Flashcards in Pharmacological Therapy Deck (74)
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
Selective serotonin and noradrenaline reuptake inhibitor
What are Mirtazapine's SEs?
Increased appetite/weight gain
What are the SSRIs?
What are the atypical antipsychotics?
Dopamine D2 receptor blockade
Olanzapine +ve sx
Aripiprazole red EPSE
What are the typical antipsychotics?
Dopamine D2 receptor blockade
Flupentixol decanoate - depot assoc with v severe EPSEs
Tend to cause distressing EPSEs at normal treatment doses
What are SEs of typical antipsychotics?
EPSE: extra pyramidal side effects
Weight gain, dyslipidaemia + increased risk diabetes
Neuroleptic malignant syndrome
Most common side effect= hypersalivation
1-2% Agranulocytosis rate
Increased prolactin levels
What are the benzodiazepines?
Incr Cl channel freq = enhance GABA
What are the MAOIs?
Irreversible MAO inhibition
Moclobemide: reversible inhibition
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
What are common side effects of SSRIs?
Appetite, weight change
Anxiety + agitation
Insomnia, tremor, dizziness
What are common side effects for SSNRIs
Same as SSRIs plus
Noradrenergic and Specific Serotonin Antidepressant
What are the SEs of TCAs?
Dry mouth, blurred vision,
Constipation, urinary retention
Nausea, weight gain
What are the common side effects of MAOIs?
Hypertensive crisis "cheese reaction"
Postural hypotension, dizziness
Headache, blurred vision
What are the side effects of St John's Wort?
As effective as TCAs for mild-mod depression
Induces P52 risks drug interactions: reduces warfarin, ciclosporin, COCP
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
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
What is serotonin syndrome?
Sx: restlessness, sweating, myoclonus, confusion, fits
Acts on 5HT1a receptor
No antidepressant action alone
May synergistic effect in combination with SSRIs
What are the mood stabilisers?
?action on Na channels / GABA
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
Active drug= valproic acid
Plasma levels don't require monitoring
Dose related toxicity not an issue
2nd line, less effective than lithium
Can cause toxicity at high doses
Induces liver enzymes
Levels must be carefully monitored
Nausea + vomiting