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cardiovascular system 1 > CNS 4 > Flashcards

CNS 4 Flashcards

(62 cards)

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1
Q

What are the 3 classes of Antidepressants

A

Tricyclic and related Antidepressants ( Inc 5HT and N)
SSRIs( increase 5HT)
Monoamine oxidase inhibitors ( increase 5HT, NA abd DA)
SNRI( venfalaxine and duloxetine)

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2
Q

Egs of Tricyclic Antidepressants

A

Amitriptyline and nortriptyline( neuropathic pain )

Clomipramine
Dosulepin

Imipramine ( most antimuscuranic side effects)
Lofepramie ( Liver toxic)

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3
Q

List examples of tetracycline Antidepressants

A

Manserin and trazodone

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4
Q

Egs of SSRI

A

Citalopram
Fluoxetine
Sertraline
Paroxetine

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5
Q

An SSRI that is licensed for children is called?

A

Fluoxetine

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6
Q

An SSRI with a high withdrawal effect is called

A

Paroxetine

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7
Q

An SSRI safe in Unstable Angina and MI is called

A

Sertraline

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8
Q

List examples of MAOIs

A

Irreversible and reversible

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9
Q

List examples of Irreversible MAOI

A

Phenelzine
Isocarboxid
Tranylcypromine( htn crisis risk)

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10
Q

List examples of reversible MAOI

A

RIMA( no washing out period)
Eg Moclobamide- licensed for social anxiety disorder

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11
Q

What type of depression are Antidepressants effective for?

A

Moderate to severe depression

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12
Q

Which Antidepressants class is first line and why?

A

SSRIs
Better tolerated and safer in OD
Less sedating
Fewer antismuscarinic and cardiotoxic effects
Sertraline is safe in pt with Unstable Angina or recently had MI

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13
Q

Facts about TCA

A

Similar efficacy to SSRIs but more side effects
Toxicity in OD
More sedating
More Antimuscarinic and cardiotoxic side effect

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14
Q

Facts about MAOI

A

Dangerous interaction with some foods and drugs
Reserve for use by specialists

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15
Q

Facts about St John’s wort

A

It is an inducer
Used to tx mild depression
Increase conc of another drug a pt is taken
Do not Prescribe or recommend for depression
It pt stops taking St John’s wort, the concentration of interacting drugs may increase, leading to toxicity

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16
Q

Management of depression

A

Review pt every 1-2wks at start of tx
They take atleast wks to work
Continue tx for atleast 4wks ( 6wks for elderly) before switching due to lack of efficacy)

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17
Q

What’s the duration of tx depression if no efficacy efficacy after 1-2wks

A

Incase of Partial response, continue for further 2-4weeks( elderly pts may take longer to respond)

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18
Q

What’s the duration for tx pt with a hx of recurrent depression

A

2 years

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19
Q

State the duration of tx depression after remission

A

Atleast 6months
12 months in elderly
12months for generalised Anxiety disorder because higher risk of relapse

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20
Q

All Antidepressants cause hyponatremia . True or false?

A

True
Occurs more with SSRIs in elderly esp

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21
Q

What are the signs of hyponatremia( salt loss)

A

Stupor / coma
Anorexia
Lethargy
Tendon reflexes reduced
Limp muscle weakness
Orthostatic hypotension
Seizures/ headache
Stomach cramps

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22
Q

Antidepressants are linked with suicidal thoughts and behaviour. True or false?

A

True

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23
Q

What pts group are at risk of suicidal thoughts?

A

Children, young adults and individuals

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24
Q

What is serotonin syndrome?

A

High levels of serotonin esp when SSRIS /SNRis plus drugs that raises serotonin are given together esp MAOi- do not mix

