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Psychiatry > Antidepressants and mood stabilisers > Flashcards

Antidepressants and mood stabilisers Flashcards

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1
Q

What is the usual first line tx for depression?

A

SSRIs

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2
Q

How long do antidepressants take to work?

A

2-6 weeks

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3
Q

Why should you start antidepressants at a low does and titrate up?

A

avoid initiation side effects

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4
Q

What is the treatment for psychotic depression?

A

antidepressants and antipsychotics

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5
Q

What should be looked for in younger patients starting on antidepressants?

A

can cause agitation leading to suicidal behaviour

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6
Q

What should be the dosing in the elderly?

A

lower- usually half normal adult dose

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7
Q

How long should treatment be continued after full resolution of symptoms after a first episode?

A

6-12 months

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8
Q

How long should treatment be continued after full resolution after a recurrence?

A

12-24 months

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9
Q

After a thrid epsidoe of depression how long should treatment be continued?

A

indefinitely

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10
Q

What is the mainstay of treatment with bipolar disorder?

A

mood stabilisers- lithium; anticonvulsants; antipsychotics

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11
Q

What drug is good for bipolar depression?

A

lamotrigine

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12
Q

What drug is good for mania/hypomania?

A

valproate

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13
Q

What drugs are good for both elevated and depressed states?

A

lithium and antipsychotics

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14
Q

When are antidepressants useful in bipolar?

A

short term for severe depressive episodes- generally avoid

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15
Q

What happens if antidepressants are used in bipolar?

A

cause switching to mania or mood instability; not effective as mood stabilisers

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16
Q

When are depot IM antipsychotics given?

A

if compliance is poor or patient unwilling to take oral

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17
Q

Give examples of SSRIs?

A

fluoxetine; sertraline; citalopram; escitalopram; paroxetine

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18
Q

What are the SE of SSRIs?

A

GI upset; anxiety; agitation; insomnia; sexual dysfunction; hyponatraemia

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19
Q

When should SSRIs be taken and why?

A

in the morning to reduce insomnia

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20
Q

What SSRI has the worst discontinuation symptoms?

A

paroxetine

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21
Q

What are the discontinuation SE of SSRI?

A

GI upset; anxiety; agitation; insomnia; myoclonus

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22
Q

What SSRI is safest in cardiac problems?

A

sertraline

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23
Q

What SSRI is safest in epilepsy?

A

citalopram

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24
Q

What cardiac SE is citalopram associated with?

