Management Flashcards
What type of drugs get across the BBB the easiest?
hydrophobic/lipophilic drugs
What are the main classes of antidepressants?
- Monoamine oxidase inhibitors
- Monoamine reuptake inhibitors: tricyclics, SSRIs and others
- Atypical antidepressants
What are the features of monoamine oxidase inhibitors?
- irreversible or reversible inhibitors of MAO-A and B
- can cause a hypertensive crisis with cheese
- not used very commonly anymore
What are the features of tricyclic antidepressants?
- eg imipramine, dosulepin, amitriptyline and lofepramine
- block the reuptake of monoamines into the presynaptic terminals
- anticholinergic side-effects so dry mouth, blurred vision, constipation and urinary retention and tachycardia, weight gain, sedation
What are some other monoamine reuptake inhibitor antidepressants?
eg venlafaxine and duloxetine with side-effects similar to SSRIs
What are the features of SSRIs?
- eg fluoxetine, citalopram, sertraline
- selectively inhibit reuptake of serotonin from the synaptic cleft
- side effects are nausea and headache
- can have transient increase in anxiety and suicidal ideation, vivid dreaming and sweating
What are the features of atypical antidepressants?
- eg mirtazapine
- can block serotonergic side-effects of other drugs
- can cause severe weight gain and sedation
How do the antidepressant drugs differ?
all similar efficacy with delayed onset of action of a few weeks but differ in terms of side-effects
What are the side-effects of lithium?
- nausea, hypothyroidism, tremor and polyuria
- toxicity= ataxia, vomiting and diarrhoea
What drug is particularly bad in pregnancy?
valproic acid
What drugs are good mood stabilisers?
- Antipsychotics eg quetiapine etc
- Anticonvulsant drugs eg valproic acid, lamotrigine and carbamazepine
What is the mechanism of action of most antidepressants?
- affect synaptic levels of the monoamine neurotransmitters
- reduce the breakdown of neurotransmitters or inhibit their reuptake into the presynaptic terminal
What do patients need if they are on lithium?
- side-effect education
- blood levels monitoring is essential for Li, U&E, ECG, LFTs and Ca
- therapeutic window is very near the toxic window
What are the four main scoring systems for mood disorders?
- IDS is sections with options for how the patient is feeling
- QIDS is same questions but shorter
- MADRS is a scale
- HADS is hospital anxiety and depression scale
How is ECT delivered?
under GA with a muscle relaxant and then stimulant given causes seizure for 15-30 seconds with EEG for monitoring
How does ECT work?
acts on the CNS, how neurons connect with each other/fire and the amount of neurotransmitters being released in severe depression
What are the types of psychotherapy that can be given to patients?
- CBT
- CBASP
- ACT
- psychoeducation
How do antipsychotics work?
- dopamine receptor binding (60-80% of receptor blocking is ideal)
- commonly at the mesolimbic pathway especially the D2 receptors
- causes a functional decrease in dopamine
What are common dopaminergic side effects?
- extra-pyramidal: acute dystonia, parkinsonism and tardive dyskinesia (nigrostriatal pathway)
- hyperprolactinemia: sexual side-effects, amenorrhea, galactorrhea and osteoporosis (tuberoinfundibulnar pathway)
- akathisia/restless legs (nigrostriatal pathway)
How are the extrapyramidal side-effects of antipsychotics treated?
lowering the ACh to the lowered dopamine level with anticholinergics eg procyclidine
What is a rare but fatal side-effect of antipsychotics?
Neuroleptic malignant syndrome presents as increasing muscle tone, pyrexia, with changing BP to rhabdo to coma to death
