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Psychiatry > Antidepressants and mood stabilisers > Flashcards

Antidepressants and mood stabilisers Flashcards

1
Q

What is the usual first line tx for depression?

A

SSRIs

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2
Q

How long do antidepressants take to work?

A

2-6 weeks

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3
Q

Why should you start antidepressants at a low does and titrate up?

A

avoid initiation side effects

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4
Q

What is the treatment for psychotic depression?

A

antidepressants and antipsychotics

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5
Q

What should be looked for in younger patients starting on antidepressants?

A

can cause agitation leading to suicidal behaviour

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6
Q

What should be the dosing in the elderly?

A

lower- usually half normal adult dose

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7
Q

How long should treatment be continued after full resolution of symptoms after a first episode?

A

6-12 months

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8
Q

How long should treatment be continued after full resolution after a recurrence?

A

12-24 months

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9
Q

After a thrid epsidoe of depression how long should treatment be continued?

A

indefinitely

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10
Q

What is the mainstay of treatment with bipolar disorder?

A

mood stabilisers- lithium; anticonvulsants; antipsychotics

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11
Q

What drug is good for bipolar depression?

A

lamotrigine

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12
Q

What drug is good for mania/hypomania?

A

valproate

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13
Q

What drugs are good for both elevated and depressed states?

A

lithium and antipsychotics

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14
Q

When are antidepressants useful in bipolar?

A

short term for severe depressive episodes- generally avoid

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15
Q

What happens if antidepressants are used in bipolar?

A

cause switching to mania or mood instability; not effective as mood stabilisers

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16
Q

When are depot IM antipsychotics given?

A

if compliance is poor or patient unwilling to take oral

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17
Q

Give examples of SSRIs?

A

fluoxetine; sertraline; citalopram; escitalopram; paroxetine

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18
Q

What are the SE of SSRIs?

A

GI upset; anxiety; agitation; insomnia; sexual dysfunction; hyponatraemia

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19
Q

When should SSRIs be taken and why?

A

in the morning to reduce insomnia

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20
Q

What SSRI has the worst discontinuation symptoms?

A

paroxetine

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21
Q

What are the discontinuation SE of SSRI?

A

GI upset; anxiety; agitation; insomnia; myoclonus

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22
Q

What SSRI is safest in cardiac problems?

A

sertraline

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23
Q

What SSRI is safest in epilepsy?

A

citalopram

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24
Q

What cardiac SE is citalopram associated with?

A

long QTc

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25
Q

Why are tricyclic antidepressants not first line?

A

cardiac SE and dangerous in OD

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26
Q

What are the SE of TCAs?

A

sedation; confusion; dizziness; antimuscarinic effects; sexual dysfunction; cardiac arrthymias

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27
Q

What TCA has a lower cardiac risk?

A

lofepramine

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28
Q

When should TCAs be taken? Why?

A

at night as cause sedation

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29
Q

What patients should TCAs be avoided in?

A

cardiac problems; older people; suicidal intent

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30
Q

What type of antidepressant is mirtazapine?

A

noadrenergic and speciic serotonergic

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31
Q

When would mirtazapine be first line?

A

if patient has insomnia or poor appetite

32
Q

What can mirtazapine be used in combination with?

A

SSRIs or venlafaxine

33
Q

What are the SE of mirtazapine?

A

sedation; hunger/weight gain; constipation; dizziness; falls; dry mouth; unusual/vivid dreams; blood dyscrasias; seizures

34
Q

When should mirtazapine be taken and why?

A

at night due to sedation

35
Q

What happens if mirtazapine is taken with alcohol?

A

GI upset

36
Q

Give examples of SNRIs?

A

venlafaxine and dulozetine

37
Q

What is duloxetine used for other than depression?

A

neuropathic pain and bladder instability

38
Q

What are the SE of SNRIs?

A

same as SSRIs; HT; cardiac arrhythmias

39
Q

When should SNRIs be taken?

A

in the morning to avoid insomina

40
Q

Give examples of irreversible MAOIs?

A

phenelzine; tranylcypromine; isocarboxazid

41
Q

Give examples of reversible MAOIs?

A

moclobemide

42
Q

When are MAOIs used?

A

treatment resistant depression

43
Q

Why are MAOIs only used in tratment resistant depression?