A

long QTc

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25
Why are tricyclic antidepressants not first line?
cardiac SE and dangerous in OD
26
What are the SE of TCAs?
sedation; confusion; dizziness; antimuscarinic effects; sexual dysfunction; cardiac arrthymias
27
What TCA has a lower cardiac risk?
lofepramine
28
When should TCAs be taken? Why?
at night as cause sedation
29
What patients should TCAs be avoided in?
cardiac problems; older people; suicidal intent
30
What type of antidepressant is mirtazapine?
noadrenergic and speciic serotonergic
31
When would mirtazapine be first line?
if patient has insomnia or poor appetite
32
What can mirtazapine be used in combination with?
SSRIs or venlafaxine
33
What are the SE of mirtazapine?
sedation; hunger/weight gain; constipation; dizziness; falls; dry mouth; unusual/vivid dreams; blood dyscrasias; seizures
34
When should mirtazapine be taken and why?
at night due to sedation
35
What happens if mirtazapine is taken with alcohol?
GI upset
36
Give examples of SNRIs?
venlafaxine and dulozetine
37
What is duloxetine used for other than depression?
neuropathic pain and bladder instability
38
What are the SE of SNRIs?
same as SSRIs; HT; cardiac arrhythmias
39
When should SNRIs be taken?
in the morning to avoid insomina
40
Give examples of irreversible MAOIs?
phenelzine; tranylcypromine; isocarboxazid
41
Give examples of reversible MAOIs?
moclobemide
42
When are MAOIs used?
treatment resistant depression
43
Why are MAOIs only used in tratment resistant depression?
dietary and medication restriction
44
What are the monoamine neurotransmitters?
norepinephrin; serotonin; dopamine
45
What are the SE of monoamine oxidase inhibitors?
postural hypotension; drowsiness; insomnia; nausea; tiredness; constipation; hypertensive crisis; hepatic impairment; seizures
46
Why are there difficulties with compliance in MAOIs?
three times daily dosing
47
What does the aminoacid tyramine do?
potent releaser of norepinephrine
48
What are the symptoms of a hypertensive crisis?
HA; SOB; nosebleed; anxiety; arrhythmias; stroke; seizures; death
49
What are high tyramine foods?
cheese; alcoholic drinks; dried meats; stock cubes; soy; tofu; pate; marmite; caffeine
50
How is a hypertensive crisis treated?
phentolamine infusion
51
Give an example of a serotonin antagonist/reuptake inhibitor?
trazodone
52
What are the SE of trazodone?
GI upset; dizziness; sedation; tiredness; HA; hypotension; incoordination; oedema; blurred vision; priapism
53
What is the most effective treatment for bipolar?
lithium
54
What are the SE of lithium?
GI upset; dry mouth; feeling of weakness; sedation; weight gain; fine tremor; polydipsia; polyuria; ankle swelling; renal impairment; cardiac arrhythmias; hypothyroidism hypoparathyroidism
55
When should lithium be taken?
at night due to sedation
56
What are th drug interactions of lithium?
NSAIDs; ACEIs; ARBs; diuretics
57
What tests should be done prior to commencing lithium?
U&Es; TFTs; ECG
58
What tests should be done during initiation of lithium tx?
lithium level (12 hours after last dose) and U&Es every 5 days
59
What should be done every 3 months on lithium?
lithium level and U&Es
60
What should be checked every 6 months on lithium?
TFTs
61
What are the warning signs of lithium toxicity?
GI upset; blurred vision; coarse tremor; ataxia; drowsiness
62
What are the signso f severe lithium toxicity?
confusion; LOC; seizures; coma; death
63
What are the causes of lithium toxicity?
increased dose; dehydration (physical illness; lack of fluid intake; alchohol; hot weather; exercise); drug interactions; reduction in salt intake
64
What is the treatment for lithium toxicity?
stop lithium; IV fluids; monitor renal function
65
What is the action sodium valproate?
blocks voltage sensitive sodium channels; increses levels of GABA
66
What are the SE of sodium valproate?
sedation; tremor; dizziness; GI upset; tiredness; weight gain; hepatotoxicity; pancreatitis; increase in suicidal behaviour; tertogenic
67
What should be chekced before starting sodium valproate?
platelets and LFTs
68
What is the action of lamotrigine?
blocks voltage sensitive sodium channels
69
What are the SE of lamotrigine?
rash; GI upset; insomnia; sedation; dizziness; ataxia; tiredness; SJS; blood dyscrasias
70
How should lamotrigine be started to reduce risk of rash and SJS?
titrate slowly over 6 weeks
71
What are the SE of atypical antipsychotics?
sedation; weight gain; metabolic syndrome; extrapyramidal symptoms; constipation; QTc prolongation; neuroleptic malignant syndrome
72
What are the SE of aripiprazole?
insomnia; GI upset; agitation; akathisia; orthostatic hypotension; headache; constipation
73
Give examples of atypical antipsychotics?
olanzapine; risperidone; quetiapine; amisulpride; paliperidone; clozapine; aripiprazole
74
Give examples of typical antipsychotics?
haloperidol; chlorpromazine;
75
What is the main action of typical antipsychotics?
dopamine 2 receptor blockade
76
What are the SE of typical antipyschotics?
extrapyramidal symptoms; sedation; dizziness; QT prolongation; hyperprolacintaemia; neuoleptic malignant syndrome; tardive dyskinesia; akathisia

Psychiatry (20 decks)

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