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Antidepressants Flashcards

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1
Q

Phenelzine (Nardil), Tranylcypromine (Parnate)

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Monoamine oxidase inhibitors
  2. Major depression (third line), Some anxiety disorders (phobic,panic)
    • Mania
      - BP - hypertensive crisis can occur
      - Serotonin toxicity
      - BSLs - MAOIs may ↓ sugars, may need to ↓ antidiabetics.
      - Epilepsy - increase seizure risk
      - Overdose= high risk of fatality
      - Interact - illicit drugs
      - C/I - combos w/SSRIs, des/ven, dextromethorphan, duloxe, fentanyl, linezolid, mianserin, oxycodone, phentermine, phenylephrine, pseudoephedrine, St John’s wort, TCAs, tramadol.
      - MONITOR FOR worsening of smx or increased suicidal thoughts and behaviour during initial months of therapy 7 @ dose △s.
      - Hepatic failure - avoid use
      - tx with rizatriptan or sumatriptan—C/I
      - CVD— risk of orthostatic hypotension and hypertensive crisis.
  5. GENERIC COUNSELLING:
    - Takes time to work, may take 1-2 weeks before notice a difference and a month to know if it is working effectively.
    - 6-8 weeks for full effect
    - dont put up if it gets bad go see HCP
    - S/Es may be experienced before depressive smx improve, what to do if suicidal
    - Discuss w/doctor for non-pharm measures eg: mindfullness, CBT.
    - Regular r/v with doctors
    - Beyondblue

SPECIFIC
- LABELS: 1, 5, 9, 12?, 16,
- take last dose of day at 3pm, other keep you up
- avoid tyramine
- caffeine = jittery = reduce intake
- Tell all HCprof.
- Tell Dr if frequent h/aches or other unusual symptoms.
- Do not use OTC products (even nasal sprays), or herbal products can interact.
- Stop taking immediately if palpitations or severe headache occur, and seek medical attention urgently.
S/E orthostatic hypotension, sleep disturbances (including insomnia and less commonly hypersomnia), headache, drowsiness, fatigue, weakness, agitation, tremors, twitching, myoclonus, hyperreflexia, dizziness, constipation, dry mouth, weight gain, elevated serum aminotransferases, sexual dysfunction, eg impotence, loss of libido

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2
Q

Fluoxetine

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. SSRI
  2. Major depression
  3. Escitalopram (Lexapro,Laxam) = 10-20mg OD
    Citalopram (Talam,Cipramil) = 20-40mg OD
    Fluoextine (Lovan,Prozac) = 20-60mg OD or BD (mane &midi)
    Sertraline (Zoloft,Eleva) = 50-200mg OD
    Fluvoxamine (Luvox) = 50-300mg D.
    Paroextine (Aropax,Extine) = 20-50mg OD
    Usually taken mane, if make drowsy take nocte.
    • Serotonin toxicity - tx w/MAOI C/I during & 14 days after for fluoextine, 2 days for moclobemide.
      - Mania
      - Compliance - sexual dysfn may drive non-compli
      - CYP2C19 metabolises citalopram - in pts w/↓ enzyme activity, ↓ dose!!!
      - Na+ conc at baseline&soon after starting esp elderly.
      - ECG - QT PROLONGATION & arrhythmia RISK W/ cital, escital, fluox.
      - MONITOR FOR worse smx or ↑ suicidal thoughts/ behaviour during initial months & @ dose △s.
      - Hepatic fn - must be dose reduce
      - Preg - FIRST LINE EXCEPT FLUOX & PAROX cat C caution Breastf - safe
      - pts at high risk of bleeding (eg:>80y/o), hx of GI bleed - ↑ risk of srs bleeding - consider avoid use

Fluoextine has a longer half life than other SSRIs (16 days)= takes weeks to achieve steady state & eliminate.
Gradually stopping fluoextine is usually unecessary.

