Mental health Flashcards
(39 cards)
What are the indications of SSRI’s and provide examples?
1) Depression (1st line)
2) GAD/Panic disorders
3) OCD
-Citalopram, Sertraline, Fluoxetine
What is the mechanism of action of SSRI’s?
Selective serotonin reuptake inhibitors inhibit serotonin reuptake.
Why use SSRI’s over TCA’s?
SSRI’s are generally preferred as they have fewer adverse effects and less dangerous in overdose than TCA’s.
What are the important side effects of prescribing SSRI’s and SNRI’s?
- Weight disturbance (loss or gain)
- Insomnia
- Sexual dysfunction
- Hyponatraemia in the elderly
- Citalopram specifically can prolong QT interval, predisposing to arrhythmias
- Suicidal thoughts and behaviour increased, just use with caution
- GI upset (nausea, vomiting, pain, diarrhoea)
- At high doses can cause serotonin syndrome (triad of altered consciousness level, neuromuscular abnormalities and autonomic hyperactivity), but this usually responds to treatment withdrawal.
What is serotonin syndrome? What other medication can increase the risk of it?
At high doses of SSRI’s can cause serotonin syndrome (triad of altered consciousness level, neuromuscular abnormalities and autonomic hyperactivity), but this usually responds to treatment withdrawal of SSRI’s.
-Other antidepressants such as MAOI, have the same effect, so when used simultaneously with SSRI’s can increase risk of serotonin syndrome.
What happens when antidepressants are stopped?
-Discontinuation syndrome occurs with symptoms such as GI upset, diarrhoea, dizziness, headache, insomnia, tremor. So antidepressants need to be gradually tapered down before being withdrawn completely
What are interactions of SSRI’s?
- Do not combine with MAOI/triptans as can increase chance of serotonin syndrome
- Do not combine with Antipsychotics as can prolong QT interval, predisposing to arrhythmias
- If using with NSAIDS co-prescribe PPI as NSAID and SSRI can cause GI bleeding.
What are MAOI’s and action?
Monoamine oxidase inhibitors inhibit monoamine oxidase A. These are typically used for atypical depression.
What are CI of SSRI’s and SNRI’s?
- prolonged QT interval
- young people.
- mania, may actually worsen symptoms of bipolar or uncover a manic episode
What are SNRI’s?
Serotonin-noradrenaline reuptake inhibitors inhibit uptake of serotonin and noradrenaline.
What are indications of TCA’s and examples?
1) Depression (2nd line)
2) Anxiety/panic disorders
3) OCD
4) Neuropathic pain in MS
Examples: Amitriptyline
What is the mechanism of action of TCA’s?
-Tricyclic antidepressants inhibit reuptake of serotonin and noradrenaline. Also blocks wide array of receptors e.g. muscarinics, histamine, adrenergic, dopamine
What are adverse effects of TCA’s?
- Blockage of histamine and adrenergic receptors can cause sedation and hypotension
- Cardiac effects can cause ST elevation and QT interval prolongation
- cause sexual dysfunction
- DANGEROUS in overdose causing convulsions, arrhythmias
- Sudden withdrawal can cause GI upset, insomnia
What are CI of TCA’s?
- Arrhythmias
- Recent MI
- Pts with high risk of overdose
What are indications of Mirtazapine?
1)Antidepressant for major depression, can be given to patients with depression whereby sedation or increased oral intake is needed
What are side effects of mirtazapine?
-Associated with increased appetite, weight gain
-sedation
So can be given to patients with depression whereby sedation or increased oral intake is needed.
What are indications of Benzodiazepines?
1) Seizures (1st line) - lorazepam
2) Alcohol withdrawal (1st line) - chlordiazepoxide/diazepam
3) Short treatment for insomnia - temazepam
4) Short term treatment for anxiety disorders - temazepam
5) Sedation for acute mania or psychosis
What is the mechanism of action of Benzodiazepines?
Benzodiazepines facilitate and enhance binding of GABA to the GABAA receptor.
What are the side effects of Benzodiazepines?
- Can cause dose-dependent drowsiness, coma and sedation. Important to warn pts about potential dangers of drowsiness when driving.
- Risk of substance dependence with prolonged use
- Sudden withdrawal can cause withdrawal symptoms
What are the warnings of Benzodiazepines?
- Use with caution in pts with chronic respiratory disease (COPD, sleep apnoea) as may depress respiration.
- Use lower doses for elderly, their more susceptible to side effects leading to falls
What is the antagonist for Benzodiazepines?
-Flumazenil can reverse effects of benzodiazepines
What is the mechanism of action and types of antipsychotics?
- First generation (typical) are D2 (dopamine) receptor antagonist
- Second generation atypical antipsychotics act on a variety of receptors.
What are the indications of antipsychotics?
1) Schizophrenia - Haloperidol (first generation antipsychotic)
2) Bipolar disorder
3) Severe psychomotor agitation that is causing dangerous, impulsive, violent behaviour (calms patients)
4) Depression or mania with psychotic features
What are extrapyramidal side effects and which drug associated with?
Commonly in first generation typical antipsychotics e.g. haloperidol, blocking dopamine pathway can cause extrapyramidal effects (movement abnormalities e.g.
- parkinsonism (bradykinesia which is slowing of movements)
- dystonia (muscle spasms)
- akathisia (severe restlessness)
- tardive dyskinesia (involuntary movements of head, limbs, trunk)
Other side effects are include impaired glucose tolerance, prolonged qt intervals, hyperprolactinaemia.
