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Central Nervous System > Depression > Flashcards

Depression Flashcards

1
Q

How to treat mild depression

A

cognitive behaviour therapy

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2
Q

How to treat moderate to severe depression

A

Antidepressants

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3
Q

How long do you need to take Antidepressants for it to be deemed ineffective

A

4 weeks

(as the first 1 to 2 weeks symptoms might get worse)

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4
Q

How long do you need to take Antidepressants for it to be deemed ineffective for ELDERLY

A

6 weeks

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5
Q

How long after remission should you still be taking Antidepressants

A

6 months
(1 year in elderly and recurrent depression)

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6
Q

What is the 1st and 2nd Line treatment for Depression

A

1st Line:
SSRI

2nd Line:
- increase dose
- change SSRI
- TCA
- Venlafelaxine
- Mirtazapine

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7
Q

What is the 3rd and 4th Line treatment Line for Depression

A

3rd Line:
+ Lithium / Antipsychotics

4th Line:
Electrocompulsive Therapy

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8
Q

What is the 1st Line medication for Depression for a paitent who is =<17 years

A

Fluoxetine

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9
Q

If a patient is at risk of bleeding and needs to be treated for depression, what medication would you use

A

Mirtazapine

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10
Q

What is the most suitable medication for depression for patients who have cardiac events

A

Sertraline

(SSRIs)

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11
Q

Which SSRIs induce QT prolongation

A

Escitalopram nd Citalopram

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12
Q

Side Effects of SSRIs

A
  • GI disturbances
  • Weight gain
  • Sexual dysfunction
  • risk of bleeding
  • Insomnia (take it in the morning)
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13
Q

Interactions of SSRIs

A
  • CYP450 inducers and inhibitors
  • drugs that cause QT prolongation
  • drugs that increase risk of bleeding
  • drugs that cause hyponatraemia
  • drugs that cause serotonin syndrome
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14
Q

Which drugs cause serotonin syndrome

A
  • SSRI
  • TCA
  • MAOaI
  • Triptans
  • Tramadol
  • Lithium
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15
Q

What 3 types of side effects can serotonin syndrome cause

A
  • Cognitive
  • Autonomic
  • Neuromuscular
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16
Q

What are cognitive side effects

A
  • confusion
  • coma
  • headache
  • agitation
17
Q

What are Autonomic side effects

A
  • sweating
  • nausea
  • hyperthermia
  • Diarrhoea
18
Q

What are Neuromuscular side effects

A
  • termour
  • teeth grinding
  • myoclonus (sudden muscle contractions)
19
Q

Examples of Sedating Tricyclic Antidepressants

A
  • Amitriptyline
  • Clomipramine
  • Dosuleptin
  • Trazodone
20
Q

Examples of Less-Sedating Tricyclic Antidepressants

A
  • Imipramine
  • Lofepramine
  • Nortriptaline
21
Q

Which 2 Tricyclic Antidepressants are not recommended in Depression and why

A
  • Amitriptyline
  • Dosuleptin

because they are dangerous in overdose

22
Q

Side effects of Tricyclic Antidepressants

A
  • dry mouth, dehydration (anti-muscarinic)
  • hypotension
  • hallucinations
  • cardiac events
23
Q

Interaction of Tricyclic Antidepressants

A
  • CYP450 inhibitors and Inducers
  • drugs that cause QT prolongation
  • anti-muscarinic drugs
  • anti-hypertensive
  • drugs that cause serotonin syndrome
24
Q

Which foods should you avoid with Monoamine Oxidase-A Inhibitors

A

Tyramine rich foods

25
Q

Which OTC product should you avoid with Monoamine Oxidase-A Inhibitors and why

A
  • Pseudoephedrine

because MAOi cause hypertensive crisis

26
Q

What toxicity do Monoamine Oxidase-A Inhibitors cause

A

Hepatotoxicity

27
Q

Examples of Monoamine Oxidase-A Inhibitors

A
  • Selegiline
  • Isocarboxazid
  • Phenelzine
  • Tranylcypromine
28
Q

Clomipramine(TCA) + Tranylcypromine(MAOi) Interaction

A

Fatal (AVOID)

29
Q

How long should you wait between taking these medication:

Clomipramine/Imipramine(TCA)
+
Tranylcypromine(MAOi)

A

3 weeks

30
Q

How long should you wait to start other Antidepressants after taking MAOi

A

2 weeks

31
Q

How long should you wait to start taking MAOi after stopping other MAOi

A

2 weeks

32
Q

How long should you wait to start taking MAOi after stopping TCAs

A

1 to 2 weeks

33
Q

How long should you wait to start taking MAOi after stopping SSRIs

A

1 week

34
Q

How long should you wait to start taking MAOi after stopping Fluoxetine

A

5 weeks

35
Q

Why does there need to be a gap between different Antidepressants and MAOi

A

Because MAOi need a washout period

Central Nervous System (14 decks)

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