PTS Flashcards
SSRI
Eg: sertraline, fluoxetine, paroxetine, citalopram, escitalopram
* Fluoxetine for under 18s
* Indicated for use in: depression, anxiety, OCD, bulimia nervosa
* Mechanism: inhibit the reuptake of serotonin from
presynaptic serotonin pumps
* Side effects: GI symptoms, anxiety/agitation, insomnia,
sweating, sex (anorgasmia)
* Other side effects: associated with increased suicidality, can
cause hyponatraemia, cytochrome-mediated interactions
(fluoxetine)
* Withdrawal: dizziness, headache, tremor, agitation, GI issues ~
esp paroxetine and sertraline
SNRI
Eg venlafaxine, duloxetine
* Indicated for use in: depression, anxiety
* Mechanism: presynaptic blockade of both noradrenaline and serotonin reuptake
pumps (in high doses also blocks dopamine reuptake); low effects on muscarinic,
histaminergic and alpha-adrenergic receptors.
* Side effects: dizziness, dry mouth, constipation, hot flushes
NaSSAs
Noradrenergic and Specific Serotonergic Antidepressants
* Ie Mirtazapine
* Indicated for use in: depression, anxiety (off license)
* Mechanism: presynaptic alpha2 blockage -> increased noradrenaline and
serotonin from presynaptic neurons; histamine antagonist
* Side effects: sedation and weight gain (blocking histamine), headache, postural
hypotension, dizziness, tremor
TCA
Eg amitriptyline
* Indicated for use in: depression, anxiety, OCD, chronic pain (much lower dose),
nocturnal enuresis
* CI: IHD, arrhythmias, severe liver disease, overdose risk!!
* Mechanism: blockade of both noradrenaline and serotonin reuptake pumps (also
dopamine to a small extent). Muscarinic, histaminergic, alpha-adrenergic.
* Side effects - Triple A:
* Anticholinergic effects (muscarinic receptor block): dry mouth, constipation, blurred vision, urinary retention
* Antiadrenergic effects: postural hypotension (dizziness and syncope)
* Antihistaminergic effects: sedation and weight gain
* Also cardiac effects: prolonged QT, heart block, arrhythmias, palpitations
MAOI
Monoamine Oxidase Inhibitors
MAOIs
* Mechanism: inhibit enzyme Monoamine oxidase A & B
* Indicated for use in: depression
* Side effects: overdose risk, tyramine cheese reaction (hypertensive crisis)
* Not often used in clinical practice
Lithium
Indicated for use in: mania (acute/prophylaxis), treatment-resistant depression, aggression and impulsivity, mood stabilisation
* Mechanism not clearly known
* Renally metabolised and excreted - avoid NSAIDs, ACEi, diuretics
* MONITORING essential!!!
* Baselines prior to starting: FBC, U&E, Ca2+, PO4*3-, thyroid, ECG, pregnancy
* Weekly blood tests until stable levels, then 3-monthly ~ renal & thyroid bloods too
* Narrow therapeutic index: range generally 0.5-1, 1.5-2= signs of toxicity, >2 signs of
severe toxicity
* Side effects: polyuria, polydipsia, weight gain, oedema, fine tremor
* Serious side effects: coarse tremor, ECG changes (QT), arrhythmias, nystagmus
dysarthria, brisk reflexes, impaired consciousness
* TERATOGENIC - causes Ebstein’s anomaly (congenital malformation of tricuspid valve)
Benzo
Eg: lorazepam (short acting), diazepam (longer acting), midazolam, chlordiazepoxide
* Indicated for use in: anxiety (short term in extreme cases only), mania, psychosis,
alcohol withdrawal, insomnia, acute agitation/aggression, epilepsy, acute back pain
* Mechanism: bind to GABA receptor -> neuronal inhibition
* Cautions: can be addictive if taken long term, resp and CNS depressant effects (so
check if other CNS depressants being taken eg xs alcohol or antipsychotics)
* Avoid in neuro disease, severe resp disease
Z drugs
Eg: zopiclone
* Indicated for use in: initiating sleep (sleeping tablets)
* Mechanism: stimulate GABA receptor
* Can become dependent
* Again caution in resp and neuro disease
Sodium valproate
Indicated for use as: mood stabiliser, anticonvulsant, migraine
* HIGHLY TERATOGENIC - avoid in pregnant women/women of childbearing age!
* Side effects: weight gain, dizziness, hair loss, n+v, tremor, deranged LFTs
Antipsychotics
Indicated for use in: psychosis, mania, depression, refractory anxiety, PTSD, behavioural challenges in dementia, tourettes, rapid tranquilisation
- Side effects: effects of anticholinergic, histamine blockage, alpha-adrenergic receptor blockage; can lower seizure threshold, ECG QT prolongation
- Extrapyramidal side effects (assoc with typical APs):
- Parkinsonian symptoms: resting tremor, rigidity, bradykinesia
- Acute dystonia: painful involuntary contraction of muscles - in neck/jaw/eyes
- Tardive dyskinesia: rhythmic movements of tongue/face/limbs/trunk - after years
- avoid anticholinergic drugs!
Antipsychotics - typical
Mechanism: antagonise D2 receptors involved in: mesolimbic (delusions and hallucinations), mesocortical (negative symptoms), substantia nigra (movement, blocking -> extrapyramidal side effects), tuberoinfundibular (prolactin secretion -> sexual function and libido), chemoreceptor trigger zone (n+v)
* Eg: haloperidol, chlorpromazine, flupentixol
Atypical antipsychotics
Mechanism: block 5HT2 receptor -> metabolic side effects (eg weight gain, impaired glycaemic control, lipid elevation)
* Eg: risperidone, olanzapine, quetiapine, aripiprazole, clozapine
* Clozapine: use in treatment-resistant schizophrenia; lots of side effects inc hypersalivation, constipation, myocarditis, cardiomyopathy, neutropenia and agranulocytosis!
Methadone
Used as oral substitution therapy in addictions
* Opiate receptor agonist
* Risk of respiratory depression
Buprenorphine
Oral substitution in opiate dependence
* Partial opiate receptor agonist
* Patient needs to be in state of withdrawal
before starting or will cause withdrawal
AChE inhibitors
- Eg: donepezil, rivastigmine, galantamine
- Indicated for use in: mild-moderate Alzheimer’s disease
- Baseline ECG and PR - risk of bradycardia
- Side effects: fatigue, GI issues, bradycardia
