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Flashcards in Pharmacological Therapy Deck (74)
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1

What are the TCAs?

Amitriptyline - most tox, sed
Imipramine - less sed
Lofepramine - least tox in OD, less sed
Clomipramine - sed
Dosulepin - most tox, sed
Trazodone - sed

2

SSNRIs
Selective serotonin and noradrenaline reuptake inhibitor

Venlafaxine
Duloxetine

3

What are Mirtazapine's SEs?

Increased appetite/weight gain
Sedation
Oedema

4

What are the SSRIs?

Sertraline
Paroxetine
Citalopram
Fluoxetine
Fluvoxamine
Escitalopram

5

What are the atypical antipsychotics?

Dopamine D2 receptor blockade
Olanzapine +ve sx
Risperidone
Clozapine
Aripiprazole red EPSE
Quetiapine
Amisulpride

6

What are the typical antipsychotics?

Dopamine D2 receptor blockade
Haloperidol
Chlorpromazine
Flupentixol decanoate - depot assoc with v severe EPSEs
Tend to cause distressing EPSEs at normal treatment doses

7

What are SEs of typical antipsychotics?

EPSE: extra pyramidal side effects
Hyperprolactinaemia
Weight gain, dyslipidaemia + increased risk diabetes
Sedation
Anticholinergic SE
Arrhythmias
Seizures
Neuroleptic malignant syndrome
Hypotension
Tachycardia

8

Clozapine


Most common side effect= hypersalivation
1-2% Agranulocytosis rate
Myocarditis
Arrhythmia

9

Quetiapine

Diabetes
Weight gain
Lipid abnormalities

10

Risperidone

Increased prolactin levels

11

Olanzapine

Diabetes
Weight gain
Lipid abnormalities

12

What are the benzodiazepines?

Incr Cl channel freq = enhance GABA

Diazepam
Clonazepam
Alprazolam

13

What are the MAOIs?

Irreversible MAO inhibition
Phenelzine
Moclobemide: reversible inhibition
Trancypromine

14

How would you counsel patients regarding SSRIs?

Avoid drinking alcohol whilst in antidepressants due to increased sedation
Never drive if feeling drowsy on antidepressants
Onset of action is delayed
Outline side effects

15

What are common side effects of SSRIs?

Nausea, vomiting
Appetite, weight change
Blurred vision
Anxiety + agitation
Insomnia, tremor, dizziness
Headache
Sweating

16

What are common side effects for SSNRIs

Same as SSRIs plus
Constipation
Hypertension
Raised cholesterol

17

NASSAs
Noradrenergic and Specific Serotonin Antidepressant

Mirtazapine

18

What are the SEs of TCAs?

Tachycardia, arrhythmia
Dry mouth, blurred vision,
Constipation, urinary retention
Postural hypotension
Sedation
Nausea, weight gain

19

What are the common side effects of MAOIs?

Hypertensive crisis "cheese reaction"
Postural hypotension, dizziness
Drowsiness, insomnia
Headache, blurred vision
Nausea, vomiting
Constipation

20

What are the side effects of St John's Wort?

As effective as TCAs for mild-mod depression
Photosensitivity
Anxiety dizziness
GI symptoms
Fatigue, headache
Induces P52 risks drug interactions: reduces warfarin, ciclosporin, COCP

21

What are discontinuation symptoms?

Occur when antidepressant stopped suddenly:
Flu like sx, electric shock sensations, headaches, vertigo, irritability
To avoid withdraw over a few weeks

22

What should you be careful of when swapping antidepressants?

If of different classes they might interact dangerously: check!
SSRI-> TCA: cross-taper
Drug free washout period: fluoxetine 1 wk
Start venlafaxine v slowly 37.5mg each day

23

What is serotonin syndrome?

Excess serotonin
Potentially life-threatening
Sx: restlessness, sweating, myoclonus, confusion, fits

24

Buspirone

Acts on 5HT1a receptor
Anxiolytic
No antidepressant action alone
May synergistic effect in combination with SSRIs

25

What are the mood stabilisers?

Lithium
Sodium valproate
Carbamazepine
?action on Na channels / GABA

26

Lithium

Unknown mech of action ? cAMP inhibition
Therapeutic range: 0.6-1mmol/L
>1.2 mmol/L = toxic
Monitored weekly after start/ dose change until a steady therapeutic level achieved
U+Es & TFTs every 3-6 months
Can cause renal impairment + hypothyroidism

27

Valproate

Active drug= valproic acid
An anticonvulsant
Plasma levels don't require monitoring
Dose related toxicity not an issue

28

Carbamazepine

2nd line, less effective than lithium
Anticonvulsant
Can cause toxicity at high doses
Induces liver enzymes
Levels must be carefully monitored

29

Lithium SEs

Mild tremor
Nausea + vomiting
Polyuria, polydipsia
Arrhythmia
Hypothyroidism
Weight gain

30

Valproate SEs

Nausea, vomiting, diarrhoea
Liver failure
Thrombocytopenia
Hair loss
Weight gain