Antidepressants

Question 1

4 classes of antidepressants

Answer 1

tricyclics, SSRIs, MAOIs and SNRIs

Question 2

main problem with TCAs

Answer 2

many side effects

Question 3

3 categories of TCA side effects

Answer 3

antihistaminic, anticholinergic and antiadrenergic

Question 4

sedation and weight gain are what category of side effects

Answer 4

antihistaminic

Question 5

a dry mouth, dry eyes, constipation, memory deficits and delirium are what category of side effet

Answer 5

anticholinergic

Question 6

antiadrenergic side effects

Answer 6

orthostatic hypotension, sedation and sexual dysfunction

Question 7

two causes of the sedation side effect in TCAs

Answer 7

antihistaminic and antiadrenergic

Question 8

two types of TCAs

Answer 8

tertiary and secondary (secondaries are metabolite of tertiaries)

Question 9

mechanism of tertiary TCAs

Answer 9

block reabsorption of serotonin

Question 10

mechanism of secondary TCAs

Answer 10

block noradrenaline reabsorption

Question 11

what type of drug is amitryptyline

Answer 11

a tertiary TCA

Question 12

what type of drug is desipramine

Answer 12

a secondary TCA

Question 13

which class of drugs affects the QT interval

Answer 13

TCAs - lengthen QT interval

Question 14

which type of TCA has more severe side effects

Answer 14

tertiary

Question 15

5 side effects of TCAs

Answer 15

weight gain, sedation, orthostatic hypotension, constipation, dry mouth

Question 16

what does MAOI stand for

Answer 16

monoamine oxidase inhibitor

Question 17

main indication for MAOI use in depression

Answer 17

treatment resistant depression

Question 18

mechanism of MAOIs

Answer 18

binds to monoamine oxidase preventing its inactivation of the neurotransmitters NA, dopamine and serotonin

Question 19

what type of drugs are isocarboxazid and selegiline

Answer 19

MAOIs

Question 20

2 main side effects to look out for in MAOIs

Answer 20

cheese reaction and serotonin syndrom

Question 21

what drugs do the “cheese reaction” occur in and what is it

Answer 21

MAOIs - a hypertensive crisis occuring when you eat tyramine rich foods like cheese or sympathomimetics

Question 22

side effects of MAOIs aside from cheese reaction

Answer 22

serotonin syndrome
weight gain
dry mouth
sedation
sexual dysfunction
sleep distrurbance
orthostatic hypotension

Question 23

what happens in serotonic syndrome

Answer 23

drug that increases serotonin –> dangerously high serotonin –> abdominal pain, diarrhoea, sweats, tachycardia, HTN, myoclonus, irritability and delirium –> in severe CV shock and death

Question 24

how to prevent serotonin syndrome

Answer 24

wait 2 weeks before switching SSRI to MAOI or 5 weeks for fluoxetine to MAOI

Question 25

what does SSRI stand for

Answer 25

selective serotonin reuptake inhibitor

Question 26

mechanism of SSRIs

Answer 26

block presynaptic serotonin reuptake

Question 27

what is the most commonly prescribed type of antidepressant

Answer 27

SSRI

Question 28

paroxetine, sertaline and fluoxetine, citalopram, escitalopram and fluvoxamine are what type of antidepressant

Answer 28

SSRI

Question 29

what is activation syndrome

Answer 29

restlessness, agitation and anxiety during inital weeks of treatment, especially in under 25s

Question 30

what drug type do you get activation syndrome and discontinuation syndrome in

Answer 30

SSRIs

Question 31

what is discontinuation syndrome

Answer 31

agitation, nausea and dysphoria when you stop SSRIs. Not withdrawal because it's not a craving for the drug

Question 32

which drug classes have the most risk of sexual dysfunction

Answer 32

SSRIs and SNRIs - in >30%

Question 33

which 2 SSRIs lengthens QT interval

Answer 33

citalopram and escitalopram (the prams)

Question 34

relationship between half-life and build-up of a drug

Answer 34

Longer half-life increases build-up. As does an active metabolite

Question 35

which SSRI has a long half-life making is less likely to induce discontinuation syndrome

Answer 35

fluoxetine

Question 36

what is the first line type of antidepressants

Answer 36

SSRI

Question 37

general side effects from SSRIs

Answer 37

gi upset, increased risk of gi bleed and agitation/anxiety

Question 38

fluoxetine and paroxetine has a high propensity for _______

Answer 38

DDIs

Question 39

given the gi risks of SSRIs what drug should be prescribed along side it if the patient takes NSAIDs

Answer 39

PPI

Question 40

mechanism of SNRIs

Answer 40

inhibit serotonin and NA reuptake

Question 41

main difference between TCAs and SNRIs

Answer 41

SNRIs don't have the anticholinergic, antiadrenergic or antihistaminic side effects of TCAs

Question 42

two SNRIs

Answer 42

venlafaxine and duloxetine

Question 43

indications of SNRIs

Answer 43

anxiety, depression and neurpathic pain

Question 44

side effects of venlafaxine

Answer 44

``` lengthens QT interval raises diastolic BP significan nausea sexual dysfunction bad discontinuation syndrome ```

Question 45

good things about venlafaxine

Answer 45

short half-life and fast renal clearance making it good in elderly low DDIs

Question 46

which SNRI raises diastolic BP more, venlafaxine or duloxetine

Answer 46

venlafaxine

Question 47

pros of duloxetine

Answer 47

good for physical symptoms of depression | less effect on diastolic BP

Question 48

how much does mirtazapine raise cholesterol by

Answer 48

~20%

Question 49

what type of side effects make mirtazapine sedating and cause weight gain

Answer 49

antihistaminic

Question 50

which drug is also a 2nd line in ADHD

Answer 50

buproprion

Question 51

buproprion has an increased risk of ______ and can induce ______ and ______

Answer 51

seizures, anxiety and psychosis

Question 52

for a treatment naive patient what drug type should you start them on

Answer 52

an SSRI

Question 53

how to treat treatment resistant depression

Answer 53

combination of antidepressants adjunct with lithium adjunct with atypical antipsychotic ECT

Question 54

how long do you continue antidepressant treatment for after a 1st episode

Answer 54

6-12 months

Question 55

how long do you continue antidepressant treatment after a 2nd episode

Answer 55

2 years

Question 56

how long do you continue antidepressant treatment after a 3rd episode

Answer 56

consider life-long