Antidepressants & Anxiolytics/Hypnotics

Question 1

What are 5 examples of SSRIs?

Answer 1

• Fluoxetine
• Sertraline
• Citalopram
• Escitalopram
• Paroxetine

Question 2

What are 2 examples of SNRIs?

Answer 2

• Venlafaxine

- Duloxetine

Question 3

What are 2 examples of TCAs?

Answer 3

• Amitriptyline

- Imipramine

Question 4

What is an example of a MAOI?

Answer 4

Moclobemide (rarely used nowadays)

Question 5

What are 2 examples of other receptor blockers used as antidepressants?

Answer 5

• Mirtazapine

- Trazodone

Question 6

What are the 5 classes of antidepressants?

Answer 6

1) SSRIs
2) SNRIs
3) TCAs
4) MAOIs
5) Other receptor blockers

Question 7

How do SSRIs and SNRIs work?

Answer 7

Block the re-uptake of serotonin (and noradrenaline) which increases the levels of extracellular serotonin present in the synapse and magnifies its effects

Question 8

What is the first line medication for depression and anxiety?

Answer 8

SSRIs (and SNRIs) - generally very safe

Question 9

What is important to tell patients when they are started on an SSRI/SNRI?

Answer 9

Can increase suicidality in the first few weeks after initiation

Question 10

Which SSRI is best in young people?

Answer 10

Fluoxetine

Question 11

What are side effects of SSRIs/SNRIs?

Answer 11

• Nausea
• Hyperprolactinaemia
• GI upset
• Dry mouth
• Sexual dysfunction

Question 12

Why do you need a gradual tapered withdrawal over a few months with SSRIs/SNRIs?

Answer 12

To avoid discontinuation syndrome (negative physical and mental side effects)

Question 13

Which SSRI is first line in anxiety?

Answer 13

Sertraline

Question 14

How do TCAs work?

Answer 14

Act by blocking cholinergic receptors

Question 15

What are side effects of TCAs?

Answer 15

Anticholinergic

• Dry mouth
• Blurred vision
• Constipation
• Urinary retention
• Tachycardia
• Postural hypotension

Question 16

What can be another effect of some TCAs?

Answer 16

Sedative

Question 17

In which group of people should you avoid TCAs and why?

Answer 17

Elderly - side effects e.g. constipation can lead to delirium

Question 18

When is mirtazapine good to prescribe?

Answer 18

• Depression with insomnia - slightly sedative (due to antihistamine properties)
• Weight loss - can cause increased appetite and weight gain
• Elderly

Question 19

What is a benefit of mirtazapine vs TCAs?

Answer 19

Fewer anticholinergic side effects

Question 20

What are the 4 classes of drugs used as anxiolytics/hypnotics?

Answer 20

• Benzodiazepines
• Z-drugs
• Antidepressants
• Beta-blockers

Question 21

What are 4 examples of benzodiazepines?

Answer 21

• Lorazepam
• Diazepam (valium)
• Alprazolam (xanax)
• Temazepam

Question 22

What is the effect of benzodiazepines?

Answer 22

Sedative and anxiolytic effect

Question 23

What is the difference between different types of benzos?

Answer 23

Different half-lives and onset/offset times

Question 24

How do you prescribe benzos and why?

Answer 24

• Short term (5 days) prescriptions or PRN

- Can be v addictive (be aware of drug seeking behaviours)

Question 25

Which benzo has a fast onset and offset time and therefore it is used when?

Answer 25

Lorazepam - used in seizures and rapid tranquillisation (don’t want to be woozy for a long time)

Question 26

What is an example of a Z-drug and what does it help with?

Answer 26

Zopiclone - sleep

Question 27

Which beta-blocker is used in anxiety and why?

Answer 27

Propanolol - non-cardiogenic selective

Question 28

Why are beta blockers used in anxiety?

Answer 28

To treat physical symptoms - help to slow heart rate, reduce tremor

Question 29

What is an important side effect of benzos?

Answer 29

Reduce respiratory drive (respiratory depressant)

Question 30

What should you not do when on benzos bc could reduce respiratory drive further?

Answer 30

Take certain drugs and alcohol

Question 31

What is the antidote to benzos?

Answer 31

Flumazenil