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Therapeutics > Depression, Anxiety, and Bipolar > Flashcards

Depression, Anxiety, and Bipolar Flashcards

1
Q

Examples of TCA.

A

Amitriptyline
Nortriptyline
Imipramine

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2
Q

Mechanisms of Side effects of TCAs.

A

Antagonism at alpha1 adrenoceptors (vasodilation = hypotension),

Antagonism at histamine (H1) receptors (antihistamine effect = sedation, stimulation of appetite and weight gain),

Antagonism at muscarinic receptors (anticholinergic effects = dry mouth; urinary retention)

Blockage of voltage-gated sodium channels (responsible for lethality in OD)

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3
Q

Treatment of the Cardiac conduction abnormalities include increased risk of arrythmias, prolonged QTc and prolongation of QRS complex, due to TCA overdose.

A

Sodium Bicarbonate

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4
Q

Contra-indications for TCA.

A

Acute closed angle glaucoma (pupil dilation which may worsen closure of angle)
BPH (urinary retention),
Myocardial infarction or arrhythmias.

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5
Q

Examples of SSRTis.

A

Fluoxetine
Citalopram
Sertraline
Paroxetine
Escitalopram

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6
Q

Pathanogenesis of Serotonin Syndrome.

A

SSRI’s have long half-lives. In particular, fluoxetine has a half live of around 23 - 75 hours, plus It is metabolized into norfluoxetine, an active metabolite with a half life of 6 days - the result is a very long duration of action.
This becomes important when switching between agents, when there is a concern for development of serotonin syndrome. For example, fluoxetine must be discontinued for 4 weeks or more, prior to the initiation of MAOi

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7
Q

Which drugs does SSRI interact with?

A

Warfarin and Aspirin

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8
Q

SSRI increases suicide in which age group?

A

below 25s

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9
Q

Side effects of SSRI

A

Insomnia
Sexual Dysfunction
Anxiety
Nausea
Drug interaction

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10
Q

Charateristics of the Serotonin Syndrome.

A

syndrome is the rapid onset of neuromuscular hyperactivity, autonomic dysfunction and altered mental state due to excessive serotonin levels peripherally and in the CNS.

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11
Q

Which SSRIs are safe in pregnancy as a second line?

A

citalopram, escitalopram, sertraline

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12
Q

How does SSRI affect the newborn?

A

Syndrome of poor neonatal adaptation
Persistent pulmonary hypertension of newborn

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13
Q

First line treatment to acute mania

A

Combination therapy has superior efficacy to monotherapy
First line
Lithium plus antipsychotic
Or
Valproate plus antipsychotic

Other:
Choice of antipsychotics: Olanzapine, risperidone, quetiapine, haloperidol, aripiprazole

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14
Q

Monotherapy of acute depression

A

Monotherapy: Quetiapine, Lamotrigine, Olanzapine, Lithium, Valproate.

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15
Q

Second line treatment to acute depression

A

Olanzapine plus fluoxetine
Lithium plus valproate/lamotrigine
Lithium/Valproate plus antidepressant

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16
Q

Maintenance management of BMD

A

Mood stabilizers:
Lithium (first line)
Other - AEDs: Lamotrigine; Valproate

Antipsychotics with mood stabilising effects:
Quetiapine
Olanzapine

17
Q

Which antipsychotic increases the risk of developing diabetes?

A

olanzapine

18
Q

Contraindication of Sodium Valproate.

A

Liver disease and Women in child bearing age.

19
Q

Adverse effects of lithium.

A

neutrophilia, weight gain
polydipsia and polyuria
hypothyroidism
renal toxicity

20
Q

Drug interactions with lithium

A

NSAIDs - decreased renal excretion with potential toxicity; Thiazides - increased lithium reabsorption with toxicity, ACEi - increased lithium concentrations with toxicity.

21
Q

Management of Acute anxiety

A

Benzodiapines

22
Q

Mechanism of action for Benzodiazepines.

A

Benzodiazepines bind to site closely related to the GABA-A receptor, inducing a conformational change in the GABA receptor that enhances its affinity for the GABA neurotransmitter. In other words, benzodiazepines have no direct action on ion flow and only enhance GABA- mediated opening of the ion channel.

This increased inhibitory neurotransmission causes sedation, onset of sleep, anterograde amnesia, anxiolysis via limbic and hypothalamic systems, anticonvulsant activity and reduction of skeletal muscle tone.

23
Q

ultrashort acting benzo

A

Midazolam

24
Q

short acting benzo

A

Oxazepam

25
Q

Intermediate-acting benzo

A

Lorazepam

26
Q

Long acting benzo

A

Diazepam

27
Q

Indications for benzodiazepine.

A

Alcohol withdrawal states
Seizures
Muscle relaxant
Acute sedation
Perioperatively

28
Q

Antidote for Benzo

A

Flumazenil
Short-acting GABA-A receptor antagonist
Reversal of procedural sedation
Risk of seizures if used in patients who are chronic benzodiazepine users

29
Q

Adverse effects of benzodiapines

A

Sedation
Respiratory depression
Amnesia
Tolerance and dependence
Potentiation of sedative effects when given with other CNS depressants
Paradoxical increase in aggression

Therapeutics (12 decks)

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