Flashcards in CNS Deck (67):
According to the Maudsley guidelines, how long does it take before antidepressants exert their effects?
What are the risk factors for antidepressant-induced hyponatraemia?
Low body weight
Low baseline sodium concentration
Some drug treatments (e.g. diuretics, NSAIDs, carbamazepine, chemotherapy)
Reduced renal function
Medical co-morbidity (e.g. hypothyroidism, diabetes, COPD, hypertension, head injury, CVA, various cancers)
Warm weather (summer)
What are the five steps to better wellbeing?
What is the aetiology of depression?
What are the two core screening questions used for depression?
During the last month have you often been bothered by feeling down, depressed or hopeless?
Do you have little interest or pleasure in doing things?
What are the typical symptoms of depression?
Fatigue/loss of energy
Worthlessness/excessive or inappropriate guilt
Recurrent thoughts of death, suicidal thoughts, or actual suicide attempts
Diminished ability to think/concentrate or indecisiveness
Psychomotor agitation or retardation
Significant appetite and/or weight loss
Define subthreshold depression
Where there is more than 2 but less than 5 symptoms of depression
Define persistent subthreshold depression
Dysthymia, patient has had at least 2 years of depressed mood on more days than not and has at least 2 but less then 5 symptoms
Define mild depression
Few, if any, symptoms in excess of the five required to make the diagnosis, and only minor functional impairment
Define moderate depression
Symptoms or functional impairment between mild and severe. Some symptoms would be expected to be marked
Define severe depression
Several symptoms in excess of those required to make the diagnosis. Some symptoms would be expected to be severe and markedly interfere with functioning
Give an example of a tricyclics antidepressant
What are the main ADRs associated with TCAs?
Sedation, postural hypotension, tachycardia/arrhythmia, dry mouth, blurred vision, constipation, urinary retention
What are the major interactions associated with TCAs?
SSRIs (except citalopram), phenothiazines, cimetidine, alcohol, antimuscarinics, antipsychotics, MAOIs
Give an example of an SSRI
What are the main ADRs associated with SSRIs?
Nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, rash, sweating, agitation, anxiety, headache, insomnia, tremor, sexual dysfunction, hyponatraemia, cutaneous bleeding disorders
What SSRIs are used in panic disorder?
Citalopram, escitalopram, paroxetine
What SSRIs are used in agoraphobia?
Citalopram, escitalopram, paroxetine
What SSRIs are used in social anxiety?
Escitalopram and paroxetine
What SSRIs are used in GAD?
Escitalopram and paroxetine
What SSRIs are used in OCD?
Escitalopram, fluoxetine, fluvoxamine, sertralineline
What interactions are associated with SSRIs?
What cautions surround the use of SSRIs?
Patients under 18
What are the contraindications for the use of SSRIs?
What cautions surround the use of TCAs?
Depression associated with suicidal thoughts
Give an example of an SNRI
What ADRs are associated with SNRIs?
Nausea, HTN, serotonin syndrome
What cautions surround the use of SNRIs?
What interactions are associated with SNRIs?
What class of drug is mirtazapine?
Presynaptic alpha-2 adrenoceptor blocker
What ADRs are associated with mirtazapine?
What class of drug is trazodone?
Serotonin receptor blocker
What ADRs are associated with MAOIs?
Dose-related postural hypotension
What interactions are associated with non-selective MAOIs?
Amine-containing drugs including sympathomimetics and tyramine
What ADRs are associated with reversible MAOIs?
What are the symptoms of serotonin syndrome?
What drugs cause serotonin syndrome?
Serotonin precursors (tryptophan)
Serotonin agonists (triptans, buspirone, LSD)
Serotonin releasing agents (ecstasy, amphetamines)
St John’s wort
How does hypertensive crisis occur?
MAOIs reduce breakdown of NA in adrenergic nerve ending
=> large stores that can be released into synaptic cleft in response to a neuronal discharge or an indirectly acting amine
What are the symptoms of hypertensive crisis?
How is hypertensive crisis managed?
Alpha-blockade with phentolamine
Describe the aetiology of anxiety
Temporal lobe lesions
Rare hormone-secreting tumours e.g. phaeochromocytoma
What are the clinical features of anxiety?
Apprehension and fear
Somatic symptoms: palpitations, chest pain, SOB, dizziness, loss of libido, headaches, tremor
Describe the mechanism of action of benzodiazepines
Selective agonist on GABAa receptors, enhance responses to GABA by facilitating the opening of GABA-activated chloride channels, inhibit neuronal excitability
What ADRs are associated with benzodiazepines?
Respiratory distress and arrest
Confusion and amnesia
Tolerance and dependence
What cautions surround the use of benzodiazepines?
Avoid in pregnancy
What are the contraindications for the use of benzodiazepines?
What interactions are associated with benzodiazepines?
Erythromycin, ketoconazole, fluconazole
What advice can be provided for benzodiazepine withdrawal?
Avoid prolonged treatment (<4w)
Gradual withdrawal over 4-8 weeks is desirable
Switch to a longer acting benzo
Dose reduction 2mg diazepam equivalents every 2w
What are the effects of benzodiazepine toxicity?
Excessive sedation, respiratory depression, coma
What is the treatment for benzodiazepine toxicity?
Romazicon (flumazenil) 0.2mg over 30s, wait 30s, 0.3mg over 30s, then 0.5mg every 60s up to a maximum of 3mg
What class of drug is buspirone?
5HT1a partial agonist
What ADRs are associated with buspirone?
What ADRs are associated with z-drugs?
What cautions surround the use of z-drugs?
What are the contraindications for the use of z-drugs?
What are the symptoms of Alzheimer’s disease?
Problems with visuospatial skills
Difficulties with organisational skills
Difficulties with orientation
What are the symptoms of vascular dementia?
Inability to recognise familiar objects
What are the symptoms of DLB?
Problems with executive functions
Transient, unexplained loss of consciousness
Severe autonomic dysfunction
What are the symptoms of behavioural variant frontotemporal dementia?
Loss of inhibitions
Loss of motivation
Loss of sympathy or empathy
Craving sweet or fatty foods
Difficulty planning, organising or making decisions
Lack of insight into their symptoms
What are the symptoms of progressive non-fluent aphasia?
Slow, hesitant speech
Difficulties with grammar
Difficulties understanding complete sentences
What are the symptoms of semantic dementia?
Asking the meaning of familiar words
Difficulty finding the right word or use of generalised words
Difficulty recognising familiar people or common objects
What class of drug is rivastigmine, donepezil and galantamine?
How do acetylcholinesterase (AChE) inhibitors work?
Block breakdown of acetylcholine, compensating for the loss of cholinergic neurones
What ADRs are associated with AChEIs?
SA and AV block
What class of drug is memantine?
Glutamate receptor antagonist
What ADRs are associated with memantine?