antidepressants

Question 1

tricyclic method of action?

Answer 1

TCAs inhibit the re-uptake of serotonin and noradrenaline at the pre synaptic neuron leaving more of the neuro transmitter to have action.
Also affects histamine, muscularinic and acetylcholine receptors.

Question 2

Non selective TCAs?

Answer 2

AMITRIPTYLINE, Imipramine, clotmipramine

Question 3

Noradrenaline selective TCAs?

Answer 3

NORTRITYLINE, Lofepramine

Question 4

Other uses of Amitriptyline?

Answer 4

At low doses used as a seditive and as an long term analgesic

Question 5

Adverse effects of TCA’s?

Answer 5

Weight Gain, Sedation, Postural hypotension, tachycardia, arrhythmias, Antimuscularinic (“can’t see, Can’t pee, can’t shit, can’t spit” Affects sight, voiding and saliva)

Question 6

Contraindication of TCAs?

Answer 6

HEART ISSUES. to be used with caution in people w. Cardiovascular disease.
Recent M.I. and heartblock, glaucoma, prostatism,

Question 7

TCAs in overdose?

Answer 7

Incredibly dangerous. Death is caused by acidosis, arrhythmia and low GCS. Treat with NaHCO3
“Red as a beet, Blind as a bat, dry as a bone, hot as a hare, mad as a wet ham”.

Question 8

Example of a Irreverisble non-selective binding MAOI?

Answer 8

PHENZELZINE, isocarboxizid, tranycipromine. these drugs are to be administer under supervision and are not recommended.

Question 9

Example of an reversible MAOI?

Answer 9

MACLOBEMIDE (most important MAOI)

Question 10

Major interaction of MAOI’s?

Answer 10

Tyramine - Found in Cheese, beer, herring, soy + chocolate. Can cause a major hypertensive crisis.
Also, opiods and pethedine (sudafed)

Question 11

MAOI adverse effects?

Answer 11

Postural hypotension, Drowsiness diziness, weight gain, Anticholinergic effect (although less than TCAs) CNS stimulation.

Question 12

SSRI method of action?

Answer 12

Blocks serotonin re-uptake.

Question 13

What are the first line Antidepressant?

Answer 13

SSRI’s, normally citalopram.

Question 14

MAOI Cautions?

Answer 14

Major withdrawal symptoms. Aggitation, insomnia, irritability, ataxia, drowsiness, vivid dreams, cognitive impairment.

Question 15

Major SSRI’s?

Answer 15

CITALOPRAM, FLUOXITINE, SERTRALINE, paroxetine, escitalopram.

Question 16

SSRI common side effects?

Answer 16

Nausea, anorexia, Insomnia, GI bleeding

Question 17

When should you take SSRI’s?

Answer 17

Common side effect is insomnia so should be taken in the morning.

Question 18

Adverse effects of Citalopram and escitalopram?

Answer 18

Associated with prolonged QT syndrome. Half dose in those over 65 and with hepatic impairment.

Question 19

contraindication of SSRIs?

Answer 19

Not to be taken in those under 18. Raised risk of suicide.

Question 20

Which Antidepressant is used post MI?

Answer 20

Sertraline

Question 21

Why cant paroxetine be stopped abruptly?

Answer 21

Short half life results in withdrawl symptoms.

Question 22

Are Antidepressants addictive?

Answer 22

No, but there are withdrawl issues.

Question 23

Adverse effects of SSRIs?

Answer 23

HYPONATREAMIA! nausea and vomiting, GI disturbance, Sexual dysfunction, QT prologation.

Question 24

Signs of hyopnatreamia?

Answer 24

Diziness, lethargy, nausea, confusion, cramps, seizures.

Question 25

hyponatraemia treatment?

Answer 25

Withdraw antudepressant. If serum Na+ >125mmol/l - monitor daily If serum Na+

Question 26

Caution in Fluoxetine?

Answer 26

reduced antiplatlet effect of clopidogrel.

Question 27

Interactions of SSRIs?

Answer 27

Tramadol - "Serotonin syndrome" caused by excess serotonin. also, alcohol, MOAIs, NSAIDs and antiplatlet.

Question 28

Method of action for receptor blockers?

Answer 28

They block H1 receptors inhibiting the feedback loop that tells the neuron to stop releasing serotonin and noradrenalin. Binds to pre synaptic alpha receptor.

Question 29

examples of receptor blockers?

Answer 29

MIRTRAZIPINE, trazodone

Question 30

Adverse effects of receptor blockers?

Answer 30

Weight gain and increased appetite,postural hypotension, sedation.

Question 31

Reason to chose a receptor blocker over other antidepressants?

Answer 31

Less cardiotoxic than TCAs.

Question 32

Receptor blocker interactions?

Answer 32

Sedatives, alcohol and with trazodone, avoid other antidpressants.

Question 33

Non-selective re-uptake inhibitor method of action?

Answer 33

Inhibit neurotransmitter reuptake.

Question 34

Non-selective re-uptake inhibitor example?

Answer 34

veneflaxine.

Question 35

Non-selective re-uptake inhibitor adverse effects?

Answer 35

Raised blood pressure and to be avoided if there is a risk of arrhythmia. Also, weight changes, nausea, sexual dysfunction, nervousness.

Question 36

Non-selective re-uptake inhibitor risks?

Answer 36

High risk of Arrhythmia and uncontrolled hypotension. Also withdrawl symptoms