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Behaviour > Depression > Flashcards

Depression Flashcards

1
Q

interactions with MAOIs

A

tyramine containing products -> cheese reaction
Ephedrine containing products -> severe hypertension
Pethidine
other antidepressants -> needs does titration and 2-3 week washout period

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2
Q

why are SSRIs safer than TCAs

A

no anti-cholinergic or anti-muscarinic activity -> more selective for serotonin

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3
Q

common side effects of SSRIs

A 
nausea
anorexia
insomnia
GI disturbance
loss of libido/failure of orgasm
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4
Q

adverse effects of SSRIs

A

hyponatraemia
GI bleeds
serotonin syndrome
QT prolongation

contraindicated in under 18s and lowers seizure threshold

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5
Q

SSRI interactions

A

drugs which increase the risk of bleeding (anti-coat, NSAIDs, corticosteroids)

other antidepressants

tramadol

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6
Q

mirtazipine

A

alpha 1 adrenoreceptor blocker
inhibits negative feedback loop on serotonin release

also blocks H1 receptor producing a sedative effect

has fewer autonomic side effect compared to other drugs
can increase appetite and weight gain
less cardiotoxic and less dangerous in OD
good for frail or elderly pts

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7
Q

trazodone

A

tricyclic related
blocks 5HT2A/2C
blocks the re-uptake of 5HT

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8
Q

venlafaxine

A

5ht reuptake inhibitor with some action on NA

used in severe depression

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9
Q

duloxetine

A

inhibits 5ht and NA
used for major depressive disorders
also used for urinary incontinence and diabetic neuropathy

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10
Q

citalopram

A

SSRI

QT prolongation

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11
Q

phenelzine

A

irreversible non-selective MAOI

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12
Q

isocarboxazid

A

irreversible non-selective MAOI

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13
Q

tranylcypromine

A

irreversible non-selective MAOI

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14
Q

moclobemide

A

MAOI

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15
Q

imipramine

A

TCA

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16
Q

antidepressants with a sedation effect (e.g. agitation/insomnia)

A

amitryptiline

mirtazapine

17
Q

antidepressant without sedately effect

A

SSRIs or imipramine

18
Q

antidepressants avoiding anti-cholinergic activity (e.g. in glaucoma or protatism)

A 
SSRI
or Lofepramine (TCA)
19
Q

important issues to counsel pt about

A

gradual development of anti-depressant effect
puts must take medication beyond remission
potential side effects and interactions
risk and nature of discontinuation symptoms
addiction does not occur

20
Q

antidepressant considerations in pts with high suicide risk

A

venlafaxine a/w/ greater risk of death in OD
TCA -> ventricular dysrhythmias
small safety margin on dosulepin

must follow up pt regularly

21
Q

withdrawal symptoms of antidepressants

A 
flu like symptoms
insomnia
vivid dreams
agitation
irritability
GI disturbance (SSRI)
cardiac arrhythmias (TCAs)
mania
22
Q

lithium

A

decreases NA and increases the synthesis of 5HT
most often used as a mood stabiliser
long term use has been associated with thyroid disorders and mild cognitive/memory impairment

renal function must be carefully monitored
diuretics (esp thiazides) should be avoided

23
Q

signs of lithium overdose

A 
tremor
ataxia
dysarthria
nystagmus
renal impairment
convulsions
potentially fatal (serum li >1.5 mmol/l)
24
Q

4 antipsychotic agents commonly used to augment antidepressants

A

aripiprazole
olanzapine
quetiapine
risperone

25
Q

aripiprazole

A

D2 partial agonist and weak 5HT1a agonist and 5HT2a antagonist
can cause nausea and lower prolactin

26
Q

olanzapine

A

D, 5HT2, H1 and muscarinic antagonist

27
Q

Quetiapine

A

D1&2, 5HT2a, alpha 1 and H1 antagonist

28
Q

Risperone

A

D2, 5HT2a, alpha 1 and H1 antagonist

29
Q

three types of hypnotic short acting benzodiazepines used to treat insomnia

A

temazepam
nitrazepam (hangover effect)
Z-related compounds (zopiclone,zolpidem,zaleplon)

30
Q

four types of anxiolytic benzos

A

diazepam
chlordiazepoxide
lorazepam
oxazepam

31
Q

mode of action of benzdiazepines

A

binds to GABAa and increases the inhibitory effect by opening Cl channels

this leads to sedation and a reduction in anxiety

32
Q

adverse effects of benzos

A 
drowsiness and falls
impairment in judgement and dexterity
increased risk of RTAs from hangover effect
forgetfulness
confusion
irritability
agression
paradoxical dis-inhibition
33
Q

how do TCAs work

A

inhibit reuptake of NA and 5HT
antimuscarinic effects
blocks alpha 1 adrenoreceptors (postural hypotension, prolonged QT, ventricular dysrhythmia)

34
Q

symptoms of TCA overdose

A 
visual disturbance
warm dry skin
urine retention
hypothermia
sedation
TACHYCARDIA
ARRTHYMIAS
SEIZURES
35
Q

TCA interactions

A

additive effect with other sedative agents
drugs which prolong the QT interval (amiodarone)
catecholamines -> hypertension

36
Q

which subtype of monoamine oxidase enzyme to MAOIs target

A

MAO-a which show preference for serotonin

37
Q

adverse effects of MAOIS

A

postural hypotension
atropine-like effects
wt gain
CNS stimulation - restlessness, insomnia, hallucinations

38
Q

what is the cheese reactions

A 
tyramine containing products interact with MAOIs causing severe hypertension
egs:
beer
chees
game
yeast/soy
pickled herring

Behaviour (10 decks)

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