Mental Health Flashcards
Amitryptalline (Elavil)
Tricyclic Antidepressants: Serotonin/Noradrenaline reuptake inhibitors (SNRIs)
Mechanism of Tricyclic Antidepressants
3 ring structure that blocks the reuptake channels (A2-adrenoreceptors) in the presynaptic membrane inhibiting uptake of Noradrenaline and Serotonin (5-HT)
Indications for Amitryptalline
Second-line choices after SSRIs
- Depression accompanied by anxiety or insomnia
- Neuropathic pain
- Migraine Prophylaxis
- Eneuresis (bedwetting)
Contraindications for Amitryptalline
CV disease, hyperthyroidism, phaechromocytomas
Comas, Fits, Arrhythmias
Prosthatic hypertrophy, constipation, urinary retention, increase intraocular pressure
Psychosis or Bipolar Disorder
Side effects of Amitryptilline
CV: heart block, arrhythmias, postural hypotension, tachycardia
CNS: anxiety dizziness, agitation, confusion, hallucinations, delusions, tremor, dysarthria
Antimuscarinic: dry mouth, blurred vision, constipation, urinary retention
Endocrine: breast enlargement, galactorrhoea, gynaecomastia, sexual dysfunction, increase appetite, weight gain, restlessness,
Drowsiness
Interactions of Amitriptyline
-TCA or SSRI should not be given with Monoamine Oxidase Inhibitors (MOAs)
All drugs that have a sedative effect intensifies Amitripytyline
- Anti-arrhythmic drugs with TCA can increase arrhythmia
- Anti-epileptics drug effects are reduced with TCA
Elimination of Amitryptyline
Onset slow: 4-6 weeks before concluding drug is not working
Rapidly absorbed orally
Metablosed in the liver
Dose of Amitryptiline
Depression: 75mg OD
Neuropathic pain: 10mg every night (ON)
Migraine prophylaxis: 10mg every night (ON)
Citalopram (Escitalopram)
Selective Serotonin Reuptake Inhibitors
Mechanism of SSRIs
SSRIs block receptors on the presynaptic membrane that take up Serotonin
Indications of Citalopram
Depressive illness and panic disorder
Social and generalized anxiety disorder
Contraindications for SSRIs
Epilepsy Diabetes Liver or kidney problems Have had a manic-depressive illness Cardiac Disease Have been taking MAOIs or other antidepressants Present in milk
Specific Contraindication for Citalopram
Susceptibility to QT-interval prolongation
Interactions for Citalopram
Sumatriptan, other 5HT1 agonists, and lithium
Anticoagulants
St John’s Wort
MOAIs: avoid if MAOIs have been taken in the last 14 days
Side effects of Citalopram
Acute angle closure glaucoma Apathy (lack of interest) Flatulence Hyper salivation Migraine Rhinitis
Diazepam (Lorazepam, Dialar, Diazemuls)
Benzodiazepine
Mechanism of Benzodiazepam
Depresses activity in the brain by promoting action of GABA which binds to neurons blocking transmission of impulses. Benzodiazepines increases the inhibitory effects of GABA on brain cells.
Indications for Diazepam
Relieve tension and nervousness
Muscle relaxant
Encourage sleep
Anxiety, insomnia, treatment for alcohol withdrawal and relief of epileptic seizures
Contraindications for Diazepam
Severe respiratory disease
Long-term liver or kidney problems
Have had alcohol or drug-abuse
Have myasthenia gravis or muscle weakness
Sleep apnoea, marked personality disorder
Porphyria (abnormal metabolism of Hb)
Interactions for Diazepam
- Sedatives: anti-anxiety drugs, sleeping drugs, antihistamines, opioid analgesics, antidepressants and antipsychotics
- Omeprazole, Cimetidine, Iosaniazid, Fosamprenavir and ritonavir
- Rifampicin may reduce effect of Diazepam
Donepezil
Acetylcholinesterase Inhibitor
Donepezil
Acetylcholinesterase Inhibitor. Blocking the enzyme raises levels of acetylcholine in the brain increasing awareness and memory
Indications for Donepezil
Alzheimers Disease
10mg ON
Contraindicatons for Donepezil
Asthma Chronic Obstructive Pulmonary Disease Sick Sinus Syndrome Gastric or Duodenal ulcer Taking NSAID regularly Pregnancy and breast feeding
