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CNS - Lucocq > Antidepressants > Flashcards

Antidepressants Flashcards

(57 cards)

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1
Q

Cause of Depression?

A

Originally low levels Serotonin
Many had normal/high levels
Now levels of Serotonin receptors in Hippocampus

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2
Q

How long do SSRI’s take to have effect?

A

6-10 weeks

7-10 day period of side effects with no improvements

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3
Q

MAOI - What does it stand for?

A

Monoamine Oxadase Inhibitors

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4
Q

Examples of MAOI’s?

A

Phenelzine
Selegiline (Parkinson’s)
Tranylcypromine

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5
Q

Action of MAO?

A

Break down Norepinephrine/Serotonin & Dopamine

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6
Q

Side Effects of MAOI’s?

A 
Weight gain
Impotence (erections)
Dizzy
Headache
Weakness
Fatigue
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7
Q

First class of antidepressants?

A

MAOI’s

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8
Q

What can MAOI’s not be used with? Why?

A

Tricyclics
SSRI’s
Analgesics (Tramadol, Morphine)

Risk of Neuroleptic Malignant Syndrome (Confusion, tremor, HT, Coma, Death)

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9
Q

What shouldn’t be eaten/drank at same time as MAOI’s?

A

High in Tyramine
Cheese, Venison, Green Veg (Broads), Alcohol

Increased risk of Hypertensive Crisis (Stroke)

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10
Q

How long rest between MAOI’s & other meds?

A

14 day washout period

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11
Q

Example of Reversible MAOI?

A

Moclobemide

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12
Q

Action of Reversible MAOI? So other name?

A

Reversible inhibition of MAO Type A

‘RIMA’

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13
Q

Benefit of RIMA?

A

Less effect of Tyramine
Short acting so shorter washout - 7 days
Less side effects (no dietary restriction etc.)

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14
Q

Examples of Tricyclics

A 
Amitriptyline
Nortriptyline
Lofeprimine
Clomipramine
Imipramine
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15
Q

Method of Tricyclics

A

Block reuptake of Serotonin & Norepinephrine
Inhibit transporters of reuptake
More in synapses so more neurotransmission

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16
Q

Uses of Tricyclics

A 
Depression
Anxiety
Chronic pain (Fibromyalgia)
Nocturnal Enuresis
IBS
OCD
PTSD
Neuralgia
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17
Q

Risks of Tricyclics

A

Overdose - careful with patients at high risk of suicide

CVD patients - incr. risk arrhythmias

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18
Q

Side Effects Tricyclics

A

Antimuscarinic activity - block muscarinic ACh receptors
Causes constipation (less intestinal mobility)
Brady>Tachycardia
Dry mouth
Reduced bronchial secretions
Urinary retention (catheterise)
Confusion - risk of falls in elderly

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19
Q

Most common Tricyclics

A

Ami & Nor
Fibromyalgia - pain control
Lower dose than depression

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20
Q

Name of drug related to Tricyclics

A

Trazodone

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21
Q

Trazodone side effects

A

More sedating than Tri’s - can cause insomnia at night

Problems with balance & confusion for elderly

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22
Q

Possible precaution for Tricyclics

A

Daily dispensation to limit patients use - risks with overdose

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23
Q

SSRI Action

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A

Reduce Serotonin reuptake
Block 5-Hydroxytryptamine (5-HT) receptors
Pure SSRI = Weak Norepinephrine & Dopamine affinity

