Antidepressants/Mood stabilisers

Question 1

Which antidepressent group in most dangerous in overdose?

Answer 1

Tricyclics

Question 2

How long does it take for the patient to feel the improvement from an antidepressant drug?

Answer 2

2 - 3 weeks.

Question 3

What is the general action of antidepressent medications?

Answer 3

Inhibit reuptake of norepinephrine/seratonin (5HT)

Question 4

Briefly describe how SSRIs work

Answer 4

Reduce the reabsorption of serotonin into the presynaptic cell.
This increases the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor.
Overall there is an increase in neurotransmitter availability

Question 5

Give an example of a tricyclic antidepressent

Answer 5

Amitryptyline

Question 6

Give an example of an Monoamine oxidase inhibitor

Answer 6

Phenelzine

Question 7

Give 3 examples of SSRIs

Answer 7

Fluoxetine
Citalopram
Setraline

Question 8

What other 3 types of receptor will tricyclic antidepressents block?

Answer 8

Muscarinic receptors
Alpha adrenoreceptors
Histamine receptors

Question 9

List some common side effects of tricyclic antidepressentss

Answer 9

Dry mouth
Blurred vision
Constipation
Urinary retention
Tachycardia
Postural hypotension
(Sedative effect)

Question 10

What is a contraindication to use of tricyclic antidepressents?

Answer 10

Recent MI

Question 11

In general, what is the first line antidepressant?

Answer 11

SSRIs

Question 12

List some common side effects of SSRI antidepressents

Answer 12

Nausea
Vomiting
Diarrhoea
Sexual dysfunction

Question 13

How do Monoamine oxidase inhibitors work?

Answer 13

Inhibit the action of monamine oxidase

Prevents breakdown of dopamine, noradrenaline and serotonin

Question 14

What pathway do some SSRIs (eg fluoxetine) block?

Answer 14

CYP450

Question 15

A 26 year old man has just been started on an SSRI for depression. He has started to suffer from some sexual dysfunction. What drug would be useful?

Answer 15

Trazodone

Question 16

What cardiac arrhythmia may arise due to tricyclic antidepressants?

Answer 16

Prolonged QT syndrome

Question 17

What drug is more often used to treat atypical depression?

Answer 17

Monoamine oxidase inhibitor

Question 18

What substance in the gut becomes inactivated by monoamine oxidase inhibitor and then acts by releasing noradrenaline?

Answer 18

Tyramine

Question 19

What does tyramine release when it is inactivated in the gut by a monoamine oxidase inhibitor?

Answer 19

Noradrenaline

Question 20

What is a patient on a Monoamine oxidase uptake inhibitor at risk of if the eat lots of tyramine containing foods?

Answer 20

Hypertensive crisis due to release of noradrenalin

Question 21

What foods should patients be told to avoid if the are tacking a MAOI?

Answer 21

cheese, yoghurt, yeast extracts, meat, alcohol, broad

beans, pickled herring

Question 22

How do you treat a hypertensive crisis die to MAOI use?

Answer 22

Alpha blockade (phentolamine

Question 23

List three anti convulsant drugs which are also used as mood stabilisers

Answer 23

Carbamazepine
Valproate
Lamotrigine

Question 24

List some atypical antipsychotics

Answer 24

Olanzapine
Risperidone
Ariprazole

Question 25

What citrate drug is used in bipolar disorder?

Answer 25

Lithium carbonate

Question 26

What calcium channel agonist is used in the treatment of bipolar disorder?

Answer 26

Nimodipine

Question 27

What receptor do true antipsychotic drugs have affinity for?

Answer 27

D2 receptor

Question 28

Which SSRI is safest if a patient has a past history of MI?

Answer 28

Sertraline

Question 29

A patient on long term aspirin is about to be started on an SSRI. What must also be presscribed?

Answer 29

PPI

Question 30

If you are prescribing an SSRI to a 17 year old, which one would be most appropriate?

Answer 30

Fluoxetine

Question 31

Which SSRI is associated with prolongation of the QT interval?

Answer 31

Citalopram

Question 32

Which drug group, most often prescribed for headaches is a contrainditicion to SSRI?

Answer 32

Triptans