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Pre Reg Pharmacy > Antidepressants and Antipsychotics > Flashcards

Antidepressants and Antipsychotics Flashcards

1
Q

What are the three characteristic groups of serotonin syndrome?

A

Autonomic dysfunction
Neuromuscular hyperactivity
Altered mental state

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2
Q

What are the the symptoms if autonomic dysfunction in serotonin syndrome? (5)

A 
Tachycardia
BP changes 
Hyperthermia 
Shivering 
Diarrhoea
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3
Q

What are the the symptoms of an alter mental state in serotonin syndrome? (3)

A

Mania,
Confusion
Agitation

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4
Q

What are the the symptoms of neuromuscular hyperactivity in serotonin syndrome? (5)

A 
Tremor 
Hyperreflexia
Clonus
Myoclonus
Rigidity
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5
Q

How many weeks after starting an antidepressant therapy should a patient be followed up?

A

1-2 weeks

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6
Q

How long must you continue an antidepressant for until swapping or stopping due to lack off effect?

A

4 weeks (6 weeks for the elderly)

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7
Q

What receptors do tricyclic antidepressants block to cause their side effects

A

Histamine, muscarinic, alpha receptors and dopamine

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8
Q

What are the side effects of tricyclic antidepressants?

A 
Sedation 
Constipation 
Sexual disfunction and breast changes 
Arrhythmia/ QT prolongation 
Dry mouth
blurred vision 
Hypotension
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9
Q

How long does it take for antidepressants to work?

A

2 weeks

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10
Q

What SSRI are safest in patients with angina or had an MI?

A

Sertraline

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11
Q

What hypo can SSRIs cause?

A

Hyponaturaemia

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12
Q

What is the antidepressant of choice in anxiety disorder? (3)

A

Escitalopram
Paroxetine
Sertraline (unlicensed)

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13
Q

For a patient with chronic anxiety who has not responded to an SSRI what drugs can be offered next?

A

Venlafaxine

Duloxetine

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14
Q

What are the sedating tricyclic? (7)

A 
Amitriptyline
Clomiprame 
Dosulepin
Mianserin 
Trazodone
Trimipramine
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15
Q

What are the non sedating tricyclic? (3)

A

Imipramine
Lofeptamine
Nortriptyline

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16
Q

What tricyclic has the least side effects but is Hepatotoxicity?

A

Lofepramine

17
Q

What tricyclic has more pronounced antimucarinic effects?

A

Imipramine

18
Q

What conditions can tricyclic antidepressants worsen?

A 
Dementia 
Narrow angle glaucoma 
Cardiac conditions 
Prostatism 
Urinary retention
19
Q

What are the MOA’s?

A

Isocarboxazid
Phenelzine
Tranycypromine
Moclobemide

20
Q

What MOA has the greatest risk of a hypertension crisis?

A

Tranylcypromine

21
Q

What MOA are more hepatoxic?

A

Isocarboxazid

Phenelzine

22
Q

What antidepressants are best for panic/ depression with atypical, hypochondriacal or hysterical features?

A

MOAs

23
Q

How long must you wait to start an alternative antidepressant after trying (and now stopping) treatment with MOA. Also what are the exceptions?

A

2 weeks

But 3 weeks if you’re starting imipramine or clomipramine

24
Q

If you are changing treatment and starting a MOA. What is the time period to wait when starting a tricyclic, SSRI or another MOA?

A

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)

25
Q

What are the side effects if tricyclic antidepressants?

A 
Dry mouth, 
Constipation, 
Urinary retention,
Blurred vision,
Hypotension,
Arrhythmia
Breast changes and sexual dysfunction 
Convulsions 
Hallucinations 
Mania
26
Q

What are the side effects of SSRIs?

A 
GI upset
Changes in appetite and weight changes 
Hyponaturaemia 
Sucidial ideal idealation 
Lower seizure threshold 
QT prolongation 
Bleeding risk
Serotonin syndrome
27
Q

What are the warnings for SSRIs?

A

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

28
Q

What are the interactions with SSRIs?

A

MOA - increased serotonin
Aspirin or NSAIDS - increased bleeding risk
Drugs that prolong QT interval

29
Q

Which SSRI has fewer interactions?

A

Citalopram and sertraline

30
Q

What are side effects for SNRI?

A

GI upset ( dry mouth, nausea, changes in weight, diarrhoea or Constipation)

Neurological effects ( headaches, abnormal dreams, insomnia, confusion and Convulsions)

Hyponaturaemia

Serotonin syndrome

31
Q

What are the warnings with SNRIs?

A

Elderly
Hepatic and renal impairment
Venlafaxibe should be used in caution due to Arrhythmias risk

32
Q

Is mirtazapine more sedative at low or high doses?

A

Lower doses

33
Q

What is the MoA of mirtazapine?

A

Antagonist of inhibitory pre synaptic alpha2 receptors which increase noradrenaline and serotonin activity

Pre Reg Pharmacy (9 decks)

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