2010A08 Classify drugs used in the treatment of depression.
Outline the interactions between anti-depressant drugs and drugs that are commonly used in the peri-operative period.

Avoid serotonergic drugs

Avoid indirect acting noradrenergics

SSRI e.g. fluoxetine

Y

SNRI e.g. venlafaxine

Y

Y

NRI e.g. reboxetine

Y

TCA e.g. amitryptiline

Y

Y

MAO inhibitor e.g. moclobemide

Y

Y

Serotonin syndrome

·  Cause: serotonin reuptake inhibitor + tramadol/pethidine

·  Features:

o CNS (agitation)

o ANS (↑HR, ↑BP, sweating)

o PNS (hyperreflexia, clonus)

o GI upset (nausea)

·  Treatment: cyproheptadine

Hypertensive crisis

·  Cause: noradrenaline reuptake inhibitor + indirect acting sympathomimetic amine

·  Especially ephedrine

·  Avoid indirect-acting vasopressors, especially ephedrine

·  Use direct-acting vasopressors i.e. phenylephrine, noradrenaline

·  Treatment: adrenergic antagonist e.g. labetalol, phentolamine