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PRP2 > 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:

  • Clomipramine
  • Amitriptyline
  • Dosulepin
  • Trazadone

C-DATing

25
Which is the best sedating TCA
Trazadone
26
Highest risk of overdose TCA?
Amitriptyline or Dosulepin
27
Non sedating TCA?
Nortriptyline Imipramine Lofepramine ***NIL***
28
TCA Side effects?
Cardiac events Anti muscarinics (dry mouth/constipate) Seizures (reduces threshold) Hypotension (more associated overdose) Hallucination ****CASHH****
29
TCA avoid Grapefruit juice why?
It is a CYP450 inhibitor which will therefore increase plasma conc of TCA Risk of toxicity = Serotonin syndrome
30
TCA AND OTC St John’s wort?
St John’s wort is an CYP450 enzyme inducer which will reduce TCA Effectiveness
31
Which other QT prolongation drugs should TCA AVOID?
Amiodarone Sotalol Quinolones
32
Which anti muscarinic drug should TCA avoid?
Atropine
33
Which anti hypertensive drug should TCA avoid?
Amlodopine
34
MAO inhibitors with Pseudoephedrine can cause?
Hypertensive Crisis
35
Mao inhibitors must avoid which foods?
Tyramine rich foods
36
Fatal SERIOUS REACTION WITH MAOI?
Clomipramine & Tranylcypromine (TCA). (MAOI)
37
Which MAOI - b inhibitors cause Hepatotoxicity?
- Phenelzine - isocarboxazid
38
How long must pt wait to switch from MAO inhibitor to another depressant?
At least 2 weeks
39
How long must pt taking Clomipramine/Imipramine take to switch antidepressants?
3 weeks
40
How many weeks for moclobemide to be stopped to start MAO INHIBITOR?
0 weeks
41
Do not start MAO inhibitor till how long after TCA stopped?
1-2 weeks
42
How long after SSRI has been stopped can you start MAOI?
1 week
43
How long after Fluoxetine stopped can pt start a MAO inhibitor?
5 weeks
44
Tyramine rich foods?
Yeast rich foods - Marmite - Salami - Tofu - Yeast - Mature cheese

PRP2 (74 decks)

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