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25
What are the symptoms of Serotonin syndrome
Neuromuscular hyperactivity( tremor, clonus, rigidity, hyper reflexia) Autonomic dysfunction ( Tachycardia, BP, hyperthermia, diarrhoea, sweating) Altered mental State( confusion, coma, agitation) Withdraw medication if symptoms occur
26
Tx failure with Antidepressants
Increase dose or switch to different SSRIs or Mirtazapine if initial response to SSRIS fail Or second line choice eg Fluoxetine, roboxetine or moclobemide Venlafaxine reserved for more severe cases MAoi requires specialist Third line Add another Antidepressants class or lithium or Antisychotics
27
Examples of sedating TCA's
Give to anxious pt Amitriptyline Clomipramine Dosulepin( toxic in OD) Trazodone Trimipramine Doxepin
28
Examples of less sedating TCA's
Imipramine ( most antimuscarinic side effects Lofepramine Nortripyline For withdrawn and apathetic patients NIL
29
Contraindications of TCA's
Manic phase in bipolar Arrhythmia Heart block Immediate recovery period after M.I Mainly CV related
30
TCA cautions
CV disease Diabetes Chronic constipation Epilepsy History of bipolar and psychosis Hyperthyroidism ( risk of Arrhythmia) Glaucoma, urinary retention Elderly pts more susceptible to side effects cus can cause hypotension
31
Common side effects of TCA
TCA T- more toxic in OD than SSRIS C- Cardiac side effects, QT prolongation, heart block, HTN, Arrhythmia) A- Antimuscarinic side effects S- seizures
32
Common side effects of TCA
QT interval elongation Drowsiness, Anticholinergic syndrome
33
What are Antimuscarinic side effects
Can't see Can't pee Can't shit Can't spit Anorexia Blurry vision Constipation/ Confusion Dry mouth Static urine ABCDS
34
Signs of TCA OD
Dry mouth Coma Hypotension ( Amitriptyline) Hypothermia Convulsions Arrhythmia Dilated pupil Urinary retention Cardiac conduction defect Respiratory failure
35
TCAs have varying Antimuscarinic and cardio toxic effects in OD. True or false
True
36
Facts about Lofepramine as a TCA
Less side effects, Less dangerous in OD but associated with hepatoxicity
37
Is Lofepramine safe in severe liver impairment?
Avoid
38
A TCA that has more Antimuscarinic side effects than the rest is ....
Imipramine
39
A TCA that is effective but dangerous in OD and not recommended in tx of depression is...
Amitriptyline/ dosulepin
40
Why are TCA's given once daily at night?
Due to long half life
41
TCAs can aggravate conditions especially in mania. T/f
True Stop if pts enter manic phase
42
Common TCAs interaction
Lithium ( increase risk of toxicity...see photo on fav.
43
Examples of irreversible MAOI s
Isocarboxazid( cause hypatoxicity) Phenelzine( hepatoxicity) Tranylcypromine( greater stimulant action than above more likely to cause htn crisis
44
List examples of reversible MAOI( RIMA)
Moclobemide- reserved for 2nd line
45
Important points to note about MAOIs
Massive hypertensive crisis eg massive headache Avoid tyramine( triggers htn crisis) -Stroke and MI Interacts with OTc meds Increase suicide risk Don't give with pseudoephredine Do not mix with other Antidepressants cause Serotonin syndrome
46
State the withdrawal symptoms associated with MAOIs
Agitation, irritability, ataxia, movement disorders, Insomnia, drowsiness, vivid dreams, hallucinations, slowed speech, delusion Risk of symptoms increased if stopped suddenly after regular administration 8wks or more
47
Side effects of MAOIs
Risk of postural hypertension mainly in elderly and hypertensive responses( severe increase in BP that may cause a stroke) Withdraw if palpitation or frequent headches occur
48
Wash out period for Antidepressants
See fav photos
49
List drugs that can cause hypertensive crisis when given with MAOI
Sympathomimetics such as Ephedrine and pseudoephridine eg cold and flu remedies TCA( imipramine and clomipramine) Dopaminergic drugs such as Levodopa and MAO-B
50
Food that interacts with MAOI
Food that contains tyramine cus tyramine triggers nerve cell to release noradrenaline which increase NP which cause throbbing headache
51
Which food contains tyramine
Mature cheese Pickled herring Broad bean pods Bovril, Oxon, Marmite Fermented soya bean extract
52
Pt and carer advise for pt on MAOI
Eat only fresh food and avoid stale food or going off food esp meat, poultry, fish or offal. Game should be avoided Avoid alcoholic drink or dealcholized drinks Drowsiness may affect skilled task Danger of food and drug interaction last for 2weeks after MAOI is stopped
53
Facts about RIMA
Moclobemide- major depressed and social anxiety Reversible inhibition of monoamine oxidase A- second line tx
54
Interaction with RIMA
Less tyramine effects than irreversible MAOI but avoid large amounts in tyramine rich food Less risk of drug interaction but still avoid Sympathomimetic Don't give with other Antidepressants
55
Examples of SSRI
Sertraline (safe in Angina and MI) Citalopram ( QT prolongation) Escitalopram( qt prolongation) Fluoxetine ( can be given to children) Fluvoxamine Paroxetine ( higher withdrawal)
56
Which Antidepressants has increased harmful outcomes in children and adolescent such as self harm, aggression and suicide risk?
SSRIs
57
Which Antidepressants is licensed for children and at what age?
8-17 Unlicensed- 5-7 Fluoxetine
58
Contraindications of SSRI
Poorly controlled epilepsy ( discontinue if convulsion occurs) Manic phase
59
Cautions for SSRIs
See fav photos
60
What is the MHRA/ CSM advice for SSRIs or SNRis
Small risk of post partum haemorrhage when used the month before delivery Increased risk of bleeding Risk more significant in patients with other risk factors for bleeding disorders Anticoagulant medication in women at high risk of thrombotic events should not be stopped but prescriber should be aware of this
61
Facts about SSRIS
Less sedating and fewer Antimuscarinic effects than TCA Hypontraemia Anxiety, Arrhythmia, confusion, drowsiness, constipation, QT interval prolongation, dry mouth, skin reactions, nausea, Palpitation
62
Important SSRIS interaction
See fav photos

cardiovascular system 1 (42 decks)

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