Rx Flashcards
Antidepressants BPD medication Anti-psychotics Anxiolytics
Antidepressants
Indications [7]
Unipolar and bipolar depression Organic mood disorders Schizoaffective disorder Anxiety disorders OCD Impulsivity associated with personality disorders Premenstrual dysphoric disorder
Antidepressant
Indications - anxiety disorders [3]
PTSD
Panic disorder
Social phobia
Antidepressant
First line
How long after therapeutic dose achieved that improvement is seen?
SSRI
3-6 weeks after therapeutic dose achieved before improvement seen
Antidepressant
5 types
SSRI SNRI TCA MAOI Novel antidepressants
TCA Tertiary TCA MOA Secondary TCA MOA Side effects [3 headings] Why are the SE's so widespread NB side effects in secondary TCA are generally less severe than tertiary TCA
Tertiary TCA MOA:
- acts on serotonin receptors
Secondary TCA MOA:
- blocks noradrenaline
Side effects:
Antihistaminic
Anticholinergic
Anti-adrenergic
Made up of amine side chains which are prone to react with a wide range of receptors
Tertiary TCA eg [4]
Secondary TCA eg [2]
Amitriptyline
Imipramine
Doxepine
Clomipramine
Desipramine
Nortriptyline
Name 2 anti-histaminic SE
Sedation and weight gain
Name 6 anti-cholinergic SE
Dry mouth, eyes
Constipation
Memory deficits
Delirium ~
MAOI
MOA [3]
Indication - very effective in… [1]
Eg [2]
Binds irreversibly to monoamine oxidase
Prevent inactivation of amines e.g. NE, DA, serotonin
Increased synaptic levels
Very effective in depression
Seligiline
Rasagiline
MAOI
SE [7]
Con - strict diet causes [2]
Orthostatic hypotension \+ SSRI side effects - Sick stomach, dizziness - Sedation, weight gain - Restlessness, anxiety, nervousness - Insomnia - Sexual dysfunction Hypertensive crises so strict diet required - tyramine rich foods (Cheese Reaction) or sympathomimetics
MAOI Serotonin syndrome Causes [1] Sx [7] Serious consequences [3] How to avoid Special instructions for fluoxetine and why
Cause: can develop if taken with medication that increases serotonin or have sympathomimetic actions
Sx Shivering Hyper-reflexia + myoclonus Increased temperature - pyrexial Vital sign instability Encephalopathy - delirium Restlessness Sweating - diaphoresis
Serious consequences
Hyperpyrexia
CVS shock
Death
Avoid by waiting 2 weeks before switching from SSRI > MAOI - washout period
5 week washout period if switching from fluoxetine due to long half-life
SSRI MOA Indication Eg [6] Pros
Blocks presynaptic serotonin re-uptake
Treats both anxiety and depression sx
Eg Paroxetine Sertraline Fluoxetine Citalopram Escatilopram Fluvoxamine
Pros: very little risk of cardio toxicity in overdose
SSRI
SE [7]
Pros
Cons [1] and give duration, 4 symptoms of [1]
SSRI SE
- Sick stomach, dizziness
- Sedation, weight gain
- Restlessness, anxiety, nervousness
- Insomnia
- Sexual dysfunction
Pros: very little risk of cardio toxicity in overdose Cons - discontinuation syndrome - week long - agitation, nausea, diseqm, dysphoria
SSRI - Paroxetine
Pros
Cons
Pros
- short half-life so less build up
- sedating properties offering relief from anxiety, insomnia
Cons - - Discontinuation syndrome Significant CYP2D5 inhibition so drug2 interaction - Sedating - Weight gain
SSRI - Sertraline
Pros [3]
Cons [2]
Pros
- Weak P450 interactions so fewer drug2 interactions
- Short half-life so less build up
- Less sedating that paroxetine
Cons
- Max absorption requires full stomach
- Increased no of GI SE’s
SSRI - Fluoxetine
Well known trade name?
Pros [2]
Cons [3]
Prozac
Pros
- Long half life so less incidence of discontinuation syndromes
- Initially activating providing increased energy
Cons
- Build up not good in patient with hepatic disease
- Significant P450 interactions
- More likely to induce mania than other SSRIs
SSRI - Fluoxetine
Good for which group of patients? [1]
Not so good in which group of patients? [3]
Good in non-compliant patients due to long half-life
Not so good in…
- hepatic disease due to build-up
- polypharmacy due to significant P450 interactions
- Manic, anxiety
SSRI - Paroxetine
Indication
Sedating properties are good for relief from anxiety and insomnia
SSRI - Citalopram
Half life
Pros [1]
Cons [3]
Intermediate half-life
Pros
- Low inhibition of P450 enzymes, fewer drug2 interactions
Cons
- QT prolongation
- Sedating
- GI side effects (but less than sertraline)
Which 2 SSRIs cause dose-dependent QT interval prolongation with doses 10-30mg daily and how does this influence precautions when prescribing?
Citalopram
Escitalopram
due to this risk doses of >40mg/day not recommended!
Which SSRI is associated with an increased no of GI side effects
Sertraline
Escatilopram Half-life Pros [1] Cons [3] Effectiveness compared to citalopram?
Intermediate half-life
Pros
-Low inhibition of P450 enzymes, fewer drug2 interactions
Cons
- QT prolongation
- Nausea
- Headache
- more effective than citalopram in acute response, remission
Fluvoxamine
Pros [2]
Cons [6]
Pros
- shortest half-life
- analgesic properties
Cons - discontinuation syndrome - GI upset - Headaches Sedation Strong CYP1A2, CYP2C19 inhibitor
SNRI Describe MOA, similar to...? Pro [1] Indications [3] Eg [2]
SNRI MOA: inhibits both serotonin and NE reuptake Pro: no antihistamine, anticholinergic, antiadrenergic Indications - Anxiety - Depression - ? Neuropathic pain Eg - Venlafaxine - Duloxetine
