Pre Reg > DEPRESSION > Flashcards

DEPRESSION Flashcards

(59 cards)

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1
Q

What should be assessed before starting antidepressant treatment?

A

History previous treatment relationships lifestyle stress or trauma living conditions drugs alcohol employment loneliness

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2
Q

How long do antidepressants take to show effect?

A

4–6 weeks

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3
Q

When should the first antidepressant review occur?

A

After 2 weeks or after 1 week if age 18–25 or suicide risk

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4
Q

How long should antidepressants be continued after remission?

A

At least 6 months

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5
Q

What non-prescription treatments can be used for depression?

A

CBT St John’s wort light therapy in winter

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6
Q

First-line treatment for mild depression?

A

CBT

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7
Q

First-line drug treatment for moderate–severe depression?

A

SSRI

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8
Q

What should be done if there is limited response to an SSRI?

A

Increase dose or switch within same class

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9
Q

What is the next step if switching within SSRI class fails?

A

Switch to different class e.g. SNRI TCA MAOI

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10
Q

Treatment for severe depression?

A

Electroconvulsive therapy

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11
Q

When should SSRIs NOT be given?

A

Manic phase of bipolar disorder or uncontrolled epilepsy

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12
Q

Which SSRI is preferred in unstable angina or recent MI?

A

Sertraline

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13
Q

Which SSRIs increase QT prolongation risk?

A

Citalopram and escitalopram

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14
Q

Which SSRI should be avoided in severe hepatic impairment?

A

Sertraline

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15
Q

Common SSRI side effects?

A

Suicidal ideation QT prolongation appetite change seizures hepatic impairment sexual dysfunction insomnia GI bleeding serotonin syndrome

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16
Q

When should SSRIs be taken if insomnia occurs?

A

In the morning

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17
Q

Which drugs increase serotonin syndrome risk with SSRIs?

A

SNRI opioids St John’s wort triptans

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18
Q

Which drugs increase QT prolongation risk with SSRIs?

A

Lithium antiarrhythmics TCAs

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19
Q

Which drugs increase bleeding risk with SSRIs?

A

Anticoagulants antiplatelets NSAIDs

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20
Q

Which drug increases hyponatraemia risk with SSRIs?

A

Carbamazepine

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21
Q

Which SSRIs reduce tamoxifen effectiveness?

A

Fluoxetine and paroxetine

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22
Q

What are the three key features of serotonin syndrome?

A

Altered mental status neuromuscular abnormalities autonomic hyperactivity

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23
Q

Mental status changes in serotonin syndrome?

A

Agitation anxiety excitement

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24
Q

Neuromuscular signs of serotonin syndrome?

Study These Flashcards
A

Tremor clonus muscle rigidity

25
Autonomic signs of serotonin syndrome?
Tachycardia flushed skin vomiting diarrhoea
26
Drugs that can cause serotonin syndrome?
SSRIs SNRIs MAOIs TCAs opioids triptans linezolid ondansetron metoclopramide buspirone bupropion St John’s wort
27
Examples of tricyclic antidepressants?
Amitriptyline clomipramine imipramine nortriptyline lofepramine dosulepin
28
Which TCAs are sedating?
Amitriptyline clomipramine
29
Sedating TCAs are best for which patients?
Anxious and agitated
30
Which TCAs are less sedating?
Imipramine nortriptyline
31
Less sedating TCAs are best for which patients?
Withdrawn and apathetic
32
Which TCA is no longer prescribed?
Dosulepin
33
Which TCAs are dangerous in overdose?
Amitriptyline and dosulepin
34
Common side effects of TCAs?
Dry mouth blurred vision constipation weight gain sedation headache tremor sexual dysfunction
35
Serious toxicity risks of TCAs?
QT prolongation hypotension arrhythmias
36
Which drugs increase serotonin syndrome risk with TCAs?
SNRI opioids tramadol triptans St John’s wort
37
Which drug increases BP with TCAs?
Phenylephrine
38
Which substances increase sedation with TCAs?
Alcohol benzodiazepines barbiturates
39
Which drugs increase QT prolongation risk with TCAs?
Lithium antiarrhythmics other TCAs
40
Effect of CYP450 inhibitors on TCAs?
Increase concentration
41
Effect of CYP450 inducers on TCAs?
Decrease concentration
42
Which TCA interaction is fatal?
MAOI with TCA e.g. tranylcypromine and clomipramine
43
Examples of MAO-A inhibitors?
Phenelzine tranylcypromine isocarboxazid moclobemide
44
Why should MAOIs not be stopped abruptly?
Risk of withdrawal effects
45
What monitoring is required with MAOIs?
Monitor blood pressure
46
What dietary advice is required with MAOIs?
Avoid tyramine-rich foods and alcohol
47
Examples of tyramine-rich foods?
Mature cheese salami marmite yeast tofu
48
What happens if tyramine is eaten with MAOIs?
Hypertensive crisis
49
Which MAOIs are hepatotoxic?
Isocarboxazid phenelzine
50
Which MAOI is strongly associated with hypertensive crisis?
Tranylcypromine
51
Which decongestant should be avoided with MAOIs?
Phenylephrine
52
How long after stopping an MAOI can most antidepressants be started?
2 weeks
53
How long after stopping an MAOI before clomipramine or imipramine?
3 weeks
54
Washout period between MAOIs?
2 weeks
55
Exception to MAOI washout rule?
Moclobemide requires no washout
56
How long after stopping a TCA before starting an MAOI?
1–2 weeks
57
Washout period for clomipramine or imipramine before MAOI?
3 weeks
58
How long after stopping an SSRI before starting an MAOI?
1 week
59
Which SSRI requires 5-week washout before MAOI?
Fluoxetine
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