Psychiatric drugs Flashcards
Types of antidepressants
SSRIs NSRIs Mirtazapine Tricyclic antidepressants MAOIs Vortioxetine
Examples of SSRIs
Sertraline Fluoxetine Citalopram Venlafaxine Paroxetine
MoA of SSRIs
Inhibit serotonin reuptake so increase concentration of serotonin in synaptic cleft
Leads to down regulation of post synaptic receptors
Side effects of SSRIs
GI disturbance Weight change Agitation Sexual dysfunction Discontinuation syndrome Serotonin syndrome (fluoxetine) QTc prolongation (citalopram)
Examples of NSRIs
Duloxetine
Venlaxafine
Side effects of NSRIs
Similar to SSRIs except higher incidence of:
Nausea
Sexual dysfunction
Sedation
Venlaxafine can exacerbate heart failure
What antidepressants treat neuropathic pain
NSRIs
Tricyclic antidepressants
Indications for mirtazapine
Weight loss and insomnia with depression
Side effects of mirtazapine
Histamine side effects - sedation
Weight gain
Side effects of tricyclics
Muscurinic and histaminic (sedation, diarrhoea)
Arrhythmia in overdose
Disadvantages of MAOIs
Risk of tyramine reaction
Need 6 week washout period before changing to another antidepressant due to drug interactions
Examples of MAOIs
Moclobamide
What does vortioxetine treat
Cognitive symptoms in depression
What to do if antidepressants had no improvement in 2-3 weeks
Significant side effects switch immediately or see if get better in few weeks before switching
For depression- switch
For anxiety- increase dose
Describe discontinuation syndrome
Sweating Shaking Agitation Insomnia Headache Clonus N+V
Features of serotonin syndrome
Cognitive: headache, agitation, hypomania
Autonomic: sweats, hyperthermia, tachycardia, diarrhoea, vomiting
Somatic: clonus, hyperreflexia, tremor
Management of serotonin syndrome
Fluids
Monitoring
Target pathways of antipsychotics
Mesocortical
Mesolimbic
Unwanted pathways of antipsychotics and example side effects
Nigrostriatal - extrapyramidal side effects
Tuberoinfundibular - amenorrhoea, lactorrhoea, sexual dysfunction
Side effects of all antipsychotics
Sedation Extrapyramidal Weight gain Acute dystonia/oculogyric crisis QTc prolongation
How to treat extrapyramidal side effects with antipsychotics
Give anticholinergics (procyclidine) to modulate dopamine:ACh ratio
When should procyclidine not be given for antipsychotic side effects
Not if tardive dyskinesia only symptoms as can exacerbate
Examples of typical and atypical antipsychotics
Typical: haloperidol, flupenthixol
Atypical: clozapine, risperidone, olanzapine, aripiprazole
Which side effects are more common in typical and atypical classes
Typical: extrapyramidal, sexual dysfunction
Atypical: weight gain, hyperlipidaemia, diabetes
