Depression

Question 1

interactions with MAOIs

Answer 1

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

Question 2

why are SSRIs safer than TCAs

Answer 2

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

Question 3

common side effects of SSRIs

Answer 3

nausea
anorexia
insomnia
GI disturbance
loss of libido/failure of orgasm

Question 4

adverse effects of SSRIs

Answer 4

hyponatraemia
GI bleeds
serotonin syndrome
QT prolongation

contraindicated in under 18s and lowers seizure threshold

Question 5

SSRI interactions

Answer 5

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

other antidepressants

tramadol

Question 6

mirtazipine

Answer 6

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

Question 7

trazodone

Answer 7

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

Question 8

venlafaxine

Answer 8

5ht reuptake inhibitor with some action on NA

used in severe depression

Question 9

duloxetine

Answer 9

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

Question 10

citalopram

Answer 10

SSRI

QT prolongation

Question 11

phenelzine

Answer 11

irreversible non-selective MAOI

Question 12

isocarboxazid

Answer 12

irreversible non-selective MAOI

Question 13

tranylcypromine

Answer 13

irreversible non-selective MAOI

Question 14

moclobemide

Answer 14

MAOI

Question 15

imipramine

Answer 15

TCA

Question 16

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

Answer 16

amitryptiline

mirtazapine

Question 17

antidepressant without sedately effect

Answer 17

SSRIs or imipramine

Question 18

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

Answer 18

SSRI
or Lofepramine (TCA)

Question 19

important issues to counsel pt about

Answer 19

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

Question 20

antidepressant considerations in pts with high suicide risk

Answer 20

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

must follow up pt regularly

Question 21

withdrawal symptoms of antidepressants

Answer 21

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

Question 22

lithium

Answer 22

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

Question 23

signs of lithium overdose

Answer 23

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

Question 24

4 antipsychotic agents commonly used to augment antidepressants

Answer 24

aripiprazole
olanzapine
quetiapine
risperone

Question 25

aripiprazole

Answer 25

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

Question 26

olanzapine

Answer 26

D, 5HT2, H1 and muscarinic antagonist

Question 27

Quetiapine

Answer 27

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

Question 28

Risperone

Answer 28

D2, 5HT2a, alpha 1 and H1 antagonist

Question 29

three types of hypnotic short acting benzodiazepines used to treat insomnia

Answer 29

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

Question 30

four types of anxiolytic benzos

Answer 30

diazepam chlordiazepoxide lorazepam oxazepam

Question 31

mode of action of benzdiazepines

Answer 31

binds to GABAa and increases the inhibitory effect by opening Cl channels this leads to sedation and a reduction in anxiety

Question 32

adverse effects of benzos

Answer 32

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

Question 33

how do TCAs work

Answer 33

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

Question 34

symptoms of TCA overdose

Answer 34

``` visual disturbance warm dry skin urine retention hypothermia sedation TACHYCARDIA ARRTHYMIAS SEIZURES ```

Question 35

TCA interactions

Answer 35

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

Question 36

which subtype of monoamine oxidase enzyme to MAOIs target

Answer 36

MAO-a which show preference for serotonin

Question 37

adverse effects of MAOIS

Answer 37

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

Question 38

what is the cheese reactions

Answer 38

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