MANAGEMENT Flashcards
(39 cards)
When are anti-depressants used?
moderate-severe depression
Which class of drug is first-line in depression? Why?
SSRI eg. sertraline or citalopram
better tolerated, safe in overdose, less sedating
How do SSRIs work?
block serotonin reuptake into the pre-synaptic terminal by binding to the serotonin transporter and changing its shape
this increases the amount of serotonin available to the post-synaptic nerve
Give another name for serotonin
5-HT
Name 4 SSRIs
fluoxetine, paroxetine, citalopram and sertraline
Give side-effects of SSRIs
- sexual dysfunction
- GI distubance
- short-term anxiety
- hyponatraemia
Which drug can increase risk of GI bleeding when on an SSRI?
if on NSAID give PPI
Can SSRI’s be used in pregnancy?
Yes but only if benefit>risk
1st trimester –> congenital malformation (Esp paroxetine)
3rd trimester –> persistent pulmonary hypertension of newborn
Which drug would be first choice in a patient with depression post-MI?
sertraline
How do TCAs work?
block reuptake of both serotonin and noradrenaline in the synaptic cleft by inhibiting their transporters.
Name 4 TCAs
- amitriptyline
- clomipramine
- imipramine
- dosulepin
Give side-effects of TCAs
- cardiotoxic
- anti-cholinergic
- constipation
- blurred vision
- dry mouth
- urinary retention
- postural hypotension
- sedative
Which TCA is particularly sedative?
amitryptiline
How are TCA and SNRI’s different?
TCAs are an old class of drugs that are very toxic. SNRI is a new class of drug trying to block the same thing.
They both block serotonin and noradrenaline. TCAs also block post-synaptic AcH and histamine.
How do SNRIs work?
block the reuptake of noradrenaline and serotonin in to the presynaptic terminals by binding to their transporters
Name 2 SNRIs
duloxetine and venlafaxine
What are the side-effects of SNRI?
- dizziness
- dry mouth
- GI dysfuntion
- sexual dysfunction
- short-term anxiety
How do monoamine oxidase inhibitors work?
they slow the breakdown of neurotransmitters (noradrenaline, adrenaline and serotonin) by inhibiting the MAO enzyme
Name a monoamine oxidase inhibitor
phenelezine
Give side-effects of MAOIs
- hypertensive crisis with food interactions (Cheese, wine..)
- insomnia
- peripheral oedema
How does mirtazapine work?
blocks alpha 2 adrenoreceptors to increase central noradrenergic and serotonergic neurotransmission
What is the important side effect of mirtazapine?
sedation causing weight gain
Which drugs are used in the management of bipolar disorder?
- lithium (mood stabiliser)
- anticonvulsants (block overactive pathways)
- antipsychotics (dopamine agonists)
Side-effects of lithium
- Nausea and vomiting
- Dry mouth
- Fine tremor
- Nephrotoxicity
- Hypothyroidism
- ECG t wave inversion
- Weight gain
- Idiopathic intracranial hypertension
