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cardiovascular system 1 > CNS 4 > Flashcards

CNS 4 Flashcards

1
Q

What are the 3 classes of Antidepressants

A

Tricyclic and related Antidepressants ( Inc 5HT and N)
SSRIs( increase 5HT)
Monoamine oxidase inhibitors ( increase 5HT, NA abd DA)
SNRI( venfalaxine and duloxetine)

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2
Q

Egs of Tricyclic Antidepressants

A

Amitriptyline and nortriptyline( neuropathic pain )

Clomipramine
Dosulepin

Imipramine ( most antimuscuranic side effects)
Lofepramie ( Liver toxic)

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3
Q

List examples of tetracycline Antidepressants

A

Manserin and trazodone

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4
Q

Egs of SSRI

A

Citalopram
Fluoxetine
Sertraline
Paroxetine

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5
Q

An SSRI that is licensed for children is called?

A

Fluoxetine

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6
Q

An SSRI with a high withdrawal effect is called

A

Paroxetine

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7
Q

An SSRI safe in Unstable Angina and MI is called

A

Sertraline

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8
Q

List examples of MAOIs

A

Irreversible and reversible

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9
Q

List examples of Irreversible MAOI

A

Phenelzine
Isocarboxid
Tranylcypromine( htn crisis risk)

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10
Q

List examples of reversible MAOI

A

RIMA( no washing out period)
Eg Moclobamide- licensed for social anxiety disorder

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11
Q

What type of depression are Antidepressants effective for?

A

Moderate to severe depression

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12
Q

Which Antidepressants class is first line and why?

A

SSRIs
Better tolerated and safer in OD
Less sedating
Fewer antismuscarinic and cardiotoxic effects
Sertraline is safe in pt with Unstable Angina or recently had MI

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13
Q

Facts about TCA

A

Similar efficacy to SSRIs but more side effects
Toxicity in OD
More sedating
More Antimuscarinic and cardiotoxic side effect

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14
Q

Facts about MAOI

A

Dangerous interaction with some foods and drugs
Reserve for use by specialists

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15
Q

Facts about St John’s wort

A

It is an inducer
Used to tx mild depression
Increase conc of another drug a pt is taken
Do not Prescribe or recommend for depression
It pt stops taking St John’s wort, the concentration of interacting drugs may increase, leading to toxicity

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16
Q

Management of depression

A

Review pt every 1-2wks at start of tx
They take atleast wks to work
Continue tx for atleast 4wks ( 6wks for elderly) before switching due to lack of efficacy)

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17
Q

What’s the duration of tx depression if no efficacy efficacy after 1-2wks

A

Incase of Partial response, continue for further 2-4weeks( elderly pts may take longer to respond)

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18
Q

What’s the duration for tx pt with a hx of recurrent depression

A

2 years

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19
Q

State the duration of tx depression after remission

A

Atleast 6months
12 months in elderly
12months for generalised Anxiety disorder because higher risk of relapse

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20
Q

All Antidepressants cause hyponatremia . True or false?

A

True
Occurs more with SSRIs in elderly esp

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21
Q

What are the signs of hyponatremia( salt loss)

A

Stupor / coma
Anorexia
Lethargy
Tendon reflexes reduced
Limp muscle weakness
Orthostatic hypotension
Seizures/ headache
Stomach cramps

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22
Q

Antidepressants are linked with suicidal thoughts and behaviour. True or false?

A

True

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23
Q

What pts group are at risk of suicidal thoughts?

A

Children, young adults and individuals

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24
Q

What is serotonin syndrome?

A

High levels of serotonin esp when SSRIS /SNRis plus drugs that raises serotonin are given together esp MAOi- do not mix

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25
Q

What are the symptoms of Serotonin syndrome

A

Neuromuscular hyperactivity( tremor, clonus, rigidity, hyper reflexia)
Autonomic dysfunction ( Tachycardia, BP, hyperthermia, diarrhoea, sweating)
Altered mental State( confusion, coma, agitation)

Withdraw medication if symptoms occur

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26
Q

Tx failure with Antidepressants

A

Increase dose or switch to different SSRIs or Mirtazapine if initial response to SSRIS fail
Or second line choice eg Fluoxetine, roboxetine or moclobemide
Venlafaxine reserved for more severe cases
MAoi requires specialist
Third line
Add another Antidepressants class or lithium or Antisychotics

27
Q

Examples of sedating TCA’s

A

Give to anxious pt
Amitriptyline
Clomipramine
Dosulepin( toxic in OD)
Trazodone
Trimipramine
Doxepin

28
Q

Examples of less sedating TCA’s

A

Imipramine ( most antimuscarinic side effects
Lofepramine
Nortripyline
For withdrawn and apathetic patients
NIL

29
Q

Contraindications of TCA’s

A

Manic phase in bipolar
Arrhythmia
Heart block
Immediate recovery period after M.I
Mainly CV related

30
Q

TCA cautions

A

CV disease
Diabetes
Chronic constipation
Epilepsy
History of bipolar and psychosis
Hyperthyroidism ( risk of Arrhythmia)
Glaucoma, urinary retention
Elderly pts more susceptible to side effects cus can cause hypotension

31
Q

Common side effects of TCA

A

TCA
T- more toxic in OD than SSRIS
C- Cardiac side effects, QT prolongation, heart block, HTN, Arrhythmia)
A- Antimuscarinic side effects
S- seizures

