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PR P2 Clinical > CNS - Depression > Flashcards

CNS - Depression Flashcards

1
Q

Mild treatment depression?

A

CBT (Cognitive behavioural Therapy)

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2
Q

Moderate treatment for depression

A

Antidepressants (SSRI)

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3
Q

Pt returns 1wk later and says they feel worse after taking anti depressants, what should they do?

A

Continue to take as
First 1-2 weeks patient may feel worse

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4
Q

At what point is an antidepressant deemed ineffective?

A

4 weeks normal pt
Or 6 weeks in elderly

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5
Q

Pt is on remission how long after do they need to take?

A

6 months normal pt

1 year in elderly

2 years if recurrent

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6
Q

Depression first line?

A

SSRI

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7
Q

If SSRI doesn’t work then what?

A

1) Increase in dosage

2) Change to another SSRI

3) MIRTAZAPINE

4) If severe : TCA or venlafaxine

5) Mao inhibitors (Specialist/Rare)

V rare another class lithium

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8
Q

Severe refractory depression?

A

Electroconvulsive therapy

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9
Q

Next step after alternate SSRI doesn’t work?

A

Mirtazepine

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10
Q

Severe depression treatment?

A

TCA or Venlafaxine

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11
Q

If pt is 17 or less what antidepressant should be used?

A

Fluoxetine

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12
Q

If pt is at risk of bleeding which antidepressant should be used?

A

Mirtazepine

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13
Q

If pt is at risk of cardiac events which antidepressant should be used?

A

Sertraline

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14
Q

Why SSRI’s are preferred over TCA’s ?

A

Better tolerated

Overdose SSRI is a lot safer than TCA

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15
Q

SSRI SIDE EFFECTS?

A

GI disturbances

Weight gain

Sexual dysfunction

Insomnia (TAKE IN MORNING)

Risk of bleeding

QT Prolongation (Escitalopram/Citalopram)

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16
Q

Can I take Grapefruit juice with SSRI?

A

NO, AVOID GRAPEFRUIT JUICE (CYP450 Enzyme inhibitor)

It can increase plasma conc of SSRI
Leading to toxicity or even serotonin syndrome

SSRI is a CYP450 enzyme substrate

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17
Q

Can pt take OTC St John’s wort with SSRI?

A

No as it reduces SSRI effectiveness

St johns wort is a CYP450 inducer

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18
Q

SSRI should avoid being taken with which drugs to avoid QT prolongation?

A

Amiodarone, Sotalol, Quinolones

19
Q

SSRI should avoid which other hyponatraemic drugs?

A

Diuretics, Carbamazepine

20
Q

Serotonin syndrome autonomic effects?

A

Heating up symptoms

-sweating
-hyperthermia
-Nausea
-Diarrhoea

21
Q

Serotonin syndrome neuromuscular excitation symptoms?

A

Teeth grinding
Tremors
Myoclonus (uncontrollable muscle contraction)

22
Q

Serotonin syndrome Cognitive effects?

A

Headaches
Agitations
Hypomania
Confusion
Coma

23
Q

Which drugs can cause serotonin syndrome?

A
  • SSRI
  • TCA
  • MAO - I
  • Triptans
  • Tramadol
  • lithium
  • LINEZOLID ABX
24
Q

If pt is more anxious agitated which TCA would they need?

A

Sedating TCA:

  • Amitriptyline
  • Clomipramine
  • Dosulepin
  • Trazadone
25
Q

Which is the best sedating TCA

A

Trazadone

26
Q

Highest risk of overdose TCA?

A

Amitriptyline or Dosulepin

27
Q

Non sedating TCA?

A

Nortriptyline
Imipramine
Lofepramine

NIL

28
Q

TCA Side effects?

A

Cardiac events
Anti muscarinics (dry mouth/constipate)
Seizures (reduces threshold)
Hypotension (more associated overdose)
Hallucination

CASHH

29
Q

TCA avoid Grapefruit juice why?

A

It is a CYP450 inhibitor which will therefore increase plasma conc of TCA
Risk of toxicity = Serotonin syndrome

30
Q

TCA AND OTC St John’s wort?

A

St John’s wort is an CYP450 enzyme inducer which will reduce TCA Effectiveness

31
Q

Which other QT prolongation drugs should TCA AVOID?

A

Amiodarone
Sotalol
Quinolones

32
Q

Which anti muscarinic drug should TCA avoid?

A

Atropine

33
Q

Which anti hypertensive drug should TCA avoid?

A

Amlodopine

34
Q

MAO inhibitors with Pseudoephedrine can cause?

A

Hypertensive Crisis

35
Q

Mao inhibitors must avoid which foods?

A

Tyramine rich foods

36
Q

Fatal SERIOUS REACTION WITH MAOI?

A

Clomipramine & Tranylcypromine
(TCA). (MAOI)

37
Q

Which MAOI - b inhibitors cause Hepatotoxicity?

A
  • Phenelzine
  • isocarboxazid
38
Q

How long must pt wait to switch from MAO inhibitor to another depressant?

A

At least 2 weeks

39
Q

How long must pt taking Clomipramine/Imipramine take to switch antidepressants?

A

3 weeks

40
Q

How many weeks for moclobemide to be stopped to start MAO INHIBITOR?

A

0 weeks

41
Q

Do not start MAO inhibitor till how long after TCA stopped?

A

1-2 weeks

42
Q

How long after SSRI has been stopped can you start MAOI?

A

1 week

43
Q

How long after Fluoxetine stopped can pt start a MAO inhibitor?

A

5 weeks

44
Q

Tyramine rich foods?

A

Yeast rich foods

  • Marmite
  • Salami
  • Tofu
  • Yeast
  • Mature cheese

PR P2 Clinical (19 decks)

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