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PHA333 > depression (PB) > Flashcards

depression (PB) Flashcards

1
Q

definition of depression

A

disorder of mood

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2
Q

classifications of depression

A

major depression (unipolar)

bipolar depression (manic depressive illness)

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3
Q

emotional symptoms of depression

A
  • sadness
  • loss of interest/pleasure
  • overwhelemed
  • anxiety
  • diminished ability to think or concentrate/indecisiveness
  • excessive/inappropriate guilt
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4
Q

physical symptoms of depression

A
  • vague aches/pains
  • headache
  • sleep disturbances
  • fatigue
  • back pain
  • significant change in appetite resulting in weight loss/gain
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5
Q

key symptoms of depression

A
  • persistent sadness or low mood

- marked loss of interests/pleasure

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6
Q

criteria used to diagnose depression/mental health disorders

A

ICD-10 (international criteria for disease)

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7
Q

How is depression divided using the ICD-10 criteria?

A
  1. subthreshold depressive symptoms - < 5 symptoms
  2. mild depression - few symptoms in excess of the 5 required to make disgnosis and symptoms only result in minor functional impairment
  3. moderate depression - symptoms or functional impairment are between mild and severe
  4. severe depression - most symptoms, they interfere with functioning, can occur with/wo psychotic symptoms
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8
Q

When to refer to mental health services?

A
  • poor/incomplete response to 2 interventions
  • recurrent episode within 1yr
  • relative referral
  • self neglect
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9
Q

When to refer to psychiatrist?

A
  • suicidal ideas/plans
  • psychotic symptoms
  • severe agitation with severe symptoms
  • severe self neglect
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10
Q

What is mainly mediated by 5HT?

A

sex
appetite
aggression

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11
Q

What is mediated by NA?

A

concentration
interest
motivation

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12
Q

What is mediated by both 5-HT and NA?

A 
depressed mood
anxiety
vague aches and pains
irritability
thought process

-> mediate broad spectrum of depressive symptoms

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13
Q

pathophysiology of depression

A
  • dysregulation of 5-HT and NA in brain strongly associated with depression
  • dysregulation of 5-HT and NA in spinal cord may be cause of inc pain perception among depressed patients
  • imbalance of 5-HT and NA may explain presence of both emotions and physical symptoms of depression
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14
Q

areas of key priority for implementation in depression

A
  • principles for assessment
  • effective delivery of interventions
  • case ID and recognition
  • low intensity psychosocial interventions
  • drug treatment
  • treatment for mod/severe depression
  • continuation and relapse prevention
  • psychological interventions for relapse prevention
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15
Q

classes of antidepressants

A
  1. monoamine uptake inhibitors
    - SSRIs, TCAs
  2. monoamine receptor antagonists
  3. monoamine recptor inhibitors
  4. melatonin receptor agonist
  5. miscellaneous
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16
Q

examples of SSRIs

A 
fluoxetine
paroxetine
sertraline
citalopram
escitalopram
fluvoxamine
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17
Q

examples of TCAs

A

imipramide
desipramide
amitriptyline
clomipramine

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18
Q

examples of monoamine receptor antagonists

A

mirtazapine
trazodone
mianserin

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19
Q

benefits of SSRIs

A

safer in overdose

don’t stimulate appetite

fewer antimuscarinic s/e than TCAs and NA uptake inhibitors

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20
Q

uses of SSRIs

A
  • depression (similar to TCAs but more expensive)
  • panic disorder (chronic anxiety, panic attack)
  • OCD
  • bulimia nervose (binge eating disorder)
  • seasonal affective disorder
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21
Q

adverse effects of SSRIs

A 
GI disturbances
- nausea
- dyspepsia
- diarrhoea
dry mouth
headache
insomnia
dizziness
sweating
erectile dysfunction
delayed orgasm
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22
Q

metabolism of fluoxetine (SSRI)

A

fluoxetine metabolised by liver to active metabolites nurfluoxetine (longer half life)