24
Q

Examples of SSRI’s

Study These Flashcards
A 
Sertraline
Citalopram
Fluoxetine (Prozac)
Paroxetine
Escitalopram
25
What class of antidepressants are the most widely prescribed?
SSRI's
26
Uses of SSRI's
``` Depression Panic Disorder OCD PTSD Eating Disorders Anxiety ```
27
Benefits of SSRI's
Better tolerated Cleaner Fewer side effects than others Less overdose risk (just agitation for few days etc.)
28
Role & location of 5-HT receptors
PNS & CNS Excitatory & Inhibitory neurotransmission Influences on cognition, learning memory, sleep, mood, aggression & anxiety
29
What NT's do 5-HT receptors modulate release of?
``` GABA Norepinephrine ACh Dopamine Epinephrine ```
30
Sexual Side Effects of SSRI's
Loss of libido | Dysfunction
31
Cardiac side effects of SSRI's
Prolonged QT interval (>450ms) Esp. Citalopram (Dose-dependent)
32
Bleeding effects of SSRI's
Affects anticoagulants (Warfarin & Aspirin) Incr. risk GI bleeds (Fluoxetine - Action as anticoagulant)
33
Risk of SSRI's for Teens & Younger?
Suicide risk Stimulation of impulsive pathways Less inhibition in younger people
34
How do SSRI's influence epilepsy?
Reduced fit threshold
35
Other general side effects of SSRI's
``` Nausea Rash Muscle Aches Insomnia Sweating ```
36
Order SSRI's from highest to lowest overdose toxicity
``` Citalopram Escitalopram Paroxetine Sertraline Fluoxetine ```
37
2 Examples of SNRI's
Duloxetine | Venlafaxine
38
Uses of Duloxetine?
Depression Neuropathic Pain (Diabetic (periph nerve endings)& Fibromyalgia) Stress Urinary Incontinence (Ladies - after birth - pelvic floor weak)
39
Side Effects of Duloxetine?
Nausea Insomnia Dizzy Sudden withdrawal = Agitation, Insomnia, Sweaty
40
Uses of Venlafaxine?
``` Major Depressive Disorder Anxiety Panic Social Phobia Resistant Depression (3rd/4th line) ```
41
How is Venlafaxine metabolised?
In liver Cytochrome P206 Desvenlafaxine
42
What is the method of Mirtazapine?
Presynaptic a2 adrenoreceptor antagonist | Noradrenergic & specific serotonergic antidepressant (NaSSA)
43
Uses of Mirtazapine?
PTSD | Anxiety
44
Different effects of Mirtazapine by dose?
15mg - Night - Drowsy | 30-45 - Morning - Stimulant
45
Other Drugs with Antidepressant Properties
Antipsychotics - Risperidone | Lithium
46
Uses of Lithium?
Mood stability in bipolar/mania
47
Side Effects of Lithium
``` Kidney & Thyroid problems Hypothyroid Low Thyroxine Slow metabolism Low energy Lack of conc Weight gain ```
48
Important test when assessing depression?
Thyroid level tests Hypothyroid can mimic depression May just need to treat hypothyroid
49
What types of pain are antidepressants used for?
Neuropathic (nerve damage or dysfunction) | Some muscle pans
50
Why can antidepressants be used for pain? What dose?
Direct effect on pain mechs No effects on pain via mood effects 10mg for pain v 400mg depression
51
How do Tricyclics help pain relief?
Block Serotonin & Norepinephrine reuptake by nerve endings Increased levels of both in pain control pathways
52
What other effect do antidepressants have that help pain relief?
Beneficial effects on sleep
53
Common antidepressants for pain relief?
Ami- & Nortriptyline | Duloxetine
54
Other licensed use for Duloxetine?
Diabetic neuropathy
55
Drugs that cause prolonged QTc?
Citalopram Domperidone (antiemetic) Haloperidol (Antipsychotics) Methadone Antimicrobials (Erythro- & Clarythromycin) Antiarrhythmics (Amiodarone & Fleicanide) Amitriptyline
56
What is the problem caused by prolonged QT? Describe.
Torsades de Pointes >450ms Vent Tachy > Vent Fibrillation Also risk of Vent Arrhythmia
57
People at greater risk of drug-induced LQTS
Elderly Major psychiatric disorders CV Disease Women

CNS - Lucocq (6 decks)

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