32
Q

Common side effects of TCA

A

QT interval elongation
Drowsiness, Anticholinergic syndrome

33
Q

What are Antimuscarinic side effects

A

Can’t see
Can’t pee
Can’t shit
Can’t spit

Anorexia
Blurry vision
Constipation/ Confusion
Dry mouth
Static urine
ABCDS

34
Q

Signs of TCA OD

A

Dry mouth
Coma
Hypotension ( Amitriptyline)
Hypothermia
Convulsions
Arrhythmia
Dilated pupil
Urinary retention
Cardiac conduction defect
Respiratory failure

35
Q

TCAs have varying Antimuscarinic and cardio toxic effects in OD. True or false

A

True

36
Q

Facts about Lofepramine as a TCA

A

Less side effects, Less dangerous in OD but associated with hepatoxicity

37
Q

Is Lofepramine safe in severe liver impairment?

A

Avoid

38
Q

A TCA that has more Antimuscarinic side effects than the rest is ….

A

Imipramine

39
Q

A TCA that is effective but dangerous in OD and not recommended in tx of depression is…

A

Amitriptyline/ dosulepin

40
Q

Why are TCA’s given once daily at night?

A

Due to long half life

41
Q

TCAs can aggravate conditions especially in mania. T/f

A

True
Stop if pts enter manic phase

42
Q

Common TCAs interaction

A

Lithium ( increase risk of toxicity…see photo on fav.

43
Q

Examples of
irreversible MAOI s

A

Isocarboxazid( cause hypatoxicity)
Phenelzine( hepatoxicity)
Tranylcypromine( greater stimulant action than above more likely to cause htn crisis

44
Q

List examples of reversible MAOI( RIMA)

A

Moclobemide- reserved for 2nd line

45
Q

Important points to note about MAOIs

A

Massive hypertensive crisis eg massive headache
Avoid tyramine( triggers htn crisis) -Stroke and MI
Interacts with OTc meds
Increase suicide risk
Don’t give with pseudoephredine
Do not mix with other Antidepressants cause Serotonin syndrome

46
Q

State the withdrawal symptoms associated with MAOIs

A

Agitation, irritability, ataxia, movement disorders, Insomnia, drowsiness, vivid dreams, hallucinations, slowed speech, delusion
Risk of symptoms increased if stopped suddenly after regular administration 8wks or more

47
Q

Cautions with MAOIs

A

Hepatoxicity in pt with hepatic impairment
Increased risk of neonatal malformations when used in pregnancy

48
Q

Side effects of MAOIs

A

Risk of postural hypertension mainly in elderly and hypertensive responses( severe increase in BP that may cause a stroke)
Withdraw if palpitation or frequent headches occur

49
Q

Wash out period for Antidepressants

A

See fav photos

50
Q

List drugs that can cause hypertensive crisis when given with MAOI

A

Sympathomimetics such as
Ephedrine and pseudoephridine eg cold and flu remedies
TCA( imipramine and clomipramine)
Dopaminergic drugs such as Levodopa and MAO-B

51
Q

Food that interacts with MAOI

A

Food that contains tyramine cus tyramine triggers nerve cell to release noradrenaline which increase NP which cause throbbing headache

52
Q

Which food contains tyramine

A

Mature cheese
Pickled herring
Broad bean pods
Bovril, Oxon, Marmite
Fermented soya bean extract

53
Q

Pt and carer advise for pt on MAOI

A

Eat only fresh food and avoid stale food or going off food esp meat, poultry, fish or offal.
Game should be avoided
Avoid alcoholic drink or dealcholized drinks
Drowsiness may affect skilled task
Danger of food and drug interaction last for 2weeks after MAOI is stopped

54
Q

Facts about RIMA

A

Moclobemide- major depressed and social anxiety
Reversible inhibition of monoamine oxidase A- second line tx

55
Q

Interaction with RIMA

A

Less tyramine effects than irreversible MAOI but avoid large amounts in tyramine rich food
Less risk of drug interaction but still avoid Sympathomimetic
Don’t give with other Antidepressants

56
Q

Examples of SSRI

A

Sertraline (safe in Angina and MI)

Citalopram ( QT prolongation)
Escitalopram( qt prolongation)
Fluoxetine ( can be given to children)
Fluvoxamine
Paroxetine ( higher withdrawal)

57
Q

Which Antidepressants has increased harmful outcomes in children and adolescent such as self harm, aggression and suicide risk?

A

SSRIs

58
Q

Which Antidepressants is licensed for children and at what age?

A

8-17
Unlicensed- 5-7
Fluoxetine

59
Q

Contraindications of SSRI

A

Poorly controlled epilepsy ( discontinue if convulsion occurs)
Manic phase

60
Q

Cautions for SSRIs

A

See fav photos

61
Q

What is the MHRA/ CSM advice for SSRIs or SNRis

A

Small risk of post partum haemorrhage when used the month before delivery
Increased risk of bleeding
Risk more significant in patients with other risk factors for bleeding disorders
Anticoagulant medication in women at high risk of thrombotic events should not be stopped but prescriber should be aware of this

62
Q

Facts about SSRIS

A

Less sedating and fewer Antimuscarinic effects than TCA
Hypontraemia
Anxiety, Arrhythmia, confusion, drowsiness, constipation, QT interval prolongation, dry mouth, skin reactions, nausea, Palpitation

63
Q

Important SSRIS interaction

A

See fav photos

cardiovascular system 1 (42 decks)

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