Depressive disordes Flashcards
1) Name the P drugs that are selective serotonin reuptake inhibitors.
2) Name 2 serotonin and noradrenaline reuptake inhibitors.
3) What is Reboxetine and what is it used for?
1) Sertraline, Citalopram, Fluoxetine.
2) Duloxetine and Venlafaxine.
3) Selective NAD reuptake inhibitor used for depression and as an adjunct for chronic neuropathic pain.
1) Name the P drug which is a pre-synaptic alpha-2 adrenoreceptor blocker and state what it can be used for.
2) Name the 3 tricyclic antidepressant P drugs and state what they can be used for.
3) Name an MAOI and name a RIMA and state what they can be used for.
1) Mirtazapine - used for depression and as an adjunct for neuropathic pain.
2) Amitryptyline, Imipramine and Lofepramine - used for depression and as an adjunct for chronic neuropathic pain.
3) MAOI = Phenelzine, RIMA = Moclobemide. Used for major depression and phobic patients with hypochondriacal features and for social anxiety disorder.
Name the 2 common clinical indications for the use of tricyclic antidepressants.
1) 2nd line treatment for moderate to severe depression where first line SSRIs are ineffective.
2) Treatment option for neuropathic pain (not licensed for this indication).
Give a brief description of the basic mechanism of action of tricyclic antidepressants.
Inhibit neuronal uptake of serotonin and noradrenaline from the synaptic cleft, thereby increasing their availability for transmission.
Name the 5 types of receptors that tricyclic antidepressants can block and state what effect this can have.
1) Histamine - H1
2) Muscarinic
3) Alpha-1 adrenoreceptors.
2) Alpha-2 adrenoreceptors
5) Dopamine - D2
It is thought that this accounts for the extensive adverse effects profile that limits TCAs clinical utility.
1) What side effects does blockade of antimuscarinic receptors cause in use of TCAs?
2) What side effects does blockade of H1 and A1 receptors cause?
3) What cardiac adverse effects might occur as a result of using TCAs?
1) Dry mouth, constipation, urinary retention and blurred vision.
2) Sedation and hypotension.
3) Arrhythmias and ECG changes (prolongation of QT and QRS durations).
1) Name 3 serious side effects of TCAs that can affect the brain.
2) Breast changes, sexual dysfunction and occasionally extra-pyramidal symptoms can occur due to TCAs blocking which receptors?
3) Name 2 extra-pyramidal side effects.
4) Give 5 effects which make TCAs dangerous in overdose.
5) Sudden withdrawal of TCAs can cause what?
1) Convulsions, hallucinations and mania.
2) Dopamine receptors.
3) Tremor and dyskinesia.
4) Severe hypotension, arrhythmias, convulsions, coma and respiratory failure, all of which can be fatal.
5) GI upset, neurological and influenza-like symptoms and sleep disturbance.
Name the 6 groups of patients who are particularly susceptible to the adverse effects of TCAs and state why these people are at particular risk.
1) Elderly
2) Patients with CVD
3) Epilepsy
4) Constipation
5) Prostatic hypertrophy
6) Raised intraocular pressure
All of the above conditions can be worsened through the use of antimuscarinic drugs.
1) Why should TCAs not be used with MAOIs?
2) TCAs can augment which 3 types of adverse effects of other drugs?
1) Both classes increase serotonin and noradrenaline levels at the synapse and together these can precipitate hypertension, hyperthermia and serotonin syndrome.
2) antimuscarinic, sedative or hypotensive adverse effects of other drugs.
1) Why are TCAs reserved for patients in whom SSRIs are ineffective?
2) Name the TCA with fewer adverse effects than the others.
3) Name the TCA which is more commonly used for neuropathic pain at a much lower dose than for depression.
4) For TCAs, how long does it take for relief of symptoms to develop and evolve?
1) Because they have more adverse effects and are more dangerous in overdose than SSRIs but have the same efficacy.
2) Lofepramine.
3) Amitriptyline.
4) From the first week.
