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CNS - Lucocq > Antidepressants > Flashcards

Antidepressants Flashcards

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

A

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

24
Q

Examples of SSRI’s

A 
Sertraline
Citalopram
Fluoxetine (Prozac)
Paroxetine
Escitalopram
25
Q

What class of antidepressants are the most widely prescribed?

A

SSRI’s

26
Q

Uses of SSRI’s

A 
Depression
Panic Disorder
OCD
PTSD
Eating Disorders
Anxiety
27
Q

Benefits of SSRI’s

A

Better tolerated
Cleaner
Fewer side effects than others
Less overdose risk (just agitation for few days etc.)

28
Q

Role & location of 5-HT receptors

A

PNS & CNS
Excitatory & Inhibitory neurotransmission
Influences on cognition, learning memory, sleep, mood, aggression & anxiety

29
Q

What NT’s do 5-HT receptors modulate release of?

A 
GABA
Norepinephrine
ACh
Dopamine
Epinephrine
30
Q

Sexual Side Effects of SSRI’s

A

Loss of libido

Dysfunction

31
Q

Cardiac side effects of SSRI’s

A

Prolonged QT interval (>450ms)
Esp. Citalopram
(Dose-dependent)

32
Q

Bleeding effects of SSRI’s

A

Affects anticoagulants (Warfarin & Aspirin)
Incr. risk GI bleeds
(Fluoxetine - Action as anticoagulant)

33
Q

Risk of SSRI’s for Teens & Younger?

A

Suicide risk
Stimulation of impulsive pathways
Less inhibition in younger people

34
Q

How do SSRI’s influence epilepsy?

A

Reduced fit threshold

35
Q

Other general side effects of SSRI’s

A 
Nausea
Rash
Muscle Aches
Insomnia
Sweating
36
Q

Order SSRI’s from highest to lowest overdose toxicity

A 
Citalopram
Escitalopram
Paroxetine
Sertraline
Fluoxetine
37
Q

2 Examples of SNRI’s

A

Duloxetine

Venlafaxine

38
Q

Uses of Duloxetine?

A

Depression
Neuropathic Pain (Diabetic (periph nerve endings)& Fibromyalgia)
Stress Urinary Incontinence (Ladies - after birth - pelvic floor weak)

39
Q

Side Effects of Duloxetine?

A

Nausea
Insomnia
Dizzy
Sudden withdrawal = Agitation, Insomnia, Sweaty

40
Q

Uses of Venlafaxine?

A 
Major Depressive Disorder
Anxiety
Panic
Social Phobia
Resistant Depression (3rd/4th line)
41
Q

How is Venlafaxine metabolised?

A

In liver
Cytochrome P206
Desvenlafaxine

42
Q

What is the method of Mirtazapine?

A

Presynaptic a2 adrenoreceptor antagonist

Noradrenergic & specific serotonergic antidepressant (NaSSA)

43
Q

Uses of Mirtazapine?

A

PTSD

Anxiety

44
Q

Different effects of Mirtazapine by dose?

A

15mg - Night - Drowsy

30-45 - Morning - Stimulant

45
Q

Other Drugs with Antidepressant Properties

A

Antipsychotics - Risperidone

Lithium

46
Q

Uses of Lithium?

A

Mood stability in bipolar/mania

47
Q

Side Effects of Lithium

A 
Kidney & Thyroid problems
Hypothyroid
Low Thyroxine
Slow metabolism
Low energy
Lack of conc
Weight gain
48
Q

Important test when assessing depression?

A

Thyroid level tests
Hypothyroid can mimic depression
May just need to treat hypothyroid

49
Q

What types of pain are antidepressants used for?

A

Neuropathic (nerve damage or dysfunction)

Some muscle pans

50
Q

Why can antidepressants be used for pain? What dose?

A

Direct effect on pain mechs
No effects on pain via mood effects
10mg for pain v 400mg depression

51
Q

How do Tricyclics help pain relief?

A

Block Serotonin & Norepinephrine reuptake by nerve endings
Increased levels of both in pain control pathways

52
Q

What other effect do antidepressants have that help pain relief?

A

Beneficial effects on sleep

53
Q

Common antidepressants for pain relief?

A

Ami- & Nortriptyline

Duloxetine

54
Q

Other licensed use for Duloxetine?

A

Diabetic neuropathy

55
Q

Drugs that cause prolonged QTc?

A

Citalopram
Domperidone (antiemetic)
Haloperidol (Antipsychotics)
Methadone
Antimicrobials (Erythro- & Clarythromycin)
Antiarrhythmics (Amiodarone & Fleicanide)
Amitriptyline

56
Q

What is the problem caused by prolonged QT? Describe.

A

Torsades de Pointes
>450ms
Vent Tachy > Vent Fibrillation

Also risk of Vent Arrhythmia

57
Q

People at greater risk of drug-induced LQTS

A

Elderly
Major psychiatric disorders
CV Disease
Women

CNS - Lucocq (6 decks)

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