  1. GENERIC COUNSELLING:
    - Takes time to work, may see some improvement in 1-2 weeks and up to 6-8 weeks for full effect.
    - S/Es may be experienced before depressive smx improve
    - what to do if suicidal
    - dont put up if it gets bad go see HCP
    - Discuss w/doctor for non-pharm measures eg: mindfullness, CBT. - Beyondblue
    - Regular r/v with doctors

SPECFIC

  • LABELs: 5, 9, 12
  • S/Es: N, diarrhoea, dry mouth, sweating, insomnia, drowsiness, h/aches. These may disappear or decrease w/continued use.
  • Tell all HC prof. that you are taking this medicine
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3
Q

Amitriptyline (Endep,Entrip)

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. TCAs
  2. Major depression, nocturnal enuresis, adjuvant in pain management, migraine prohpylaxis
  3. Amitriptyline (Endep,Entrip) = 25-300mg d. Pain 10-150mg d.
    Clomipramine (Anafranil,Placil) = OCD = 25-(150)300mg d.
    Doxepin (Deptran) = 25-(150)300mg d.
    Imipramine (Tofranil) = 25-300mg d.
    Nortiptyline (Allegron,NotriTABS) = 25-150mg d.

Usually taken nocte to ↓ drowsiness.
Alter dose in increments every 2-3 days as needed.

  1. Sedation
  2. Anticholinergic
  3. Orthostatic hypotension
  4. Urinary retention
    Epilepsy - ↑risk of seizures
    ECG = Arrhythmias may worsen, QT prolongation
    BP sit&stand = Orthostatic hypotension may worsen
    Overdose/suicide = high fatality rate.
    Withdraw slowly to avoid withdrawal effects.
    Combo w/MAOI and 21 days after stopping for clomipramine and imipramine can cause SEVERE HYPERTENSION or development of SEROTONIN TOXICITY
    Mania
  5. GENERIC COUNSELLING:
    - Takes time to work, may see some improvement in 1-2 weeks and up to 6-8 weeks for full effect.
    - S/Es may be experienced before depressive smx improve
    - what to do if suicidal
    - dont put up if it gets bad go see HCP
    - Discuss w/doctor for non-pharm measures eg: mindfullness, CBT. - Beyondblue
    - Regular r/v with doctors

SPECIFIC

  • LABELs: 1, 5, 9, 13, 16, 12-
  • S/Es blurred vision, drowsiness, dry mouth and dizziness. May go away after 7 days.
  • May increase alcohol effects
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4
Q

Duloextine

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. SNRIs
  2. Major depression, anxiety
  3. Desvenlafaxine (Pristiq) = 50mg OD. Max 200mg OD.
    Duloextine (Cymbalta,Dytrex) = 30mg OD (Naus) 1st week, 60mg OD.
    Milnacipran (Joncia) = 25mg n for 2/7, 25mg BD for 5/7, 50mg BD.
    Venlafaxine (Efexor,Elexine) = 75-150mg OD. TOXIC IN OVERDOSE, ECG △s, arrhythmias & seizures reported.
  4. SAME as SSRIs
    - Serotonin toxicity - tx w/MAOI C/I during & 14 days after for fluoextine, 2 days for moclobemide.
    - Mania
    - Compliance - sexual dysfn may drive non-compli
    - CYP2C19 metabolises citalopram - in pts w/↓ enzyme activity, ↓ dose!!!
    - Na+ conc at baseline&soon after starting esp elderly.
    - ECG - QT PROLONGATION & arrhythmia RISK W/ cital, escital, fluox.
    - MONITOR FOR worse smx or ↑ suicidal thoughts/ behaviour during initial months & @ dose △s.
    - pts at high risk of bleeding (eg:>80y/o), hx of GI bleed - ↑ risk of srs bleeding - consider avoid use
    DIFFERENT
    - ↑ seizure risk
    - renal fn may need dose ↓
    - hepatic fn C/I in hepatic impairment
    - BP frequently when starting (↑) esp w/ des/venlafaxine and milnacipran. Esp in pts with CVD.
    - Preg better- cat B3 caution limited data Breastf worse- use w/caution.
    - After stopping SNRI, wait 1-2 days before starting a MAOI.
  5. GENERIC COUNSELLING:
    - Takes time to work, may see some improvement in 1-2 weeks and up to 6-8 weeks for full effect.
    - S/Es may be experienced before depressive smx improve
    - what to do if suicidal
    - dont put up if it gets bad go see HCP
    - Discuss w/doctor for non-pharm measures eg: mindfullness, CBT. - Beyondblue
    - Regular r/v with doctors

SPECIFIC
- LABELS: 1,5,9,12,A
S/Es: N, dry mouth, dizziness, insomnia, constipation or diarrhoea. These may disappear or decrease w/continued use.
Tell all HC prof. that you are taking this medicine.
Increased suicidal thoughts and behaviour can occur soon after starting antidepressants.

