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| Questão | Responda |
| Selective Serotonin Re-uptake Inhibitors (SSRIs) | Citalopram (20-40mg), Escitalopram (10-20mg) |
| 2 Serotonin-Noradrenaline Re-uptake Inhibitors (SNRIs) | Venlafaxine (75-375mg), Duloxetine (60-120mg) |
| 2 Tricyclic Antidepressants (TCAs) | Amitriptyline (75-200mg), Clomipramine (30-250mg) |
| 2 Monoamine Oxidase Inhibitors (MAOIs) | Moclobemide (150-600mg), Phenelzine (45-90mg) |
| Neurotransmitters targeted by SSRIs, SNRIs, TCAs and MAOIs | SSRI - Seratonin SNRI – Seratonin, Norepinephrine/Noradrenaline, Dopamine TCAs – Seratonin, Norepinephrine/Noradrenaline MAOIs - Seratonin, Norepinephrine, Dopamine |
| Side-effects of Antidepressants | Sedation Dry mouth Palpitations Shake or tremor Weight gain Nausea Sweating Urinary difficulties Headache Fainting Insomnia Diarrhoea or constipation |
| different side-effects between the anti-depressant groups | (1) Tricyclics dry mouth, light tremor, fast heartbeat, constipation, sleepiness, weight gain, confusion, urinary problems, faintness through low blood pressure, sexual dysfunction, aggression (2) SSRIs Nausea, anxiety, sexual dysfunction, aggression (3) SNRIs similar to the SSRIs but can also increase blood pressure (venlafaxine) (4) MAOIs dangerously high blood pressure if eat foods containing Tyramine. NASSAs similar to SSRIs. drowsiness, weight gain, but less sexual problems. |
| Signs and symptoms of ‘serotonin syndrome’ (SS) | Twitches and jerks, Tremors of tongue + fingers, Shivering, Sweating, Confusion, Restlessness, Hyperreflexia (overactive / overresponsive reflexes), Convulsions |
| The Hunter Serotonin Toxicity Criteria | (1) Diagnostic criteria for serotonin toxicity. Good sensitivity (84%) and Specificity (97%) (2) Developed from large series of ODs on serotonergic drugs. (3) Criteria rely on a good focused neurological examination including assessing tone (muscle tone – observe movement / tremor), Clonus (involuntary muscular contractions), reflexes, Diaphoresis (excessive sweating). |
| MAOIs and foods and drinks that are contra-indicated when on these antidepressants | (1) Cheese Effect – increase in blood pressure following intake of cheese. (2) MAOIs prevent breakdown of Tyramine in gut with monoamine oxidase (3)= inc BP + headaches, neck stiffness, perspiration, flushing and vomiting. Potential of stroke. (4) Avoid: pizza, pasta (parmesan), wine, beer, herrings, caviar, sausages. |
| Clinical conditions that mood stabilisers can be prescribed for | (1) Bi-polar Disorder (Manic Depression) (2) Unipolar Disorder(recurrent depression), (3) Schizoaffective Disorder (4) Aggression (5) Self-harm (6) Mania (7) Depressive episodes |
| 2 mood stabilisers | Lithium Valproate Carbemazepine Lamotrigine |
| Serum concentrations for the therapeutic range of Lithium | 0.4-1.0mmol/L |
| Serum concentration level of Lithium that is considered toxic | Toxic range usually >2.0 mmol/L |
| Signs and symptoms of Lithium Toxicity | Loss of coordination, heavy shakes, muscle stiffness, difficulty speaking, confusion, stupor, coma, death. |
| Benzodiazepines (at least 2) | Diazepam, Lorazepam, Alprazolam |
| Recommendations for duration of use of benzodiazepines | 2-4 weeks only as dependence (physical and psychological) and tolerance occurs. Paradoxical effects (increased anxiety and aggression) can also occur. |
| clinical conditions that benzodiazepines can be prescribed for | (1) Anxiety (severe or disabling) (2) Insomnia (severe or disabling) (3) Spasticity (involuntary muscle contractions), Dystonia (sustained muscle contractions), Multiple Sclerosis. (4) Alcohol withdrawal (5) Mania (6) Catatonia and Neuroleptic Malignant Syndrome (7) Rapid Tranquilisation |
| withdrawal symptoms (at least 6) of benzodiazepines | Confusion Convulsions Insomnia Anxiety Loss of appetite Tremor Perspiration Tinnitus |
| Read up on the NMC (2010) Standards for Medicines Management: Section 4 (Standard 8) Standards for practice of administration of medicines | See notes |
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