A

dietary and medication restriction

44
Q

What are the monoamine neurotransmitters?

A

norepinephrin; serotonin; dopamine

45
Q

What are the SE of monoamine oxidase inhibitors?

A

postural hypotension; drowsiness; insomnia; nausea; tiredness; constipation; hypertensive crisis; hepatic impairment; seizures

46
Q

Why are there difficulties with compliance in MAOIs?

A

three times daily dosing

47
Q

What does the aminoacid tyramine do?

A

potent releaser of norepinephrine

48
Q

What are the symptoms of a hypertensive crisis?

A

HA; SOB; nosebleed; anxiety; arrhythmias; stroke; seizures; death

49
Q

What are high tyramine foods?

A

cheese; alcoholic drinks; dried meats; stock cubes; soy; tofu; pate; marmite; caffeine

50
Q

How is a hypertensive crisis treated?

A

phentolamine infusion

51
Q

Give an example of a serotonin antagonist/reuptake inhibitor?

A

trazodone

52
Q

What are the SE of trazodone?

A

GI upset; dizziness; sedation; tiredness; HA; hypotension; incoordination; oedema; blurred vision; priapism

53
Q

What is the most effective treatment for bipolar?

A

lithium

54
Q

What are the SE of lithium?

A

GI upset; dry mouth; feeling of weakness; sedation; weight gain; fine tremor; polydipsia; polyuria; ankle swelling; renal impairment; cardiac arrhythmias; hypothyroidism hypoparathyroidism

55
Q

When should lithium be taken?

A

at night due to sedation

56
Q

What are th drug interactions of lithium?

A

NSAIDs; ACEIs; ARBs; diuretics

57
Q

What tests should be done prior to commencing lithium?

A

U&Es; TFTs; ECG

58
Q

What tests should be done during initiation of lithium tx?

A

lithium level (12 hours after last dose) and U&Es every 5 days

59
Q

What should be done every 3 months on lithium?

A

lithium level and U&Es

60
Q

What should be checked every 6 months on lithium?

A

TFTs

61
Q

What are the warning signs of lithium toxicity?

A

GI upset; blurred vision; coarse tremor; ataxia; drowsiness

62
Q

What are the signso f severe lithium toxicity?

A

confusion; LOC; seizures; coma; death

63
Q

What are the causes of lithium toxicity?

A

increased dose; dehydration (physical illness; lack of fluid intake; alchohol; hot weather; exercise); drug interactions; reduction in salt intake

64
Q

What is the treatment for lithium toxicity?

A

stop lithium; IV fluids; monitor renal function

65
Q

What is the action sodium valproate?

A

blocks voltage sensitive sodium channels; increses levels of GABA

66
Q

What are the SE of sodium valproate?

A

sedation; tremor; dizziness; GI upset; tiredness; weight gain; hepatotoxicity; pancreatitis; increase in suicidal behaviour; tertogenic

67
Q

What should be chekced before starting sodium valproate?

A

platelets and LFTs

68
Q

What is the action of lamotrigine?

A

blocks voltage sensitive sodium channels

69
Q

What are the SE of lamotrigine?

A

rash; GI upset; insomnia; sedation; dizziness; ataxia; tiredness; SJS; blood dyscrasias

70
Q

How should lamotrigine be started to reduce risk of rash and SJS?

A

titrate slowly over 6 weeks

71
Q

What are the SE of atypical antipsychotics?

A

sedation; weight gain; metabolic syndrome; extrapyramidal symptoms; constipation; QTc prolongation; neuroleptic malignant syndrome

72
Q

What are the SE of aripiprazole?

A

insomnia; GI upset; agitation; akathisia; orthostatic hypotension; headache; constipation

73
Q

Give examples of atypical antipsychotics?

A

olanzapine; risperidone; quetiapine; amisulpride; paliperidone; clozapine; aripiprazole

74
Q

Give examples of typical antipsychotics?

A

haloperidol; chlorpromazine;

75
Q

What is the main action of typical antipsychotics?

A

dopamine 2 receptor blockade

76
Q

What are the SE of typical antipyschotics?

A

extrapyramidal symptoms; sedation; dizziness; QT prolongation; hyperprolacintaemia; neuoleptic malignant syndrome; tardive dyskinesia; akathisia

Psychiatry (20 decks)

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