Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nervous system 1 > Depression > Flashcards

Depression Flashcards

1
Q

What causes depression and how antidepressants help ?

A

depression is caused by under activity of monoamine neurotransmitters. Antidepressants increase monoamine levels at synapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name Tricyclic antidepressants ?

A 
Amitriptyline 
Clomipramine
Dosulepin
Doxepin
Imipramine ( most antimuscarinic TCA )
Lofepramine ( hepatoxicity )
Nortriptyline 
Trimipramine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name tricyclic related antidepressants ?

A

Mianserin

Trazadone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name irreversible monoamine oxidase inhibitors ?

A

phenelzine ( hepatoxicity more likely )
isocarboxazid ( hepatoxcity more likely )
Tranylcypromine ( hypertensive crises more likely )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name reversible monoamine oxidase inhibitors ?

A

moclobemide ( no washout period needed: short acting )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name SSRIs ?

A

citalopram ( qt prolongation )
escitalopram ( qt prolongation )
fluoxetine ( only antidepressants licensed in children )
fluvoxamine
paroxetine ( greater risk of withdrawal reactions )
sertraline ( safer to use after MI, unstable angina )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are other antidepressant drugs ?

A

agomelatine ( hepatoxicity; give treatment booklet )
duloxetine ( SNRI )
flupentixol
mirtazepine ( blood dyscrasias )
reboxetine (NRI)
Tryptophan
Venlafaxine ( SNRI; higher risk of withdrawal reaction )
Vortioxetine ( works on serotonergic pathway )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why SSRIs are first line treatment for depression and not TCA’s ?

A

less sedating, less antimuscarinic, less epileptogenic, less cardiotoxic. Also safest in overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When antidepressants are initiated how long does it usually take to work and how often patients should be reviewed at the start of their treatment ?

A

Takes at least two weeks to work : initially feels worse, increased agitation, anxiety and suicidal ideation.
Review every one to two weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How long should GP’s wait before deeming SSRIs ineffective ?

A

Wait at least 4 weeks ( 6 weeks in elderly )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How long SSRIs should be taken for ?

A

Continue for at least 6 months ( 12 months in elderly )
12 months in generalised anxiety disorder ( high risk of relapse )
2 years in recurrent depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a second line treatment in depression ?

A

Increase SSRI dose, change to different SSRI or mirtazapine

Other choices: lofepramine ( TCA ) reboxetine, moclobemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a third line treatment for depression ?

A 
add another antidepressant class or augmenting agent : lithium or antipsychotic. 
Electroconvulsive therapy in severe refractory depression.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antidepressants side effects ?

A
  • Hyponatraemia ( drowsiness, confusion, convulsion) = especially SSRIs and in the elderly
  • Suicidal ideation and behaviour ( at risk are young children and adults ) = important to monitor for signs of this after dose change and at the start of the treatment
  • serotonin syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the signs and symptoms of serotonin syndrome ?

A
  1. Neuromascular hyperactivity : tremors, myoclonus, muscle rigidity
  2. Altered mental state : agitation, confusion, mania
  3. Autonomic dysfunction: labile blood pressure, urination, diarrhoea, hyperthermia, tachycardia, pallor, sweating, shivering
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is washout period required when switching antidepressants ?

A

to prevent serotonin syndrome

17
Q

How long is washout period for the following antidepressants :
MAOIs
SSRIs
TCAs

A

MAOIs wait two weeks before switching ( moclobemide does not require a washout period )
SSRIs wait one week before switching ( two weeks if sertraline, 5 weeks if fluoxetine )
TCAs wait one to two weeks before switching ( three weeks if imipramine or clomipramine )

18
Q

When usually withdrawal effects occur ?

A

within five days of stopping

19
Q

When would the risk of withdrawal reaction would be increased ?

A

if antidepressant is stopped abruptly after taking for 8 weeks or more .
Must reduce gradually over four weeks. 6 months in patients on long term maintainance treatment.

20
Q

Which antidepressants have higher risk of withdrawal reaction ?

A

Paroxetine, venlafaxine

21
Q

How does TCAs work ?

A

Inhbitis the reuptake of 5 HT and NA

22
Q

Which TCAs are less sedating ?

A

Imipramine
Lofepramine
Noritriptyline
They are given for apathetic, withdrawn patients

23
Q

Which TCAs are better to give for anxious, agitated patients ?

A

Amitriptyline, clomipramine, dosulepin doxepin trimipramine, mianserin, trazadone

24
Q

Describe TCAs cardiac side effects ?

A

QT prolongation, arrythmias, heart block, hypertension

25
Q

Describe TCAs antimuscarinic side effects ?

A

dry mouth, blurred vision, constipation, tachycardia, urinary retention, pupil dilation, raised intraocular pressure, angle closure glaucoma

26
Q

What are other side effects of TCAs?

A

seizures, hallucinations, mania, hypotension, sexual dysfunction, breast changes, EPS

27
Q

When TCAs are given with carbamazepine what interactions occur?

A

Reduced TCAs levels since carbamazepine is a inducer + risk of hyponatraemia

28
Q

Which TCAs particularly can cause QT prolongation ?

A

clomipramine

29
Q

Which drugs given with TCAs can lead to hyponatraemia ?

A

LOOP/thiazide, desmopressin, carabamazepine,

30
Q

Which drugs given with TCAs can cause QT prolongation ?

A

amiodarone, sotalol, antipsychotics, citalopram/escitalopram, loop/thiazide, B2 agonists, corticosteroids, theophylline

31
Q

Which drugs given with TCAs can lead to hypotension ?

A

alpha blockers, BB, ACE, ARB, CCB

Antipsychotics, levodopa/dopaminergics, NSAIDs, SGLT inhibitors, Loop/thiazide diuretics, sildenafil

32
Q

Which drugs given with TCAs can lead to increased antimuscarinic effects ?

A

antimuscarinic drugs, atropine, antihistamines

33
Q

Which drugs given with TCAs can lead to an increased risk of serotonin syndrome ?

A

MAOIs, selegeline, tramadol, amfetamines, sumatriptan, SSRIs, ondansetron, lithium

34
Q

How does monoamine oxidase inhibitors work ?

A

Prevent breakdown of monoamine neurotransmitters , which include dopamine, noradrenaline and serotonin,

35
Q

With which two monoamine oxidase inhibitors hepatoxicicity is likely ?

A

phenelzine, isocarboxazid

36
Q

Which monoamine oxidase inhibitor has the greatest stimulant action ?

A

tranylcypromine, more likely to cause hypertensive crisis

37
Q

What symptoms would prompt to discontinue MOAI’s ?

A

palpitations or if frequent headaches occur. Discontinue if hypertensive crisis with throbbing headaches occur. Most likely to happen with tranylcypromine/

38
Q

Which drugs given with MOAIs would lead to hypertensive crisis ?

A

pseudoephedrine, adrenaline, noradrenaline, levodopa, DRAs, MAO-B inhibitors
TCAs ( potentially lethal, especially tranylcypromine and clomipramine )

39
Q

How should patients who receive MOAIs should be counselled ?

A
  • They should avoid food containing tyramine ( mature cheese, wine, pickled herring, game, broad bean pods, marmite or similar yeast extracts, fermented soya bean products .
  • Only eat fresh food, avoid stale or going off food.
  • Avoid alcohol / de-alchoholised ( low alcoholic drinks )

Nervous system 1 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions