Mental Health Drugs

Question 1

First line for moderate-severe depression, panic disorder, Obsessive compulsive disorder ?

Answer 1

SSRI’s eg citalopram and sertraline.

Question 2

How are SSRI’s eliminated?

SE’s? (& those for withdrawal)

Answer 2

by liver (avoid in hepatic impaired patients) 
SE: GI upset (offer gastroprotection, appetite and weight disturbance, hypersensitivity reactions e.g. skin. Hyponatraemia (confusion in elderly). Suicidal thoughts and behaviour. Prolong QT, arrhythmias, risk of bleeding. Serotonin syndrome = autonomic hyperactivity, altered mental state and neuromuscular excitation. Caution sudden withdrawal – GI upset, sleepy, flu-like symptoms.

Question 3

Caution prescribing SSRI’s in which groups of PTs?

Interactions?

Answer 3

epilepsy, peptic ulcers, young people

Interactions: Monoamine oxidase inhibitors (serotonin syndrome), drugs that prolong QT interval e.g. antipsychotics

Question 4

second-line treatment of moderate-to-severe depression?

Answer 4

Tricyclic antidepressants - Amitryptiline etc

Question 5

Common SE of tricyclic anti depressants? Less common?

Answer 5

These include a dry mouth, constipation, sweating, slight hesitancy in passing urine and slight blurring of vision.
Tricyclic antidepressants can cause drowsiness (a sedating effect) in some people. You must be aware of this possibility, especially if you are a driver, as it may impair your ability to drive safely.

Research studies suggest that there is a small increased risk of fractures

For a few - feeling suicidal, particularly in teenagers and young adults. This may be more of a risk in the first few weeks of starting medication or after a dose increase.

Question 6

Possible SE of withdrawal from TriCyAD?

Answer 6

Withdrawal symptoms that may occur include:

Dizziness
Anxiety and agitation
Sleep disturbance
Flu-like symptoms
Diarrhoea
Tummy (abdominal) cramps
Pins and needles
Mood swings
Feeling sick (nauseated)
Low mood

Question 7

First line for: seizures and status epilepticus and alcohol withdrawal reactions?

Answer 7

Benzodiazapines eg lorazepam (long acting)

Question 8

How do benzos work?

SE and overdose casues..?

Caution in..?

Interactions?

Answer 8

Enhance binding of GABA to GABAA Receptor – depressing synaptic transmission, reducing anxiety, sleepiness, sedation and anti-convulsive effects. (Alcohol also works on GABA R w/out it provokes excitatory state)

drowsiness (driving/heavy machinery), sedation, coma. Benzodiazepine overdose: an airway obstruction, death. And SE: Dependence & withdrawal reaction.

elderly, respiratory impairment, neuromuscular disease, liver failure.

Interactions: sedation additive e.g. alcohol, opiates and may increase effect of cyt P450 inhibitors e.g. amiodarone, macrolides etc

Question 9

Donepezil? What is it? how does it work? used in? Eliminated via..?

Answer 9

Acetylcholinesterase inhibitor. A reversible cholinesterase inhibitor, increases the amount of acetylcholine in the brain. Eliminated by liver (caution: hepatic impairment)
* Used for mild-moderate dementia in Alzheimer’s disease.

Question 10

Acetylcholinesterase inhibitors - caution in which pts?

SE’s?

Answer 10

Caution: Conduction abnormalities, asthma, COPD, peptic ulcer. Caution w/ antimuscarinics

SEs: Nausea, vomiting, anorexia, diarrhoea. Fatigue, insomnia, dizziness, syncome, strange dreams.