting a MOA. What is the time period to wait when starting a tricyclic, SSRI or another MOA?
MOA - 2 weeks
Tricyclic - 7-14 days (3 weeks if pt was taking imipramine or clomipramine)
SSRI - 1 week (5 weeks if the pt was taking fluoxetine)
What are the side effects if tricyclic antidepressants?
Dry mouth, Constipation, Urinary retention, Blurred vision, Hypotension, Arrhythmia Breast changes and sexual dysfunction Convulsions Hallucinations Mania
What are the side effects of SSRIs?
GI upset Changes in appetite and weight changes Hyponaturaemia Sucidial ideal idealation Lower seizure threshold QT prolongation Bleeding risk Serotonin syndrome
What are the warnings for SSRIs?
Caution in patients who are right risk of peptic ulcers or seizures.
Suicide risk in young people
May need a dose reducation in the hepatoc impaired
What are the interactions with SSRIs?
MOA - increased serotonin
Aspirin or NSAIDS - increased bleeding risk
Drugs that prolong QT interval
Which SSRI has fewer interactions?
Citalopram and sertraline
What are side effects for SNRI?
GI upset ( dry mouth, nausea, changes in weight, diarrhoea or Constipation)
Neurological effects ( headaches, abnormal dreams, insomnia, confusion and Convulsions)
Hyponaturaemia
Serotonin syndrome
What are the warnings with SNRIs?
Elderly
Hepatic and renal impairment
Venlafaxibe should be used in caution due to Arrhythmias risk
Is mirtazapine more sedative at low or high doses?
Lower doses
What is the MoA of mirtazapine?
Antagonist of inhibitory pre synaptic alpha2 receptors which increase noradrenaline and serotonin activity