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5
Q

Agomelatine (Valdoxan)

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. MT1 & MT2 agonist and 5HT2C receptor antagonist.
  2. Major depression
  3. 25-50mg @ bedtime
  4. LFTs - elevated aminotransferases - @ baseline, 3, 6, 12 & 24 weeks after starting or after dose increase.
    Hepatic fn- C/I in impairment (↑s conc and ↑risk of S/Es)
    Combo w/ potent CYP1A2 inhibitors: fluvoxamine, cipro
    Mania
    Avoid use in >75y/o.
    Preg/breastf = not data
    - MONITOR FOR worsening of smx or increased suicidal thoughts and behaviour during initial months of therapy & @ dose △s.
    - do not need to taper dose, non-addictive
  5. GENERIC COUNSELLING:
    - Takes time to work, may see some improvement in 1-2 weeks and up to 6-8 weeks for full effect.
    - S/Es may be experienced before depressive smx improve
    - what to do if suicidal
    - dont put up if it gets bad go see HCP
    - Discuss w/doctor for non-pharm measures eg: mindfullness, CBT. - Beyondblue
    - Regular r/v with doctors

SPECIFIC
LABELS: 5,12
You will be getting blood test regularly which your dr will check and let you know if the medicine is agreeing with you.
Cause dizziness, nausea and headache initially and should go away in 1-2 weeks.
If you develop yellow skin, dark urine, pale stool stop taking and tell Dr.

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6
Q

Mianserin (Lumin)

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Tetracyclic antidepressant
  2. Major depression
  3. 30-120mg d
  4. Complete blood count at baseline and every 4 weeks during the the first 3/12. - BLOOD DYSCRASIAS
    Hepatic fn- at baseline and periodically, stop if jaundice.
    - MONITOR FOR worsening of smx or increased suicidal thoughts and behaviour during initial months of therapy & @ dose △s.
    Mania
    Prolonged QT!
    Epilepsy
  5. GENERIC COUNSELLING:
    - Takes time to work, may see some improvement in 1-2 weeks and up to 6-8 weeks for full effect.
    - S/Es may be experienced before depressive smx improve
    - what to do if suicidal
    - dont put up if it gets bad go see HCP
    - Discuss w/doctor for non-pharm measures eg: mindfullness, CBT. - Beyondblue
    - Regular r/v with doctors

LABELS: 1,9,13,16
weight gain
sedation, dry mouth, dizziness, vertigo, jaundice

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7
Q

Mirtazapine (Avanza,Axit)

  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A
  1. Tetracyclic antidepressant
  2. Major depression
  3. 15mg nocte up to max 60mg.
    • MONITOR FOR worsening of smx or increased suicidal thoughts and behaviour during initial months of therapy & @ dose △s.
      Withdraw over at least 1-2 weeks
      Phenylketonuria - Milivin brand contains aspartame
      Mania
      MAOI
      FBE = angranulocytosis Eosinophilia
      More sedating at lower doses, less at higher doses.
  5. GENERIC COUNSELLING:
    - Takes time to work, may see some improvement in 1-2 weeks and up to 6-8 weeks for full effect.
    - S/Es may be experienced before depressive smx improve
    - what to do if suicidal
    - dont put up if it gets bad go see HCP
    - Discuss w/doctor for non-pharm measures eg: mindfullness, CBT. - Beyondblue
    - Regular r/v with doctors

Specific
- you may have an increase appetite, weight gain, sedation, weakness, peripheral oedema
nightmares

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8
Q
  1. Drug class
  2. Indication
  3. Dosage range, Frequency and best admin time
  4. Monitoring
  5. Counselling
A

…more

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