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Mental health drugs Flashcards

1
Q

Name one tricyclic antidepressant

A

amitriptyline

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2
Q

What is the mechanism by which amitriptyline exerts its action?

A
  • blocks the re-uptake of 5-HT and noradrenaline - increases availability for neurotransmission
  • Also blocks dopamine, histamine, alpha-adrenergic and muscarinic/cholinergic receptors
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3
Q

What are the indications for tricyclic anti-depressants?

A
  1. 2nd Line for moderate-severe depression where SSRIs not effective
  2. Tx option for neuropathic pain (not licensed for use)
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4
Q

What are the CIs for anti-tricyclic drugs?

A 
CV disease
Elderly
Epileptics (reduces seizure threshold)
Prostatic hypertrophy - urinary retention
Increased intra-occular pressure
Constipation
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5
Q

What are the SEs for tricyclic anti-depressants?

A

Brain - hallucinations, convulsions, mania

CV - arrthymias, prolongs QT and QRS

Dopamine blockage - breast changes/gynaecomastia, sexual dysfunction, extrapyramidal Sx (dyskinesia, tremor)

Histamine/Alpha-adrenergics - hypotension, drowsiness

Anti-cholinergics effects - constipation, urinary retention, dry mouth, blurry eyes (reduces tears)

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6
Q

What are the potential interactions of amitriptyline?

A

Should not be combined with MAO inhibitors or any other drugs that increase 5-HT/NA - may cause serotonin syndrome

Should also not be combined with drugs that block dopamine, muscarinic, histamine or hypotensive drugs

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7
Q

What happens if you take an overdose of amitriptyline?

A
  • Hypotension, arrthymias, convulsions, coma, resp failures
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8
Q

What happens if you withdraw amitriptyline too quickly?

A

GI upset, neurological and flu like symptoms, sleep disturbances

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9
Q

Name 3 SSRIs

A

Citalopram, sertraline, fluoxetine

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10
Q

What is the mechanism by which SSRIs (citralopram, sertraline, fluoxatine) exert their action?

A

Inhibits the re-uptake of serotonin back from neural cleft]

Increases avaliability of 5HT for neurotransmission (improves moods and stabilises associated behaviours)

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11
Q

Why are the SEs of SSRIs less that those of tricyclic antidepressants?

A

Because SSRIs do not block other receptors (dopamine, histamine, cholinergic, alpha-adrenergic), resulting in associated SEs

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12
Q

What are the CIs for SSRIs?

A
  • Epileptics - lowers seizure threshold
  • Young people - reduced efficacy and associated with an increased risk of suicidal thoughts and self harm
  • Peptic ulcer disease - increased risk of bleeding
  • Hepatic impairment - metabolised by liver
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13
Q

What are the SEs of SSRIs?

A

8 S’s

  • stomach upset/bleeding
  • Size (weight gain)
  • Serotonin syndrome - triad of altered mental state, neuromuscular excitability, autonomic hyperactivity (hyperthermia)
  • Sexual dysfunction
  • Skin rash (hypersensitivity)
  • Suicidal thoughts
  • Stress (anxiety/worry)
  • Seizure threshold reduced
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14
Q

What are the indications for SSRIs? Citralopram, sertraline, fluoxetine

A
  1. 1st line for treatment of moderate-severe depression
  2. Obsessive compulsive disorders
  3. Panic disorders
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15
Q

What are the drug interactions of SSRIs? (Citralopram, sertraline, fluoxetine)

A
  • Do not combine with other serotonin increasing drugs e.g. MAO inhibitors, tricyclics - serotonin syndrome and potential overdose (convulsions, coma and cardiotoxicity- arrythmias)
  • Avoid combination with Aspirin/NSAIDs - increased risk of gastric bleed - offer gastroprotection e.g. PPI
  • Avoid combo with drugs that prolong QT duration
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16
Q

How long should antidepressant drugs be taken for?

A

6 months at least

17
Q

What should be avoided wren taking anti-depressants?

A
  • St John’s wort
  • alcohol
  • reduce caffeine
18
Q

Name 3 benzodiazepines

A

Diazepam, Lorazepam, terezepam

19
Q

What is the mechanism by benzodiazepines work?

A

Act on GABAa receptors: GABA binding results in opening of chloride channels, increasing chloride entry into cell.This results in increased resistance to depolarisation.

Benzo’s facilitate and increase GABA binding to GABAa - results in widespread depression of synaptic transmission

Results in sedation, sleepiness, anti-convulsants effects and reduced anxiety

20
Q

What also acts on GABAa receptors?

A

Alcohol binds to same receptor - use this as means to treat alcohol withdrawal

21
Q

What are the indications for benzos?

A
  1. First line management and Tx for seizures and status epilepticus
  2. First line Tx for alcohol withdrawal
  3. Common use for sedating patients prior to invasive procedures that do not warrant anaesthesia
  4. Short term Tx for seizure, disabling and distressing anxiety and insomnia
22
Q

What are the CI for benzodiazepines?

A
  • Elderly (increased effect)
  • Respiratory impairment
  • neuromuscular disorders (e.g. myaesthenia gravis)
  • Liver failure - could precipitate hepatic encephalopathy
23
Q

What are the SEs of benzos?

A
  • Sedation/drowsiness
  • Coma
  • Loss of respiratory reflexes - result in airway obstruction/death
  • Dependence
  • Withdrawal (upon rapid cessation)
24
Q

What are the potential interactions of benzos?

A
  • Most are metabolised by CYP450 - increased risk of toxic doses if combined with CYP450 inhibitor
  • Additive in combo with sedating drugs e.g. opioids, alcohol
25
Q

Name one anti-cholinesterase inhibitor

A

Donepezil

26
Q

What is the mechanism by which donepezil/anticholinesterase inhibitors exert their action?

A

Alzheimer’s - mechanism implicated is a reduction in ACh in the brain

Donepezil - reversible, non-competitive inhibitor of anticholinesterase. Centrally acting.

Inhibits the hydrolysis of ACh in the brain, increasing availability for neurotransmission

27
Q

What are the indications for donepezil?

A

First line treatment for mild-moderate dementia in Alzheimers disease

28
Q

What are the CIs for donepezil?

A

Cause cause unwanted cholinergic effects! Cautioned in..

  • Asthma/COPD (can increase smooth muscle tone)
  • Supra-ventricular conduction abnormalities (reduces HR)
  • Sick sinus syndrome
  • Patients susceptible to peptic ulceration
  • Anti-psychotics
29
Q

What are the SEs of anticholinesterase inhibitors/donepezil?

A
  • Insomnia/weird dreams
  • Hallucinations
  • Agitation/aggression
  • Fatigue
  • Dizziness/drowsiness
  • Urinary incontinence
  • N/V/D
  • Muscle cramps
  • Rash/urticaria

Drugs (9 decks)

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