TCAs Flashcards
1
Q
What is the treatment algorithm for antidepressants?
A
- SSRI
- Dose Escalation (if no effect after 4-6 weeks)
- Switch to different drug (within same class)
- Augmentation: Add lithium or quetiapine or risperidone or aripiprazole
- Combinations: Use venlafaxine & mirtazapine
OR olanzapine & fluoxetine
2
Q
what other indications are there for using antidepressants?
A
- OCD (clomipramine)
- anxiety disorder
- PTSD
- neuropathic pain
- eating disorders (fluoxetine)
nocturnal enuresis (TCAs)
3
Q
what is the mechanism behind TCAs?
what examples are there of TCAs? (5)
A
- inhibit serotonin and noradrenaline reuptake
- amitryptiline
- lofepramine
- clomipramine
- dosulepin
- trazodone
4
Q
what are the side effects of TCAs?
when should you stop treatment?
A
- sedating effect
- risk of arrhythmia (use with caution in those with CV RF)
- antimuscarinic effects (don’t give in constipation/ urinary retention/ glaucoma etc)
- elderly more likely to get SEs
- hypotension
- tachycardia and prolonged QTc.
- extrapyramidal symptoms
- if patient enters manic phase
5
Q
what two TCAs are most commonly associated with fatality in overdose?
What happens in overdose?
what are the withdrawal symptoms like in TCAs?
A
- amitryptilline and dosulepin (NOT USED ANYMORE)
- arrhythmias, epileptogenesis
- like flu ( chills/ rigors, myalgia, sweating nausea)
- insomnia
- vivid dreams
