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Antidepressants Flashcards

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1
Q

Indications for tricyclic antidepressants? (2)

A
  1. Depression/ Depressive episode of BAD, Schizoaffective disorder
  2. Panic and phobic disorder
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2
Q

Examples of TCA? (4)

A
  1. Amitriptyline
  2. Clomipramine
  3. Imipramine
  4. Lofepramine
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3
Q

C/I of TCA? (7)

A
  1. Significant CVS disease (on antiarrhythmic drugs like amiodarone), recent MI
  2. Glaucoma
  3. BPH
  4. Agranulocytosis
  5. Severe Liver damage (metabolized by liver)
  6. Mania
  7. High risk of overdose
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4
Q

S/E of anticholinergic (M1) properties of antidepressants? (4)

A
  1. Dry mouth, blurred vision, narrow angle glaucoma
  2. Tachycardia
  3. Constipation, urinary retention
  4. Cognitive impairment, sexual dysfunction

咩都出唔到黎

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5
Q

S/E of antihistamine (H1) properties of antidepressants? (2)

A
  1. Sedation

2. Weight gain

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6
Q

S/E of alpha-adrenergic blockade(alpha-1) properties of antidepressants?

A

*Postural hypotension and fall

sedation, cognitive impairment, sexual dysfunction?

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7
Q

What are the S/E of membrane stabilizing properties of antidepressants?

A

Cardiac arrhythmia

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8
Q

What is the lethal dose of TCA?

A

15-20mg/kg

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9
Q

What are the toxic effects of TCA?

A
  1. CNS:
    - seizures,
    - hallucinations,
    - delirium,
    - coma
  2. Cardiac:
    - hypotension,
    - cardiac arrhythmia (ventricular fibrillation)
  3. Respiratory:
    - respiratory depression,
    - aspiration pneumonia
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10
Q

ECG features for toxic overdose of TCA?

A
  1. prolonged QT interval, QRS >0.1s
  2. ST elevation
  3. Heart block
  4. Arrhythmia
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11
Q

Management of TCA overdose?

A
  1. Resuscitation
  2. Gastric lavage (within several hours)
  3. Cardiac monitor
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12
Q

What drug class is the first line treatment for depression?

A

Selective serotonin reuptake inhibitor (SSRI)

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13
Q 
Which of the following are indications of SSRI? 
A. OCD
B. Premenstrual dysphoric disorder
C. Bulimia nervosa
D. Suicidality
E. Panic disorder
F. Alcoholism
A

All of the above

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14
Q

Contraindication of SSRI?

A

Mania (given with antimaniac medication)

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15
Q

What is the peak concentration (__hours) of SSRI? Half life is around 20-30 hours.

A

4-8 hours

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16
Q

What are the side effects of SSRI?

14

A

GI

  • N/V, dyspepsia
  • Diarrhea
  • Abdominal pain

CNS

  • Anxiety and agitation
  • Sleep disturbances (insomnia)
  • Headache, dizziness, fatigue, tremor
  • Apathy

Others

  • Loss of appetitie and weight loss/gain
  • SIADH
  • Sweating
  • Sexual dysfunction
  • Suicidality in young patients (takes 10 days to wean off)
  • rash
  • Cutaneous bleeding disorder
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17
Q

When should Fluoxetine be given at the time of the day? (Prozac)

A
  • given in morning to avoid insomnia
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18
Q

Initial dose and effective dose of Fluoxetine?

A
  • 10-20mg/day
  • 20mg may be as effective than higher dose

(*Max dose = 80mg/day) but may cause seizure)

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19
Q

What are the precautions of Fluoxetine and the use of MAOI? (2)

A
  1. 2 weeks between discontinuation of MAOI and initiation of fluoxetine
  2. 5 weeks between discontinuation of fluoxetine and initiation of MAOI
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20
Q

Dose regimen for Sertraline (Zoloft)?

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A
  1. Initial dose: 50mg once daily
  2. 25mg daily then 50mg daily after 3 weeks to minimize GI effect
  3. if no response after 1-3 weeks: increase 50mg every week up to 200mg
21
Q

What time of the day shall Sertraline be given?

Study These Flashcards
A

Given in evening for sedative effect

22
Q

Dose regimen for paroxetine?

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A
  1. initial dose: 10 or 20 mg /day
  2. upward titration in 10mg increment at weekly interval
  3. max dose: 50mg/day, but up to 80mg/day can be tolerated
23
Q

What DDI shall be noted when giving paroxetine? (2)

Study These Flashcards
A
  1. it is a potent inhibitor of CYP2D6

2. shall not be given to patients on tamoxifen for CA breast!

