Antidepressants and Antipsychotics

Question 1

What are the three characteristic groups of serotonin syndrome?

Answer 1

Autonomic dysfunction
Neuromuscular hyperactivity
Altered mental state

Question 2

What are the the symptoms if autonomic dysfunction in serotonin syndrome? (5)

Answer 2

Tachycardia
BP changes 
Hyperthermia 
Shivering 
Diarrhoea

Question 3

What are the the symptoms of an alter mental state in serotonin syndrome? (3)

Answer 3

Mania,
Confusion
Agitation

Question 4

What are the the symptoms of neuromuscular hyperactivity in serotonin syndrome? (5)

Answer 4

Tremor 
Hyperreflexia
Clonus
Myoclonus
Rigidity

Question 5

How many weeks after starting an antidepressant therapy should a patient be followed up?

Answer 5

1-2 weeks

Question 6

How long must you continue an antidepressant for until swapping or stopping due to lack off effect?

Answer 6

4 weeks (6 weeks for the elderly)

Question 7

What receptors do tricyclic antidepressants block to cause their side effects

Answer 7

Histamine, muscarinic, alpha receptors and dopamine

Question 8

What are the side effects of tricyclic antidepressants?

Answer 8

Sedation 
Constipation 
Sexual disfunction and breast changes 
Arrhythmia/ QT prolongation 
Dry mouth
blurred vision 
Hypotension

Question 9

How long does it take for antidepressants to work?

Answer 9

2 weeks

Question 10

What SSRI are safest in patients with angina or had an MI?

Answer 10

Sertraline

Question 11

What hypo can SSRIs cause?

Answer 11

Hyponaturaemia

Question 12

What is the antidepressant of choice in anxiety disorder? (3)

Answer 12

Escitalopram
Paroxetine
Sertraline (unlicensed)

Question 13

For a patient with chronic anxiety who has not responded to an SSRI what drugs can be offered next?

Answer 13

Venlafaxine

Duloxetine

Question 14

What are the sedating tricyclic? (7)

Answer 14

Amitriptyline
Clomiprame 
Dosulepin
Mianserin 
Trazodone
Trimipramine

Question 15

What are the non sedating tricyclic? (3)

Answer 15

Imipramine
Lofeptamine
Nortriptyline

Question 16

What tricyclic has the least side effects but is Hepatotoxicity?

Answer 16

Lofepramine

Question 17

What tricyclic has more pronounced antimucarinic effects?

Answer 17

Imipramine

Question 18

What conditions can tricyclic antidepressants worsen?

Answer 18

Dementia 
Narrow angle glaucoma 
Cardiac conditions 
Prostatism 
Urinary retention

Question 19

What are the MOA’s?

Answer 19

Isocarboxazid
Phenelzine
Tranycypromine
Moclobemide

Question 20

What MOA has the greatest risk of a hypertension crisis?

Answer 20

Tranylcypromine

Question 21

What MOA are more hepatoxic?

Answer 21

Isocarboxazid

Phenelzine

Question 22

What antidepressants are best for panic/ depression with atypical, hypochondriacal or hysterical features?

Answer 22

MOAs

Question 23

How long must you wait to start an alternative antidepressant after trying (and now stopping) treatment with MOA. Also what are the exceptions?

Answer 23

2 weeks

But 3 weeks if you’re starting imipramine or clomipramine

Question 24

If you are changing treatment and starting a MOA. What is the time period to wait when starting a tricyclic, SSRI or another MOA?

Answer 24

MOA - 2 weeks
Tricyclic - 7-14 days (3 weeks if pt was taking imipramine or clomipramine)
SSRI - 1 week (5 weeks if the pt was taking fluoxetine)

Question 25

What are the side effects if tricyclic antidepressants?

Answer 25

``` Dry mouth, Constipation, Urinary retention, Blurred vision, Hypotension, Arrhythmia Breast changes and sexual dysfunction Convulsions Hallucinations Mania ```

Question 26

What are the side effects of SSRIs?

Answer 26

``` GI upset Changes in appetite and weight changes Hyponaturaemia Sucidial ideal idealation Lower seizure threshold QT prolongation Bleeding risk Serotonin syndrome ```

Question 27

What are the warnings for SSRIs?

Answer 27

Caution in patients who are right risk of peptic ulcers or seizures. Suicide risk in young people May need a dose reducation in the hepatoc impaired

Question 28

What are the interactions with SSRIs?

Answer 28

MOA - increased serotonin Aspirin or NSAIDS - increased bleeding risk Drugs that prolong QT interval

Question 29

Which SSRI has fewer interactions?

Answer 29

Citalopram and sertraline

Question 30

What are side effects for SNRI?

Answer 30

GI upset ( dry mouth, nausea, changes in weight, diarrhoea or Constipation) Neurological effects ( headaches, abnormal dreams, insomnia, confusion and Convulsions) Hyponaturaemia Serotonin syndrome

Question 31

What are the warnings with SNRIs?

Answer 31

Elderly Hepatic and renal impairment Venlafaxibe should be used in caution due to Arrhythmias risk

Question 32

Is mirtazapine more sedative at low or high doses?

Answer 32

Lower doses

Question 33

What is the MoA of mirtazapine?

Answer 33

Antagonist of inhibitory pre synaptic alpha2 receptors which increase noradrenaline and serotonin activity