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CNSVS1 > Central Nerous System - Depression > Flashcards

Central Nerous System - Depression Flashcards

1
Q

What is depression?

A

less serotonin, dopamine, norephedrine, atosynaptic cleft

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2
Q

mild depression tx

A

CBT

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3
Q

moderate to severe depression tx

A

antidepressants

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4
Q

how long should antidepressants be used to be seen as ineffective?

elderly

A

4WK and 6WK for elderly
-pt may feel worse in 1st 1-2WKs

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5
Q

How long should antidepressants be taken after remission

-normal, elderly, recurrent

A

-normal = 6MT
-elderly = 1YR
-recurrent = 2YR

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6
Q

What is 1st line tx of depression

A

SSRI

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7
Q

What is done if SSRI does not work as a first line tx?

A

-increase dose
-change SSRI
-change to mitazepine
-change to MAO-I (specialist)
-if severe TCA or venlafaxine

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8
Q

If changes to SSRI doesn’t work what do you add?

A

Add another class - lithium or antipyschotics

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9
Q

tx of severe refractory depression?

A

electroconvulsive therapy

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10
Q

What are the s/e of SSRIs?

A

-GI disturbances (D+V)
-appetite/weight gain
-sexual dysfunction
-risk of bleeding
-insomnia (morning dose)
-QT prolongation (escitalopram + citalopram)

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11
Q

What are SSRI interactions?

A

-CYP inhibitors -> avoid grapefruit inc plasma conc
-CYP inducers -> lower effectivness
-drugs that cause QT prolongation (amiodarone, sotalol, quinolones)
-drugs inc risk of bleed
-hyponatraemia (carbamazepine + diuretics)
-serotonin syndrome

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12
Q

what is serotonin syndrome?

A

life-threatening drug-induced condition caused by too much serotonin in synapses of the brain

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13
Q

what are the three main symptoms of serotonin sydrome?

A

-cognitive effects
-autonomic effects
-neuromuscular excitation

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14
Q

serotonin sydrome

What are the signs of cognitive effects?

A

headahces
agitation
hypomania
coma
confusion

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15
Q

serotonin sydrome

What are the signs of autonomic effects?

A

sweating
hyperthermia
nausea
diarrhoea

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16
Q

serotonin sydrome

what are the signs of neuromuscular excitation

A

myclonus
tremor
teeth grinding

17
Q

which drugs cause serotonin sydrome?

A

SSRI
TCA
MAO-I
triptans
tramadol
lithium

18
Q

sedating better for agitated + anxious pt

Which tricyclic antidepressants are sedating?

A

CADT
-amitriptyline, clomipramine, dosulepim, trazadone

19
Q

less sedating = better for withdrawn / apathetic pt

Which tricyclic antidepressants are less sedating?

A

NIL
nortriptyline
imipramine lofepramine

20
Q

which two TCA are dangerous and can cause overdose

A

amitriptylline + dosulepin

21
Q

what are the s/e of TCA?

A

-cardiac events
-anti-muscarnic
-seizures
-hypotension
-hallucinations

22
Q

what are the interactions of TCA?

A

-cyp inhibitors (avoid grapefruit)
-cyp inducers ( reduce effectiveness)
-drugs that cause QT prolongation
-anti-muscarinic drugs
-anti-hypertensive drugs
-serotonin syndrome

23
Q

when is MAO-I used?

A

only when specialist initated

24
Q

what are the interactions of MAO-I

OTC, food, drugs

A

-phenazine + isocarboxazid
-OTC pseudoephedrine
-tyramine rich foods
-tranylcypromine + clomipramine = fatal

25
Q

what is caused if MAO-I and phenazine + isocarboxazid is given together?

A

hepatotoxicity

26
Q

what is caused if MAO-I + pseudoephedrine is given together

A

hypertensive crisis

27
Q

how long should you wait before giving antidepressant after tx with MAO-I

A

-2 weeks
-3weeks if clomipramine or imipramine

28
Q

how long should you wait before giving MAO-I after previous tx with MAO-I

A

-2 weeks after previous MAO-I has been stopped
-0 weeks with meclobemide

29
Q

how long should you wait before giving MAO-I after previous tx with TCA or related antidepressant?

A

1-2 weeks after it has been stopped

30
Q

how long should you wait before giving MAO-I after previous tx with SSRIs or related antidepressants?

A

-1 week after
-5 weeks for fluoxetine

CNSVS1 (13 decks)

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