C3: antidepressants, anxiety & insomnia, schizophrenia Flashcards
depression risk factors
- fam hist / personal
- female gender
- major life changes, trauma, or stress
- severe difficulties in childhood
- certain physical illnesses & medications
depression signs & symptoms
- depressed mood
- significant loss of interest in activities
- > 5 of SS in the same 2 week period
depression treatment
- SSRI (first line)
- NaSSa
- TCA
selective serotonin reuptake inhibitor (SSRI) drugs
- fluoxetine
- escitalopram
- fluvoxamine
why need OD for SSRI drugs?
increasing risk of insomnia (from fluvo -> esci -> fluo)
SSRI drug metabolism problem
fluoxetine = potent CYP2D6 inhibitor
fluvo…
tricyclic anti-depressants (TCA) drugs
- amitriptyline
TCA side effects
- 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)
noradrenergic & specific serotonergic anti-depressants (NaSSA) drugs
- mirtazapine
mirtazapine SE (NaSSA)
- GI: increased appetite, weight gain
- helps patients who experience loss of appetite & weight loss
mirtazapine drug metabolism
CYP3A4 substrate
-> interact with CYP3A4 inhibitors (erythromycin, clarith, grapefruit juice) & inducer (rifampicin)
antidepressant counselling points
- 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
SSRI specific CP
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
TCA specific CP
- tiredness or dw
- consti
- fast or irregular heartbeat
- confusion
- problems in urinating
- blurred vision
NaSSA SPC
- tiredness or dw
- increased in appetite, weight gain
- unexplained… (ss of serotonin syndrome)
- unusual thoguhts…
antidepressants drug-drug interaction
= serotonin syndrome (symptoms include anxiety…)
most commonly associated = selegiline
commonly associated = SSRIs
occasionally associated = tramadol, dextromethorphan (high dose)
anxiety & insomnia drugs
benzodiazepines (avoided in elderly)
non - benzo
short term use of not > 4 weeks
non - benzo hypnotics CP: insomnia
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
benzodiazepines drugs
- alprazolam
- lorazepam
- diazepam
benzodiazepines SE & contra
decreased alertness, dz, dw, hypersomnia
limit to lowest possible dose for lowest possible time
schizophrenia RF
genetic
preg & birth complications
cannabis use during young adulthood
smoking
childhood adversity
schizophrenia treatment
atypical antipsychotic
- risperidone
- olanzapine
- clozapine
risperidone: drug metabolism
major substrate for CYP2D6 = DDI with SSRIs which are inhibitors
risperidone: SE
anticholinergic = dw
endocrine & metabolic = hyperprolactinemia, weight gain, increase glucose (hyperglycemia)
CNS
movement disorder: akathisia
risperidone: serum level?
increase when given with SSRI (CYP2D6 inhibitor)
CYP3A4 can affect too
olanzapine: dose
max 20mg/day
olanzapine: SE
anticholinergic = dw
endocrine… = increase glucose or lipid level (may cause hyperglycemia or hyperlipidemia)
+ hyperprolactinemia, weight gain
… akathisia
clozapine contra & SE
significant drug interactions (cyp3A4)
anticholinergic = dw, c, dm
endocrine = increase in appetite, weight gain, increase in glucose/lipid level
CNS = dz/orthostatic hypotension
CP
- med needs to be taken regularly
- if stop taking clo for > 2 days, do not start back on same dose & ask doc
+ CP
- seizures (fits)
- confusion, high fever…
- muscle stiffness & spasms
- uncontrollable movements
- fast or irregular heartbeat…
summary of drugs
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)
