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2. CNS > Depression > Flashcards

Depression Flashcards

1
Q

What is the treatment guidelines for depression?

A

Consider CBT and then + SSRI or TCA
SNRIs
If no response, consider TCAs,
moclobemide, irreversible MAOIs,
low-dose amisulpride (seek specialist
advice)

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2
Q

What is the risk with people under 25?

A

increased risk of suicide and SSRI’sc can cause over excitement, suicidal thoughts and tendencies and agression, so review after 1 week and regularly
DONT give TCA as toxic in overdose

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3
Q

What are the classifications of depressions?

A

subthreshold depression - <5 symptoms
mild - 1 or 2 more than 5 or 5
moderate - more then 6 symptoms
severe- affecting function and majority symptoms

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4
Q

What questionnaire as part of diagnosis?

A

DSM-IV (9 characteristics)

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5
Q

How are antidepressants stopped?

A

if taken:
<8 weeks = taper over 1 to 2 wks
if 6- 8 months - taper over 4 to 8 weeks
if long term use - then taper 1/4 dose every 6-8 months and monitor for withdrawal symptoms

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6
Q

How are SSRIs changed to TCA ?
vice versa

A

reduce dose of original drug and slowly increase dose of new drug over a 2 to 4 week period

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7
Q

How is MAOis changed into SSRIs or TCA’s? and vice versa

A

TCA/SSRI’s can be started after 3 weeks of last MAOi dose
for fluoxetine (long half life) after 5 weeks

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8
Q

What are the examples of SSRI’s

A

Sertraline
citalopram, escitalopram
fluoxetine, paroxetine , dapoxetine
fluvoxamine
vortiovexetine

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9
Q

What are the common SE of SSRI’s?

A

Gi discomfort
GI bleeds
Seizure threshold lowered
QT prolongation (cital + escital)
Erectile dysfunction
sleep disturbances
serotonin syndrome

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10
Q

When should monitoring of antidepressants be?

A

1 to 2 weeks after starting
at 4 weeks - if no improvement then increase dose or change drug
no changes usually until after 6 to 8 weeks if there’s no issues

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11
Q

What drugs can increase risk of serotonin syndrome?

A

Lithium
St johns wort
sumatriptan
MAOI’s
Tramadol

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12
Q

what are the symptoms of serotonin syndrome?

A

shivering
convulsions
tremors
restlessness
hyperthermia
come and death

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13
Q

What is the treatment of serotonin syndrome?

A

discontinuation of the serotonergic agent, support, sedation with benzodiazepines, and observation for at least 6 hours

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14
Q

What are the common interaction for SSRI’s?

A

(fluox+parox) with TCA = inhibit metabolism of TCA’s so TCA toxicity
(cital+esc) with lithium = prolonged QT
(fluox+parox) with tamoxifen = lower efficacy of tamoxifen
with NSAIDS and antiplatelets = increased risk of bleeds

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15
Q

What electrolyte disturbances can SSRI’s and TCA’s cause?

A

hyponatraemia

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16
Q

What are the examples of SNRI’s?

A

venlafaxine
duloxetine
Bupropion hydrochloride
bupropion + naltrexone

17
Q

What are the SE of venlafaxine?

A

arrhythmias, ^BP, ^HR
nausea
headache

18
Q

What are the CI for Venlafaxine and duloxetine?

A

venlafax- arrhythmias and uncontrolled hypertension
dulox- hepatic impairement and CrCl <30ml/min

19
Q

What other indication may duloxetine be used for?

A

urinary retention
dose - 20mg BD initially then 40mg bd

20
Q

What are the SE of duloxetine?

A

appetite decreased
anxiety
constipation
diarrhoea
asthenia(weakness)
confusion
chills

21
Q

What are the examples of Atypical antidepressants?

A

mirtazapine and trazadone

22
Q

What are the SE of mirtazapine?

A

sedation
increased appetite
confusion
GI discomfort

23
Q

What are the SE of Trazadone?

A

Abnormal appetite, sedation and drowsiness

24
Q

What counselling is important for mirtazapine?

A

If pt develops - infection symptoms, fever, sore throat any time during treatment see GP so they could do blood count to test if blood dyscrasia has occured

25
Q

What are the examples of TCA’s?

A

amitriptyline, nortrityline
clomipramine, impiramine, trimpiramine, lofempramine
dosulepin
doxepin

26
Q

What are the common SE of TCA’s?

A

sedation (amitrip)
weight gain ( blocks histamine)
postural hypotension
QT interval prolongation
dry mouth
erectile dysfunction
constipation
seizure threshold lowered
urinary retention
cardiac conduction abnormalaties

27
Q

Why is alcohol contraindicated with TCA’s?

A

TCA increase effects of alcohol and cause repiratory depression

28
Q

Why are TCA’s CI in heart disease?

A

causes arrhythmias and dangerous in over dose

29
Q

What are the symptoms of TCA toxicity?

A

excitement
delirium
convulsions
dry mouth and dry skin
blurred vision

30
Q

What is the treatment for TCA toxicity?

A

activated charcoal - to prevent further absorption
diazepam - convulsions
O2 and NaHCO3 - hypoxia and acidosis

31
Q

What are the common interactions for TCA’s?

A

all MAOIs- severe toxic reaction (wait 3 weeks after dose )
lithium - ^ risk of neurotoxicity
terbinafine - ^ exposure to amitrip (adjust dose)
adrenaline/epinephrine - ^ effects of adrenaline (^BP and abnormal heart rhythm)

32
Q

When should TCA’s be taken?

A

At night due to sedative effects

33
Q

What are TCA’s contraindicated in?

A

heart disease/ block
arrhythmias
severe hepatic/ renal impairement
manic phase of bipolar
with MAOI’s wait 14 days at least

34
Q

What are examples of MAOI’s

A

irreversible inhibitors of MAO-A and B - isocarboxazid, phenelzine, tranycypromine
seligiline (MAO-B)
moclobemide (reversible MAO-A)

35
Q

What is the symptoms of the cheese reaction with MAOI’s?

A

throbbing headache
hypertensive crisis
haemorrhage

36
Q

what are the common interactions of MAOI’s

A

decongestants, amphetamine
they reduce metabolism of opiods,alcohol and barbituates
TCA’s severe toxic reaction
adrenaline - hypertensive crisis
carbamazepine= severe toxic reaction risk

37
Q

How long do MAOI adverse reaction taken to diminish?

A

Moclobemide - effects will finish when administration stops
for irreversible MAOI’s it can take upto 5 weeks

38
Q

What is the treatment for MAOI overdose?

A

if hypertension - phentolamine
hypotension - posture
mania - chlorpromazine

39
Q

What are 10 SE of amitriptyline?

A

Dry mouth
nausea
orthostatic hypotension
reduced libido
photosensitivity
visual disturbances
urinary retention
palpitations
sedation
tachycardia

2. CNS (8 decks)

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