Mental Health Flashcards
Example of tricyclics
amitriptyline
how does amitriptyline work
- inhibits reuptake of serotonin and noradrenaline from the synaptic cleft
- also blocks other receptors such as dopamine, histamine, muscarinic…etc.,
when is amitriptyline used?
- moderate-severe depression (when SSRIs are contraindicated / ineffective)
- neuropathic pain (at a lower dose as this is off-licence)
side effects of amitriptyline
hypotension, arrhythmias, sedation
more serious: convulsions, mania, hallucinations
when is amitriptyline contraindicated
- cardiac conditions, elderly, increased risk of epilepsy, glaucoma, constipation, prostatic hypertrophy
possible interactions with amitriptyline
mono-amine oxidase inhibitors
what is an SSRI
selective serotonin re-uptake inhibitor
example of SSRI
citalopram
how do SSRIs work
inhibit neuronal re-uptake of serotonin from the synaptic cleft - increasing serotonin availability for neurotransmission
when are SSRIs used
- depression
- OCD
- panic disorders
contraindications for SSRIs
- young people be cautious (risk of increased thoughts of self harm / suicide)
- epilepsy
- hepatic impairment (be cautious)
side effects of citalopram
GI disturbance, seizures, self harm and suicidal thoughts, increased risk of bleeding, hyponatraemia
possible interactions of citalopram
mono-amine oxidase inhibitors
difference between SSRIs and tricyclic antidepressants
- Tricyclic: also inhibits re-uptake of noradrenaline
- Tricyclic also blocks other receptors (increasing adverse effects)
examples of benzodiazepines
diazepam, lorazepam, temazepam
how do benzodiazepines work
- facilitate and enhance binding of GABA to GABAa receptors
- GABA is an inhibitory neurotransmitter which binds to the GABA chloride channel, allowing Cl- to enter the cell
- Cl- allows the cell to become more resistant to depolarisation
- overall, it gives a depressant effect on synaptic transmission
when are benzodiazepines used?
- first line treatment for seizures and static epilepticus
- alcohol withdrawal reactions
- sedatives
- anxiety and insomnia as short term relief (sleeping tablets)
when are benzodiazepines contraindicated?
- increased effect on elderly
- severe renal impairment
- severe neuromuscular disease
- liver failure
side effects of benzodiazepines
drowsiness, sedation, coma, airway obstruction which could lead to death, dependence and withdrawal symptoms
interactions of benzodiazepines
be cautious giving them with other sedately drugs
example of acetylcholinesterase inhibitors
donepezil, rivastigmine, galantamine
how do acetylcholinesterase inhibitors work
- inhibit acetylcholinesterase enzymes which breakdown acetylcholine
- this increases availability of acetylcholine which decreases the rate of cognitive decline as it is involved in functions such as learning and memory
when are acetylcholinesterase inhibitors used?
- alzheimers disease / dementia
- sometimes in dementia of Parkinson’s dosease
contraindications for acetylcholinesterase inhibitors
increases effects of: asthma, COPD, PUD
do not use if: heart block, sick sinus syndrome
side effects for acetylcholinesterase inhibitors
Nausea and vomiting, diarrhoea, altered / aggressive behaviour, COPD and asthma exacerbations, serious effects include bradycardia, heart block, peptic ulcers, bleeds
possible interactions of acetylcholinesterase inhibitors
- if on NSAIDs, increased risk of PUB
- if on beta blockers, increased risk of bradycardia
