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Psychiatry > Psychopharmacology - Antidepressants > Flashcards

Psychopharmacology - Antidepressants Flashcards

1
Q

Selective serotonin reuptake inhibitors (SSRIs) examples.

A
  • Citalopram
  • Sertaline (often used in those with a previous myocardial infarction)
  • Fluoxetine (has a long half life)
  • Paroxetine
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2
Q

SSRI uses

A

Treats both anxiety and depressive symptoms.

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3
Q

SSRI side effects

A
  • GI upset
  • Sexual dysfuction
  • Hyponaetrarmia in the elderly
  • Discontinuity syndrome
  • Serotonin syndrome
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4
Q

Tricyclic antidepressants examples

A
  • Amytriptyline
  • Imipramine
  • Clomipramine
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5
Q

TCAs uses

A

DOBS

  • Depression
  • OCD (clomipramine)
  • Bed wetting (imipramine)
  • Sometimes neuropathic pain (amitriptyline)
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6
Q

TCAs side effects

A

Linked to receptor blockade:

  • anti-adrenergic
    • postural hypotension
  • anti-muscarinic
    • dry mouth
    • constipation
    • memory deficits and potentially delirium
  • anti-histaminergic
    • weight gain
    • drowsiness

Toxicity = the 3 Cs

  • Convulsions
  • Coma
  • Cardiotoxicity
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7
Q

Serotonin noradrenaline reuptake inhibitors (SNRIs) examples.

A
  • Venlafaxine
  • Duloxetine
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8
Q

SNRIs uses

A
  • Depression
  • Generalised anxiety disorder (Venlafaxine)
  • Peripheral neuropathy (Duloxetine)
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9
Q

SNRIs side effects

A
  • Increased blood pressure
  • Nausea
  • Sedation
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10
Q

Monoamine oxidase inhibitors (MAOIs) examples.

A
  • Selegiline
  • Moclobemide (reversible inhibitor of monoamine oxidase A [RIMA])
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11
Q

MAOIs uses

A

HAD

  • Hypochondriasis
  • Anxiety
  • Depression

Selegiline is a MAO-B inhibitor that is licenced for use in Parkinsons disease.

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12
Q

MAOIs side effects

A
  • Antimuscarinic
    • dry mouth
    • constipation
    • memory deficits and potentially delirium
  • The Cheese Reaction
    • hypertensive crisis that occurs with ingestion of tyramine cntaining substances (eg. cheese, pickled herring, soybean products)
  • Serotonin Syndrome
    • can develop if take MAOI with meds that increase serotonin or have sympathomimetic actions
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13
Q

Alpha 2 antagonist example

A

Mirtazapine

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14
Q

Alpha 2 antagonist (Mirtazapine) uses

A
  • Depression
  • PTSD
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15
Q

Alpha 2 antagoinst (Mirtazapine) side effects

A
  • Increased appetite and weight
  • Dry mouth
  • Sedation
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16
Q

Which antidepressant could be used for neuropathic pain?

A

Amitriptyline

17
Q

Which antidepressant could be used for peripheral neuropathy?

A

Duloxetine

18
Q

Which antidepressant can be used in Parkinson’s disease?

A

Selegiline

19
Q

Symtoms of discontinuity syndrome:

A
  • Shivering
  • Anxiety
  • Headache
  • Nausea
  • Dizziness
20
Q

Serotonin syndrome symptoms:

A
  • Muscle rigidity
  • Seizures
  • Cardiovascular collapse
  • Hyperthermia
21
Q

How is serotonin syndrome treated?

A

Cyproheptadine

22
Q

How can serotonine syndrome be avoided?

A

To avoid need to wait 2 weeks before switching from an SSRI to an MAOI. The exception is fluoxetine where need to wait 5 weeks because of long half-life.

23
Q

How long should antidepressants be continued after symptoms have ceased?

A
  • 1st time - at least 6 months
  • 2nd time - 2 years
  • 3rd time - consider lifelong prophalaxis
24
Q

How is treatment resistance managed?

A
  • Combination of antidepressants eg SSRI or SNRI with Mirtazepine
  • Adjunctive treatment with Lithium
  • Adjunctive treatment with atypical antipsychotic
  • ECT

Psychiatry (17 decks)

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