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CNS - Depression & Bipolar - INTRO - Antidepressants Overdose

19 important questions on CNS - Depression & Bipolar - INTRO - Antidepressants Overdose

What are the risks associated with overdose attempts with TCAs?

Overdose attempts with TCAs are serious and can often be fatal. Prescriptions should be nonrefillable and for no longer than a week at a time for patients at risk for suicide.

What symptoms are associated with a TCA overdose?

Symptoms of overdose include agitation, delirium, convulsions, hyperactive deep tendon reflexes, bowel and bladder paralysis, dysregulation of BP and temperature, and mydriasis.

What is the optimal plasma concentration range for antidepressant effects of imipramine, amitriptyline, and nortriptyline?

The optimal antidepressant effect is exerted at a narrow band of plasma concentrations between 50–200 ng/ml of imipramine, amitriptyline, nortriptyline.
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How do TCAs interact with guanethidine and clonidine?

TCAs abolish the antihypertensive action of guanethidine and clonidine by preventing their transport into adrenergic neurones.

What progression might a patient experience after a TCA overdose?

The patient then progresses to coma and perhaps respiratory depression. Cardiac arrhythmias may not respond to treatment due to the long half-lives of TCAs.

What effect do TCAs have on CNS depressants?

TCAs potentiate CNS depressants, including alcohol and antihistaminics.

How is the oral absorption of TCAs described?

The oral absorption of TCAs is good, though often slow. They are highly bound to plasma and tissue proteins, therefore have large volumes of distribution (~20 L/kg).

What are some anticholinergic adverse effects associated with certain antidepressants?

Anticholinergic adverse effects include dry mouth, bad taste, constipation, epigastric distress, urinary retention (especially in males with enlarged prostate), blurred vision, palpitation.

Why should patients be monitored in an intensive care setting after a TCA overdose?

Because of the long half-lives of TCAs, the patients are at risk of cardiac arrhythmias for 3 to 4 days after the overdose, so they should be monitored in an intensive care medical setting.

What are TCAs frequently implicated in regarding antidepressant overdose?

TCAs are frequently implicated in intentional and accidental overdose with fatal outcome. Irreversible non-selective MAOIs pose a similar risk of lethality in overdose.

What adverse effects are especially associated with amitriptyline?

Sedation, mental confusion, and weakness are adverse effects especially associated with amitriptyline.

Where are TCAs extensively metabolized?

TCAs are extensively metabolized in the liver. The plasma t½ of amitriptyline, imipramine, and doxepin range between 16–24 hours.

How can phenytoin, phenylbutazone, and aspirin affect TCAs?

Phenytoin, phenylbutazone, aspirin can displace TCAs from protein binding sites and cause transient overdose symptoms.

What is the daily oral dose range for Moclobemide and its relative intensity of insomnia and agitation?

Moclobemide has a daily oral dose range of 300-600 mg. The relative intensity of insomnia is ++ (moderate), and agitation is also ++ (moderate).

How do SSRIs and moclobemide compare in terms of lethality in overdose?

SSRIs and moclobemide possess a much lower lethality in overdose when taken alone, but may be toxic when in combination with other antidepressants.

What is the range of plasma t½ for amitriptyline, imipramine, and doxepin?

The plasma t½ of amitriptyline, imipramine, and doxepin range between 16–24 hours. Because of relatively long t½s, once daily dosing (at bed time) is practicable in the maintenance phase.

Describe the adverse effects of Nefazodone in terms of sexual dysfunction and GIT effects.

Nefazodone shows 0 (absent) for sexual dysfunction and + (mild) for GIT effects. The daily oral dose range is 300-600 mg.

What is the relative intensity of agitation and GIT effects for Venlafaxine?

Venlafaxine has a relative intensity of ++ (moderate) for agitation and +++ (marked) for GIT effects. The daily oral dose range is 75-150 mg.

How does weight gain vary across Moclobemide, Nefazodone, and Venlafaxine?

Weight gain is 0 (absent) for all three drugs: Moclobemide, Nefazodone, and Venlafaxine. Their daily oral dose ranges are 300-600 mg, 300-600 mg, and 75-150 mg respectively.

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Phamarcology

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Topics that are related to CNS - Depression & Bipolar - INTRO - Antidepressants Overdose

Summaries related to CNS - Depression & Bipolar - INTRO - Antidepressants Overdose