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23
Q

interactions with SSRIs

A

TCAs - inc conc of TCA

antiepileptics - inc risk of convulsions

aspirin, warfarin, NSAIDs - bleeding risk

MAOIs - inc risk of serotonin syndrome

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24
Q

c/i for SSRIs

A

hepatic and renal failure

epilepsy

manic pase

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25
What SSRIs can prolong QT interval?
citalopram | escitalopram
26
When to avoid citalopram and escitalopram?
in patients with existing QT interval prolongation if patient already taking a medication that can prolong QT interval
27
What other meds can prolong QT interval?
TCAs methadone antipsychotics erythromycin
28
max daily dose of citalopram
adults 40mg elderly 20mg hepatic impairment 20mg
29
max daily dose of escitalopram in elderly
max 10mg daily
30
counselling with SSRIs
- takes 2-4 weeks for therapeutic effect - review pt every 1-2 weeks for at least 4 weeks - treatment continued for at least 6mths - recurrent depression pt -> treatment for 2yrs - withdrawal should be slow -> withdrawal depression
31
uses of TCAs
- depression -> major and melancholic - atypical oral and facial pain - prophylaxis of panic attacks - phobia anxiety - OCD - nocturnal enuresis (involuntary urination while sleeping, imipramine)
32
adverse effects of TCAs
``` arrhythmias anxiety dizziness headache drowsiness antimuscarinic effects hyponatraemia (common in elderly) ```
33
antimuscarinic side effects
dry mouth blurred vision constipation urinary retention
34
What is hyponatraemia?
deficiency of Na in blood Na conc < 135 mEq/L
35
metabolism of TCAs
metabolised in liver
36
half life of TCAs
long 9-80hrs -> most once daily dosing
37
drug interactions of TCAs
MAOIs - risk of hypertensive crisis and hyperpyrexia antiepeleptics - antagonise effect of antiepileptic meds and reduce seizure threshold alcohol and antihistamines - inc sedative effect antihistamines and anticholinergic - inc antimuscarinic effect
38
ontraindications with TCAs
``` recent MI, heart block cardiac arrhythmias epilepsy mania severe liver disease ```
39
overdose with TCAs
OD can be fatal due to cardiac arrhythmias - sinus tachycardia - prolonged PR interval - prolonged QRS duration - prolonged QT interval - non-specific ST and T wave changes
40
hen is imporvement seen with TCAs?
after 2 weeks
41
sedative effects of TCAs
sedative - amitriptyline non-sedating - lofepramine, impiramine -> may affect ability to drive
42
SNRIs
serotonin and noradrenaline reuptake inhibitors
43
examples of SNRIs
venlafaxine duloxetine desvenlafaxine
44
uses of SNRIs
depression anxiety panic disorder pain syndromes - fibromyalgia (duloxetine)
45
adverse effects of SNRIs
``` inc BP weight loss hepatitis GI disconfort dizziness and headache ```
46
metabolism of SNRIs
metabolised in liver
47
half life of SNRIs
between 5-11hrs
48
venlafaxine
weak NA/5-HT uptake inhibitor non-selective - depression - anxiety - panic disorder with/wo agrophobia - withdrawal effects if dose missed - s/e similar to SSRIs - useful in treatment resistant pts
49
duloxetine
potent non-selective NA/5-HT uptake inhibitor - depression - anxiety - panic disorder - urinary incontinence - fibromyalgia - diabetic neuropathy (1st line) - less s/e than venlafaxine (include sexual dysfunction, sedation, nausea)
50
NRIs
noradrenaline reuptake inhibitors
51
example of NRIs
reboxetine for depression
52
reboxetine
- NRIs - depression - s/e similar to TCAs - safe in OD - low risk fo cardiac dysrythmias
53
example of a non-selective uptake inhibitor
St John's Wort weak NA/5-HT uptake inhibitor non-selective
54
St John's Wort
- non-selective uptake inhibitor - depression - few s/e - potent enzyme inducer - interacts with warfarin, theophylline, ciclosporin, oral contraceptives
55
examples of monoamine receptor antagonists
trazodone mirtazapine
56
How does trazodone work?
weak 5-HT uptake inhibitor blocks 5-HT2A, 5-HT2C, H1 receptors
57
s/e with trazodone
redation hypotension cardiac dysrhythmias
58
MOA od mirtazapine
blocks alpha2, 5-HT2C, 5-HT3 receptors enhances NA
59
s/e with mirtazepine
dry mouth sedation weight gain
60
advantages of mirtazapine
may act more rapidly than other antidepressants less nasuea and sexual dysfunction than SSRIs
61
MAO A and B substrates
MAO-A -? 5-HT, NA, DA MAO-B -> NA, DA
62
example of MAOIs
moclobemide (depression) selegiline (parkinsons) rasagiline (parkinsons)
63
uses of MAOIs
- depression - atypical oral depression - phobia anxiety and depression with anxiety
64
s/e with MAOIs
``` orthostatic hypotension weight gain sexual dysfunction dizziness headache aggravation of migraine antimuscarinis effect (dry mouth, blurred vision, constipation) ```
65
metabolism of MAOIs
in liver
66
half life of MAOIs
1-4hrs
67
interactions with MAOIs
- accumulation of amine NT may result in hypertensive crisis and hyperpyrecia - sympathomimetics (cough/decongestants) - SSRIS, TCAs - levodopa - opioid analgesics (esp pethidine) - tyramine containing foods (mature cheese, beer, broad beans)
68
c/i MAOIs
- hepatic dysfunction - epilepcy - cerebrovascular disease - phaeochromocytoma (risk of hypertnesive crisis)
69
important info for MAOIs
- avoided due to severe s/e - s/e less with selective agents particulary MAO-B hibitors - withdrawan slowly (dependence and withdrawal syndrome) - don't start antidepressants for 2 weeks after stopping MAOI (due to irreversible MAO inhibition)
70
moclobemide
reverible MAO-1 inhibitor less problematic reserved as 2nd line treatment
71
choice of antidepressant for pt on NSAIDs.aspirin
mirtazapine trazodone reboxetine moclobemide
72
What antidepressant NOT to give to pt on NSAIDs/aspirin?
SSRIs | -> inc bleeding risk
73
choice of antidepressant for pt on warfarin/heparin
mirtazepine -> NOT SSRI
74
choice of antidepressant for pt on MAOI-B
mirtazepine trazodone reboxetine -> NOT SSRI
75
choice of antidepressant for pt on theophylline, clozapine, methadone, flecainide, propafenone
sertraline
76
divisions of depressive disorders
1. single episode depressive disoeder 2. recurret depressive disorder 3. dysthymic disorder 4. mixed depressive and anxiety disorder

PHA333 (27 decks)

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