MH Flashcards
examples for tricyclic antidepressant?
amitriptyline, lofepramine
indication for tricyclic antidepressant
second line treatment for moderate-severe depression where 1st line SSRI are ineffective
treatment option for neuropathic pain (not license though)
MOA for tricyclic antidepressant
inhibit the reuptake of serotonin (5-HT) and noradrenaline from the synaptic cleft - inc availability of neurotransmission and hence mood and physical symptoms
black muscarinic, histamine (H1), alpha-adrenergic (Alpha 1&2), dopamine receptors limiting the clinical use of this drug and many adverse effect
contra-indication ofr tricyclic antidepressants
elderly pts, cardiovascular disease, eliepsy, constipation, prostatic hypertrophy, raised IOP
side-effect of tricyclic anti-depressants
antimuscarinic - dry mouth, constipation, urinary retention and blurred vision
H1 & Alpha 1 receptors - sedation and hypotension, cardiac arrhythmia, ECG changes (incl. prolongation of QT and QRS durations)
brain - convulsions, hallucinations, and mania (period of excitement)
dopamine - breast changes, sexual dysfunction and extrapyramidal symptoms (eg tremor and dyskinesia, rare)
if in overdose - dangerous, severe hypotension, arrhythmia, convulsion, coma and resp failure - fatal
sudden withdrawal - GI upset, neurological and influenza-like symptoms and sleep disturbance
interaction of tricyclic antidepressants
should not be given with monoamine oxidase inhibitors as both inc serotonin and noradrenaline levels at the synapse - can cause hypertension and hyperthermia or serotonin syndrome
antimuscarinic, sedative or hypotensive drugs
where is tricyclic antidepressant eliminated
liver
pt info for tricyclic antidepressants
more side effects than SSRIs, continue treatment for >6 moth (can only be taken off slowly as withdrawal effect of sudden withdrawal)
constant review over 1-2 weeks
what does SSRI stand for
Selective Serotonin Reuptake Inhibitors
What are some examples for SSRI
Citalopram, Fluoxetine, sertraline, escitalopram
indication for SSRI
-1st line for moderate-severe depression and in mild depression if pyschological treatment fails
painc disorder
Obsessive compulsive disorder
MOA for SSRI
inhibit neuronal reuptake of serotonin (5-HT) from synaptic cleft
SSRi do not inhibit noradrenaline uptake and so less blockade than tricyclic
contra-indication for SSRI
eliepsy, peptic ulcer depression, young ppl (might lead to inc risk of self-harm), hepatic impairment pts
where is SSRI metabolised
liver
side effect of SSRI
GI upset, appetite and weight disturbance
hyponatraemia (low Na2+ level) - might cause confusion and reduced consciousness
suicidal thoughts and behaviour might inc in pts on SSRI
lower seizures threshold
prolong QT interval and arrhythmia (citalopram)
inc risk of bleeding
serotonin syndrome (in high dose) - triad of hypersensitivity, altered mental state and neuromuscular excitation
sudden withdrawal - GI upset, neurological and influenza-like symptoms and sleep disturbance
interaction of SSRi
monoamine oxidase inhibitors - inc synaptic serotonin level
aspirin or NSAIDs or anti-coagulants - inc risk of bleeding
drugs which prolong QT interval
pt info for SSRI
continue treatment for >6moths and review 1-2 weeks
what is the classname for diazepam
Benzodiazepines
what are some examples of benzodiazepine
diazepam, temazepam, -pam
indication for benzodiazepine
1st line for seizure and statuys epilepticus, alcohol withdrawal reactions
common choice for sedation for interventional procedures if general analgesia is unnecessary or undersirable
short-term use for severe, disabling or distressing and insomnia
MOA for benzodiazepine
target s the GABA a receptor (dorsal-aminobutyric acid type A) which is a chlordie channel that opens when binding by GABA and has the effect of inhibitory nuerotransmitter in the brain.
open of this channel allows chloride to flow into cell and make cell more resistance to depoloriation and hence firing.
Benzo failitate and enhance binding of GABA to the GABA a receptor and so depressaning on synaptic transmission
This reduce anxiety, sleepiness, sedation and anticonvulsant effect and so making pt more happy
ethanol alos binds to GABA a receptor and so cuases tolerant of ethanol in alcohol excessive use and so Benzo can be used instead of alcohol for withdrawal effect
contra-indication of benzo
elderly - more susceptible
benzo should be avoided in pt with significant resp impairment or neuromusclar disease (eg myasthenia gravis)
should be avoided in liver failure as benzo can cuase liver encephalopathy (lorzepram - depends less on liver for elmination)
where is benzo eliminated
liver
side effect of benzo
dose-dependant drowsiness, sedation and coma
can lead to airway relax loss and airway obstruction and death
dependance can be built up and cause withdrawal reaction
interaction of benzo
inc effect with drug of sedative effect which requires P450 elimination eg alochol, opioids, amiodarone, diltiazem etc
what is the class name for donepezil
ACh-ase inhibitors
MOA of donepezil
more Ach at synspes
main indiction for donepezil
Alzheimer’s
contra-indication for donepezil
heart disease, COPD, asthma, arrhythmia, peptic ulcer
side effect for donepezil
N+V, diarrhoea, sleep issues, cramps, anorexia,
where is donepezil eliminated
liver
interaction of donepezil
NSAIDs
