pharmacology Flashcards
What are the first line antidepressants?
Selective serotonin reuptake inhibitors
What are examples of SSRIs?
Fluoxetine (Prozac)
Citalopram
Sertraline
Paroxetine
Which SSRI is best for IHD?
sertraline
How long does it roughly take SSRIs to work?
6 weeks
What are side effects of SSRIs?
Anxiety; appetite abnormal; arrhythmias; arthralgia; confusion; depersonalisation; drowsiness; dry mouth; fever; gastrointestinal discomfort; haemorrhage; headache; hyperhidrosis; malaise; memory loss; menstrual cycle irregularities; mydriasis; palpitations; paraesthesia; QT interval prolongation; sexual dysfunction; skin reactions; sleep disorders; taste altered; tinnitus; tremor; urinary disorders; visual impairment; vomiting; weight changes
What are second line antidepressants?
SNRI -serotonin and noadrenaline reuptake Inhibitor.
NaSSA- noradrenergic and specific serotonergic antidepressant
Give an example of a SNRI
venlafaxine
duloxetine
Give an example or NaSSA
mirtazapine
What are the third line antidepressants?
tri cyclic antidepressants (TCA)
Give an example of a TCA
Amitriptyline. Amoxapine. Desipramine Doxepin. Imipramine Nortriptyline Protriptyline. Trimipramine
What are the side effects of TCAs?
blurred vision, dry mouth, nausea, dangerous OD
What are first line anti psychotics
second generation:
resperidone, quetiapine, olanzapine
third generation:
aripiprazole
What are the side effects of anti psychotics?
weight gain, dyslipidemia and hyperglycaemia. QT elongation, more likely to have seizures, ED and decreased libido
What side effects does olanzapine specifically cause?
raised prolactin, particularly bad for weight gain
What side effects are particular to aripiprazole?
restlessness
What are second line antipsychotics?
first generation:
haloperidol
chlorpromazine
What side effects do first generation antipsychotics cause?
extra pyramidal due to low B vitamins, eg acute dystonia
How do you treat the side effcts of first gen antipsychotics?
procyclodine
What are third line antipsychotic?
clozapine
What can be used as a mood stabiliser first line?
lithium
What are second line mood stabilisers?
quetiapine (good for psychotic sx)
sodium vaporate
carbamazepine
What are the side effects of lithium?
lithium toxicity, nephrotoxic, hypothyroid
nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia
What is contraindicated with lithium?
NSAIDs
What are used as hypnotics?
benzodiazapines eg diazepam, lorezapam
What is the cheese effect and what drugs does it happenw with?
An acute attack of hypertension that can occur in a person taking a monoamine oxidase inhibitor (MAOI) drug who eats cheese, caused by an interaction of the MAOI with tyramine
e.g. rasagiline and selegiline
SE antipsychotics in elderly
Antipsychotics in the elderly - increased risk of stroke and VTE
Which SSRI is most likely to lead to heart arrythmias?
Citalopram is the most likely selective serotonin reuptake inhibitor (SSRI) to lead to QT prolongation and Torsades de pointes.
Which atypical antipsychotic has the lowest SE profile?
aripiprazole
