The Perplexing Pharmacology of Psychiatric Pills

Question 1

Fluoxetine, citalopram, escitalopram and sertraline are what class of drugs and how do they work?

Answer 1

Selective serotonin reuptake inhibitors

Selectively inhibit reuptake of serotonin from synaptic cleft

Question 2

You are performing a med review on a man who recently had an MI. You notice that he is on citalopram which, after searching your ‘mind palace’, you remember that it is associated with a prolonged QT. The man is not keen to switch as he finds it really works; what drug should you switch him to/

Answer 2

Sertraline

Good cardiac safety profile

Question 3

Which group would you like to monitor closely after prescribing them sertraline and why?

Answer 3

Under 25s

Particularly associated with transient increased risk of suicide

Question 4

A 16 year old girl presents to the psych ward following an acute severe depressive episode. What pharma treatment would be most helpful here? What should be done if she’s known to overdose on ibuprofen?

Answer 4

Fluoxetine

Co-prescribe a PPI to reduce GI upset and bleeding

Question 5

A 19 year old presents to the GP to discuss their paroxetine. They believe that they are doing well following a year on the meds and want to come off it. What counselling should be given regarding time and side effects?

Answer 5

Will need to taper over 4 weeks

Discontinuation symptoms like GI upset are very common

Question 6

Outline why an SSRI is contraindicated if taking each of the following drugs?

NSAIDS

Asprin

Antiplatelets

Triptans

MAOIs

Answer 6

NSAIDS and aspirin: Gastric bleeding

Warfarin/heparin: Consider mirtazepine

triptans and MAOIs: Serotonin syndrome

Question 7

Venlafaxine and duloxetine are which class of drug?

Answer 7

Serotonin/noradrenaline reuptake inhibitor

Inhibits reuptake of synaptic 5-HT and NA

Question 8

What are the adverse effects of SNRIs?

Answer 8

GI upset and ‘fragile’ (shaky, weak, insomnia, nervous)

Question 9

What in particular needs monitored in SNRIs?

Answer 9

Blood pressure

Question 10

What are the two main benefits to citalopram compared to other members of its class?

Answer 10

Compared to other SSRIs…

Lesser drug interactions

Less likely to reduce seizure threshold

Question 11

Which one of the following is not a tricyclic antidepressant:

Lofepramine

Amitriptyline

Dosulepin

Mirtazepine

Answer 11

Mirtazepine: its a tetracyclic

tricyclics tend to be ‘pramines’ or ‘tylines’