pharma;antid

Question 1

indication

Answer 1

establish a diagnosis and identify target symptoms that will be used to monitor therapy response

Question 2

management

Answer 2

adjust dosage for optimum benefit, safety and compliance

use adjunctive and combination therapies if needed however always strive for simplest regime

Question 3

antidepressant indications

Answer 3

unipolar + bipolar depression
organic mood disorders
schizoaffective disorder
anxiety disorders incl OCD, panic, social phobia, PTSD

Question 4

antidepressant classifications

Answer 4

tricyclics (TCA)
monoamine oxidase inhibitors (MAOIs)
selective serotonin reuptake inhibitors (SSRIs)
serotonin/noradrenaline reuptake inhibitors (SNRIs)
novel antidepressants

Question 5

how do antidepressents work

Answer 5

we don’t actually know

neurotransmitters noradrenaline and serotonin are involved and antidepressants increase these levels in different ways

Question 6

TCAs

Answer 6

very effective but potentially unacceptable side effect profile i.e. antihisaminic, anticholinergic,

lethal in overdose

can cause QT lengthening even at therapeutic serum level

Question 7

tertiary TCAs

Answer 7

have tertiary amine side chains

side chains are prone to cross react with other types of receptors which leads to more side effects

Question 8

tertiary TCAs examples

Answer 8

imipramine
amitriptyline
doxepin
clomipramine

Question 9

secondary TCAs

Answer 9

are often metabolites of tertiary amines

primarily block noradrenaline

side effects as same as tertiary TCAs but genereallu

Question 10

antihistaminic

Answer 10

weight gain

Question 11

anticholinergic

Answer 11

dry mouth

blurred vision

Question 12

secondary TCAs examples

Answer 12

desipramine

notrtriptyline

Question 13

MAIOs

Answer 13

bind irreversibly to monoamine oxidase thereby preventing inactivation of amines such as norepinephrine, dopamine and serotonin leading to increased synaptic levels

very effective for resistant depression

Question 14

MAOIs side effects

Answer 14

orthostatic hypotension 
weight gain 
dry mouth 
sedation 
sexual dysfunction 
sleep disturbance

Question 15

MAOIs: cheese reaction

Answer 15

hypertensive crisis can develop when MAOIs are taken with tyramine-rich foods or sympathomimetics
*cheese reaction

Question 16

MAOIs: serotonin syndrome

Answer 16

can develop if take MAOI with meds than increase serotonin or have sympathomimetic actions

serotonin syndrome: abdo pain, diarrhoea, sweats, tachycardia, hrn, myoclonus, irritability, delirium

Question 17

MAOIs: avoiding serotonin syndrome

Answer 17

need to wait 2 weeks before switching from an SSRI to an MAOI

exception is fluoxetine where need to wait 5wks because of long half life

Question 18

SSRIs

Answer 18

block the presynaptic serotonin uptake, increasing level of serotonin

treat both anxiety and depressive symptoms

Question 19

SSRIs side effects

Answer 19

GI upset
sexual dysfunction 
anxiety 
restlessness
nervousness
insomnia 
fatigue 
sedation dizziness

Question 20

SSRIs: discontinuation syndrome

Answer 20

can develop this with agitation, nausea, disequilibrium and dysphoria

Question 21

activation syndrome

Answer 21

caused by increased serotonin. can be distressing for patient

nausea, inc anxiety, panic and agitation

typically lasts 2-10days - warn patients

Question 22

discontinuation syndrome

Answer 22

agitation, nausea, disequilibrium and dysphoria

more common with shorter half life drugs so consider switching to fluoxetine

Question 23

sertraline pros

Answer 23

very weak P450 interactions (only slight CYP2D6_
short half life with lower build-up of metabolities
less sedating when compared to paroxetine

Question 24

sertraline cons

Answer 24

max absorption requires a full stomach

increased number of GI adverse drug reactions

Question 25

fluoxetine (prozac) pros

Answer 25

long half-life so decreased incidence of discontinuation syndrome. good for patients with medication non-compliance issues

Question 26

fluoxetine (prozac) cons

Answer 26

long half life and active metabolite may build up (not good for pt with hepatic illness) initial activation may increase anxiety and insomnia more likely to induce mania than some of other SRRIs

Question 27

SNRIs

Answer 27

inhibit both serotonin and noradrenergic reuptake like the TCAs but without antihistamine and anticholinergic side effects used for depression, anxiety and possibly neuropathic pain

Question 28

SNRIs: venlafaxine pros

Answer 28

minimal drug interactions and almost no P450 activity short half life and fast renal clearance

Question 29

SNRIs: venlafaxine cons

Answer 29

can cause a 10-15mmHg dose dependent incr in BP may cause sig nausea can cause bad discontinuation syndrome sexual side effects in >30%

Question 30

duloxetine pros

Answer 30

some data to suggest efficacy for the physical symptoms of depression

Question 31

duloxetine cons

Answer 31

cannot break capsule, as active ingredient not stable within stomach in pooled analysis had higher drop out rate

Question 32

novel antidepressants: mirtazapine pros

Answer 32

different mechanism of action can be utilised as a hypnotic at lower doses secondary to antihistaminic effects

Question 33

novel antidepressants: mirtazapine cons

Answer 33

inc serum cholesterol by 20% in 15% pts and triglycerides in 6% assoc with weight gain very sedating at lower doses

Question 34

TCA overdose ECG signs

Answer 34

long QT wide QRS tachycardia