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clinical skills in pharm prac > C3: antidepressants, anxiety & insomnia, schizophrenia > Flashcards

C3: antidepressants, anxiety & insomnia, schizophrenia Flashcards

1
Q

depression risk factors

A
  • fam hist / personal
  • female gender
  • major life changes, trauma, or stress
  • severe difficulties in childhood
  • certain physical illnesses & medications
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2
Q

depression signs & symptoms

A
  • depressed mood
  • significant loss of interest in activities
  • > 5 of SS in the same 2 week period
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3
Q

depression treatment

A
  • SSRI (first line)
  • NaSSa
  • TCA
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4
Q

selective serotonin reuptake inhibitor (SSRI) drugs

A
  • fluoxetine
  • escitalopram
  • fluvoxamine
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5
Q

why need OD for SSRI drugs?

A

increasing risk of insomnia (from fluvo -> esci -> fluo)

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6
Q

SSRI drug metabolism problem

A

fluoxetine = potent CYP2D6 inhibitor
fluvo…

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7
Q

tricyclic anti-depressants (TCA) drugs

A
  • amitriptyline
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8
Q

TCA side effects

A
  • anti-cholinergic SE e.g. dm
  • CNS SE e.g. confusion
  • CVS SE e.g. hypotension
    (indicated but not recommended for depression due to more SE)
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9
Q

noradrenergic & specific serotonergic anti-depressants (NaSSA) drugs

A
  • mirtazapine
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10
Q

mirtazapine SE (NaSSA)

A
  • GI: increased appetite, weight gain
  • helps patients who experience loss of appetite & weight loss
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11
Q

mirtazapine drug metabolism

A

CYP3A4 substrate
-> interact with CYP3A4 inhibitors (erythromycin, clarith, grapefruit juice) & inducer (rifampicin)

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12
Q

antidepressant counselling points

A
  • 2-4 weeks to see slight improvement & max effect seen in 6-8 weeks later
  • increased suicidal risk during tx initiation in patients <25 (more association with SSRI) = refer to doc asap
  • avoid drinking alcohol
  • interact with some over-the-counter med e.g. st john’s wort
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13
Q

SSRI specific CP

A

speak with doc if these SE continue or get worse
- difficulty sleeping
- mild nervousness, trembling or increased sweating

stop med & see healthcare prof immediately if experience
- fits (seizure)
- unexplained fever, confusion…
- talking… without control

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14
Q

TCA specific CP

A
  • tiredness or dw
  • consti
  • fast or irregular heartbeat
  • confusion
  • problems in urinating
  • blurred vision
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15
Q

NaSSA SPC

A
  • tiredness or dw
  • increased in appetite, weight gain
  • unexplained… (ss of serotonin syndrome)
  • unusual thoguhts…
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16
Q

antidepressants drug-drug interaction

A

= serotonin syndrome (symptoms include anxiety…)

most commonly associated = selegiline
commonly associated = SSRIs
occasionally associated = tramadol, dextromethorphan (high dose)

17
Q

anxiety & insomnia drugs

A

benzodiazepines (avoided in elderly)
non - benzo

short term use of not > 4 weeks

18
Q

non - benzo hypnotics CP: insomnia

A

SE: tired or dw
- stop med & inform healthcare prof immediately if experiencing
- memory loss (amnesia)
- abnormal thinking or changes in behaviour
- unusual excitement, irritability…
- unusual sleep-related activities

19
Q

benzodiazepines drugs

A
  • alprazolam
  • lorazepam
  • diazepam
20
Q

benzodiazepines SE & contra

A

decreased alertness, dz, dw, hypersomnia
limit to lowest possible dose for lowest possible time

21
Q

schizophrenia RF

A

genetic
preg & birth complications
cannabis use during young adulthood
smoking
childhood adversity

22
Q

schizophrenia treatment

A

atypical antipsychotic
- risperidone
- olanzapine
- clozapine

23
Q

risperidone: drug metabolism

A

major substrate for CYP2D6 = DDI with SSRIs which are inhibitors

24
Q

risperidone: SE

A

anticholinergic = dw
endocrine & metabolic = hyperprolactinemia, weight gain, increase glucose (hyperglycemia)
CNS
movement disorder: akathisia

25
Q

risperidone: serum level?

A

increase when given with SSRI (CYP2D6 inhibitor)
CYP3A4 can affect too

26
Q

olanzapine: dose

A

max 20mg/day

27
Q

olanzapine: SE

A

anticholinergic = dw
endocrine… = increase glucose or lipid level (may cause hyperglycemia or hyperlipidemia)
+ hyperprolactinemia, weight gain
… akathisia

28
Q

clozapine contra & SE

A

significant drug interactions (cyp3A4)
anticholinergic = dw, c, dm
endocrine = increase in appetite, weight gain, increase in glucose/lipid level
CNS = dz/orthostatic hypotension

29
Q

CP

A
  • med needs to be taken regularly
  • if stop taking clo for > 2 days, do not start back on same dose & ask doc
30
Q

+ CP

A
  • seizures (fits)
  • confusion, high fever…
  • muscle stiffness & spasms
  • uncontrollable movements
  • fast or irregular heartbeat…
31
Q

summary of drugs

A

d: SSRI (fluoxetine, escitalopram, fluvoxamine), TCA (amitriptyline), NaSSA (mirtazapine)
ia: non-ben (zolpidem, zopiclone), benzodiazepine hypnotics (alprazolam, lorazepam, diazepam)
s: atypical antipsychotic (risperidone, olanzapine, clozapine)

clinical skills in pharm prac (7 decks)

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