24
Q

What is the drug class of Citalopram?

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A

SSRI

initial dose: 20mg/day for first week, generally increase to 40mg.day after that

25
What is the name of the new SSRI that can improve sleep continuity and little effect on sexual functioning?
Nefazodone
26
What are the common side effects of Nafezodone? (SSRI)
1. Dose dependent (>300mg/day) | 2. Nausea, dizziness, insomnia, weakness, agitation
27
What are the 4 indications for the SNRI venlafexine? (same as SSRI escitalopram)
1. GAD 2. Panic disorder 3. Social anxiety disorder 4. Depression
28
What is the class of bupriprion? What is its indication?
NDRI | - depression
29
What is the drug class of mirtazapine?
NaSSA
30
What are the indications of MAOI and reversible inhibitor of monoamine oxidase A (RIMA)? (4)
1. Atypical depression refractory to SSRI 2. Resistant depression: not responding to other medication or ECT 3. Refractory anxiety states 4. Narcolepsy - REM reduction
31
C/I for MAOI? (4)
1. Pheochromocytoma 2. Cerebrovascular disease 3. Hepatic impairment 4. Mania
32
List some side effects of MAOI.
1. CVS - postural hypotension - oedema of ankles 2. CNS - Tremor, paraesthesia of hands and feet - dizziness, headache, confusion 3. Others - dry mouth - difficulty in micturition - sexual dysfunction - rashes
33
What are the interactions that you must consider in prescribing MAOI?
1. Cheese effect - cheese, tyramine rich food... - sympathomimetics (amphetamines, cocaine, methylphenidate, dopamine...) - levodopa 2. Serotonin syndrome - antidepressants, opiates
34
Drug class of phenelzine and tranulcypromine?
MAOI
35
Drug class of moclobemide and selegiline?
Reversible inhibitors of monoamine oxidase A
36
Briefly describe the cheese effect. (3)
* Hypertensive crisis due to - Tyramine broken down my MAO - Causes displacement of NE from neuronal storage works - Vasoconstriction leads to increase HR and BP (severe cases adrenergic crisis can occur)
37
What is serotonin syndrome? When does it occur? (3)
- acute onset, potential life threatening - Excessive serotonergic activity at CNS - may occur during 1. Tapering of antidepressants 2. Concomitant drug use of SSRI & MAOI e.g. Li, opiate, CNS stimulants, herbs (OTC drug) 3. drug overdose
38
What are the neuromuscular abnormalities of serotonin syndrome? (3)
1. Increased activity - myoclonus/clonus - hyperreflexia - tremors - muscle rigidity 2. Altered consciousness 3. Autonomic dysfunction - hyperthermia - sweating - tachycardia - unstable BP
39
``` Which of the following about serotonin syndrome is correct? A. Increase in creatinine kinase B. increase in WBC C. increase in ALT D. metabolic acidosis E. Cyproheptadine is used in management ```
All of the above | E: 5-HT2A antagonist
40
What are the 2 indications for serotonin-noradrenaline reuptake inhibitor? (SNRI) (block reuptake of serotonin and noradrenaline)
1. Treatment for major depressive disorder and generalized anxiety disorder MDD + GAD 2. Requires rapid onset of action
41
Contraindication of SNRI?
Risk of hypertension
42
Examples of SNRI? (2)
1. Venlafaxine | 2. Duloxetine
43
SNRI DDI? (2)
1. Cimetidine (beware of overdose - inhibit first-pass hepatic metabolism) 2. Haloperidol - raise plasmas concentration of haloperidol
44
What is the drug class of Mirtazapine? (newer antidepressant!)
NaSSR - noradrenergic and specific serotonergic antidepressant > presynaptic a2-receptor blockade (increase release of NE & 5-HT from presynaptic neurons)
45
Which of the following are side effects of Mirtazapine? A. Awakeness B. Weight gain C. Increased appetide
except A | - Sedation (thus can be given at night)
46
Trazodone drug class?
- Serotonin 2A antagonist/ serotonin reuptake inhibitor
47
List 4 S/E of trazodone.
1. Excessive sedation (significant cognitive impairment!) 2. Nausea and dizzienss 3. Postural hypotension, cardiac arrhythmias 4. Priapism, sexual dysfunction
48
Agomelatine is a melatonergic agonist and 5-HT2c antagonist. | It is marketed for which disease?
Major depressive disorder | may have +ve effects on sleep and cognition, not recommended for child and adolescents

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