mental health update Flashcards

Question

what should you do if hyponatraemia with antidepressants occurs?

Answer 1

If identified stop antidepressant & sodium levels should normalise within 1-2 weeks * Urgent care if severe (Na < 125mmol/L) * Withdrawal symptoms may occur (less likely at beginning of treatment) * Once sodium normalised, choose different antidepressant (try different class)

Answer 2

By reducing the uptake of serotonin by platelets, SSRIs reduce the ability of platelets to aggregate and thereby increase the risk of haemorrhage, particularly gastrointestinal bleeding

Answer 3

– Elderly – Patients with a history of peptic ulcers – Excessive use of alcohol – Co-administration with other drugs associated with the risk of bleeding * NSAIDs, antiplatelet drugs, corticosteroids, and warfarin

Answer 4

– Avoid SSRIs/ SNRIs if possible if at increased risk – Avoid concomitant drugs which increase bleeding risk – If no suitable alternative can be found, consider gastroprotection – NICE suggests gastroprotection in older people who are taking NSAID/aspirin

Answer 5

– Antidepressants can cause QT prolongation, risk varies with each antidepressant – Thorough medical history, laboratory monitoring, and a baseline electrocardiogram (ECG) necessary to identify patients at risk for QT prolongation before starting an antidepressant that may prolong QT interval.

Answer 6

cardiac conditions- bradycardia, MI, HF electrolyte disturbances- hypokalemia, hypomg, hypocalcemia female genetic predispositions 65+ congenital long QT syndrome

Answer 7

dose-dependent QT interval prolongation. Avoid use in; – congenital long QT syndrome – known pre-existing QT interval prolongation – or in combination with other medicines that prolong the QT interval

Answer 8

ECG measurements for patients with cardiac disease * Electrolyte disturbances should be corrected before starting treatment

Answer 9

Citalopram maximum daily dose: – 40 mg for adults – 20 mg for patients older than 65 years – 20 mg for those with hepatic impairment * Escitalopram maximum daily dose: – older than 65 years is now reduced to 10 mg/day

Answer 10

* Further dose reductions in the first two weeks of treatment is recommended in patients with mild or moderate hepatic impairment or in poor metabolisers of CYP2C19 * Remember importance of drug interactions * Take care with patients prescribed CYP2C19 inhibitors - for example omeprazole (NICE 2011 recommend gastroprotection with SSRI in patients at risk of bleeding disorder)

Answer 11

fracture risk- use of TCAs and SSRIs

Answer 12

SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery (January 2021)

Answer 13

Characterized by altered mental status, neuromuscular hyperactivity, and autonomic instability Symptoms include agitation, confusion, delirium, and hallucinations profound shivering, tremor, teeth grinding, myoclonus, and hyperreflexia – Tachycardia, fever, and hypertension or hypotension – Flushing, diarrhoea, and vomiting are also common

Answer 14

Concomitant use of antidepressants with other serotonergic drugs (tramadol, triptans) or dopaminergic drugs (selegiline) can increase the risk

Answer 15

Tricyclic antidepressants (TCAs) and venlafaxine very harmful in cases of overdose

Answer 16

* When stopping an antidepressant, gradually reduce the dose, normally over a 4-week period, although some people may require longer periods, particularly with drugs with a shorter half-life (such as paroxetine and venlafaxine). * This is not required with fluoxetine because of its long half-life

mental health update Flashcards

(40 cards)