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Flashcards in Psychotropic medications Deck (76)
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1

Examples of SSRIs

Citalopram, Escitalopram, Sertraline, Fluoxetine, Fluvoxamine, Paroxetine

2

Contraindications/precautions to SSRIs

High bleeding risk, high risk for angle-closure glaucoma, bipolar disorder, concurrent treatment with other antidepressants (especially MAOIs)

3

Safety of SSRIs in pregnancy and breastfeeding

Category C in pregnancy - DON'T USE (use in 3rd trimester may also cause withdrawal in newborn)

Considered safe in breastfeeding, especially sertraline due to low levels in breast milk - potential drowsiness and irritability in newborn

4

Side effects of SSRIs

SSRI:
Serotonin syndrome
Stimulate CNS (tremor, headache, agitation)
Reproductive dysfunction (reduced libido, impotence)
Insomnia
+ GIT (nausea, diarrhoea)

Significant: hepatitis, increased QT interval, SIADH, abnormal platelet aggregation, acute angle-closure (esp paroxetine), EPS

5

Zoloft generic name

Sertraline

6

Lexapro generic name

Escitalopram

7

Prozac generic name

Fluoxetine

8

Indications for SSRIs

Major depression
Anxiety disorders (Panic disorder, OCD)
Bulimia nervosa
Premenstrual dysphoric disorder

9

Indications for SNRIs

Major depression
(duloxetine also indicated in general anxiety disorder and second line in painful diabetic peripheral neuropathy)

10

Contraindications/precautions of SNRIs

CrCl less than 30 (reduced dose)
Hepatic impairment
Bipolar
Epilepsy/increased risk of seizures
High bleeding risk
High risk of angle-closure
High risk of overdose (esp avoid venlafaxine)

11

Safety of SNRIs in pregnancy and breastfeeding

Category B2 - limited studies, use in 3rdT can cause withdrawal in newborns

Low concentrations in breast milk, monitor baby for sedation and FTT, consider using alternative to duloxetine until more data

12

Side effects of SNRIs

Common: Nausea, constipation, dry mouth, sexual dysfunction, sweating, dizziness, headache, reduced appetite, rash

Significant: seizures, myositis, Takotsubo, SIADH, orthostatic hypotension, urinary retention (duloxetine), Steven-Johnson, increased bleeding

13

Monitoring patient on SNRI

Check baseline BP and regularly after commencement for rise
Baseline Na then monitoring soon after commencement especially at risk patients(e.g. elderly)
Monitor frequently and carefully early in treatment for suicidal thoughts and behaviours

14

Monitoring patient on SSRI

Baseline sodium and soon after starting treatment if risk of hypoNa e.g. elderly
Monitor frequently early in treatment for suicidal thoughts and behaviours

15

Indications for mirtazapine

Major depression, especially useful where insomnia or anorexia are prominent features

16

Mechanism of action of mirtazapine

Blocks post-synaptic serotonin receptors and presynaptic alpha-adrenergic receptors

Also a potent H1 antagonist (causes sedation)

17

Contraindications/precautions to use of mirtazapine

Treatment with, or within 14 days of stopping, a MAOI
Epilepsy/increased risk of seizures
Phenylketonuria
Bipolar

18

Drug class of mirtazapine

Serotonin noradrenaline disinhibitor

19

Side effects of mirtazapine

Common: increased appetite, weight gain, sedation, weakness, peripheral oedema

Significant:
Mania, seizures, agranulocytosis, granulocytopaenia

20

Dosing of mirtazapine

Initial dose 15mg nocte - increase to 30-45mg nocte as indicated
Max. dose 60mg nocte
Withdraw over at least 1-2 weeks to minimise withdrawal symptoms

21

Indications for monoamine oxidase inhibitors

Major depression (third line)
Some anxiety disorders, including phobic disorders and panic disorders

22

Examples of SNRIs

Venlafaxine, desvenlafaxine, duloxetine

23

Generic name of Efexor

Venlafaxine

24

Generic name of Pristiq

Desvenlafaxine

25

Generic name of Cymbalta

Duloxetine

26

Examples of MAOIs

Phenelzine
Tranylcypromine
Moclobemide - selective for type A (second line)

27

Mechanism of action of MAOIs

IRREVERSIBLE inhibition of monoamine oxidase A and/or B - increased synaptic concentrations of adrenaline, noradrenaline, dopamine and serotonin

28

Contraindications/precautions to using MAOIs

Catecholamine-secreting tumours (e.g. phaeochromocytoma)
Cerebrovascular or cardiovascular disease
Angina/CAD (may reduce pain associated with MI)
Epilepsy/high risk of seizures
Bipolar
Diabetes (may reduce BGL)
Significant liver disease

29

Safety of MAOIs in pregnancy and breastfeeding

Category B2/3 - avoid in pregnancy until more data

Moclobemide appears safe in breastfeeding, limited data for other MAOIs

30

Side effects of MAOIs

Common: Orthostatic hypotension, sleep disturbance, headache, drowsiness, weakness, myoclonus, agitation, tremors/twitching, sexual dysfunction (less likely with moclobemide), nausea, diarrhoea/constipation

Significant: hypertensive crisis (usually precipitated by tyramine or med interactions), SIADH, hepatic damage, blurred vision