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Kirstys Flashcards > depression 2 > Flashcards

depression 2 Flashcards

1
Q

What treatment is not reccomended for patients with persistant subthreshold depressive episodes or mild to moderate depression?

A

AD drugs should be avoided!

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2
Q

In what cases could drugs be given to patients with persitant subthreshold depression or mild to moderate depression?

A
  • subthreshold depression symptoms lasting for more than 2 years
  • If there is a history of severe depression
  • mild depression that is complicating the care of a chronic physical health problem
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3
Q

What treatment should be used for patients with severe depression?

A

AD AND high intensity pyschological innervation

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4
Q

When a patient first takes antidepressants what is it important to tell them?

A
  • Initally anxiety symptoms may worsen
  • May take time for drug to work
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5
Q

For patients on Antidepressants how long after remission should they continue them? Why?

A

6 months is minimum time. This is needed as it greatly reduces risk of relapse

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6
Q

What class of drug would be prescribed for a perons first episode of depression? Examples?

A

A generic SSRI e.g. fluoxetine, citalopram, paroxetine, sertraline

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7
Q

What Antidepressant drug would be prescribed for a patient for a reccurent episode?

A

An AD that they previously had a good response too. AVOID any tried before which they didn’t respond too or couldn’t tolerate

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8
Q

If a person has chronic physical health problem which antidepressant drug is preferred and why?

A

Sertraline - lower incidence of drug interaction

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9
Q

What are SSRIs mechanism of action and what are there assoicated side effects?

A
  • Inhibit reuptake of 5-HT so that 5-HT can agonise 5-HT1A receptor. (agonism)
  • 5-HT2 agonism: restlessness, agitation, sexual dsyfunction, anxiety
  • 5-HT3 agonism : headache, Nausea, GI upset, diarrhoea (Hot Dogs Go Nuts)

Insomnia, weight gain/ loss

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10
Q

What are the risks associated with SSRIs?

A
  • All AD associated with suicide risk and suicidal thoughts. Only AD suitable for U18 is fluoxetine
  • SSRIs inhibit hepatic CYP450s. This effects metabolism and therapeutic range of other drugs
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11
Q

What are the contraindicatios and cautions associated with SSRIs?

A
  • Contraindications: MAOIs, manic episodes
  • Cautions: Antiepleptic, alchohol, anticoagulants, other ADS
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12
Q

What side effects out from withdrawl of SSRIs?

A
  • Nausea, headache, flu like, fatigue
  • insomnia, nervousness
  • paraesthesia and electric shock feelings
  • dizziness and vertigo
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13
Q

What are example of TCA drugs?

A

Clomipramine Amitriptyline Lofepramine

Imipramine Nortriptyline Trimipramine

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14
Q

Side effects of TCA drugs

A
  • 5-HT2 antagonism: sedative, sexual dysfunction, anxiolytic (SAS)
  • Muscarinic antagonism (M1): Dry mouth, blurred vision, constipation, palpitations
  • Adrenergic antagonism (α1): Drowsiness, postural hypotension, tachycardia
  • Histaminergic antagonism (H1): Drowsiness, weight gain
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15
Q

What drug interactions occur with TCAs?

A

Alcohol, other AD, Anti epiletpic drugs, anti arrhythmias, antipyschotics

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16
Q

What containdications/ cautions are there with TCAs?

A
  • Heart block
  • Arrythmias
  • Severe liver disease
  • pregnacny, lactation
17
Q

What classes of MAOIs are there. Give examples

A
  • MAOIs : Phenelezine, Isocarboxazid

Irreversible inhbition of MAO-A and B. Effects NA, DA, 5-HT and tryamine

  • RIMAs: Moclobemide

Reversible inhibition of MAO-A. Effects DA, tryamine, phenylethylamine, benzylamine

18
Q

What line of treatment are MAOIs? What are they used for?

A

2nd line therapies for treatments resistant depression with well established efficacy

19
Q

Disadvantages of MAOIs?

What effect does this have on MAOs in the liver/ GI tract?

A

Drug and diet interactions.

MAOs in liver/ GI tract normally break down dietry amines (tyramine). Inhibition of these MAOs by MAOIs allows amines from diet and drugs to enter circulation and interact with 5-HT, DA, NA receptors.

Results in sympathomimetic effects: acute hypertensive crisis, severe headache and haemorrahage

20
Q

What MAOIs are used in depression and what used in parkinsons.

What do each MAO metabolize?

A
  • depression: MAOI-A or non selective
  • Parkinsons: MAOI-B
  • MAO-A: tyramine, NA, 5-HT
  • MAO-B: DA
21
Q

Describe what happens when MAOI-As are given if someone has a diet rich in tyramine

A

tryamine is normall absorbed minimally due to metabolism by MAO-A. With an inhibitor more tyramine is absorbed by the nerve terminal through a NA reuptake transporter. Inside T displaces NA and also causes the reverse transport of NA through NET. This means more NA released therefore more sympathetic effects

22
Q

Should St John’s worts be recommended for patient with mild to moderate depression?

A

NO - may be benefical but there is uncertainity about approproate doses, serious drug side effects

23
Q

Why is it important to take care when switching/ combining ADs?

A

Some drugs require washout periods. time depends on particular AD. Can lead to serotonin syndrome

24
Q

What is serotonin syndrome and its associated side effects?

A

Rare but potentially fatal

Rapid onset with dose intiation or increase of dose of serotonergic drug

Altered mental, aggitation, tremor, shivering, diarrhoea, hpereflexia, hyperthermia

25
Q

What is bipolar?

A

Mental health disease where someone goes from having periods of depressive episodes to a manic episodes

26
Q

What symptoms occur with manic episodes?

A
  • Elevated mood - increased energy, racing thoughts
  • Increased self-esteem
  • Reduced attention

People can become agressive, suspicous, recklessly spend etc

27
Q

What are first line treatments of bipolar disorder?

A
  • Antipsychotics
  • Lithium salts
  • Adjuction use of BZs
28
Q

What is 2nd line treatment of Bipolar disorder?

A

Anti- convulsants e.g. sodium valporate and carbamazepine

29
Q

Treatment of depressive episodes in bipolar illness

A
  • Problem: antidepressants work but response rates are lower and there is a risk of inducing mania so
  • If drug free then consider lithium or an antidepressants
  • If severe depression/suicidal consider ECT
  • If already on medication check compliance
  • Careful withdrawal if on antipsychotic
  • Additional mood stabilizer or additional antidepressant
30
Q

How do Lithium salts work?

A

Complex biochemical effects

31
Q
A

Kirstys Flashcards (116 decks)

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