antidepressants

Question 1

Which AD would you choose in pt with unstable angina or who have had recent MI

Answer 1

sertraline

Question 2

…. are better tolerated and safer in overdose than other classes of AD

Answer 2

SSRIs

Question 3

These two AD classes have similar efficacy, but one if more likely to be discontinued because of SE; toxicity in overdosage is also a problem

Answer 3

SSRIs and TCAs have similar efficacy
but TCAs more likely to be discontinued because of SE and toxicity in OD is also a problem

Question 4

Which one is more sedating SSRI or TCA

Answer 4

TCA

Question 5

This drug class has dangerous interactions with some food and drugs, and should be reserved for use by specialists

Answer 5

MAOIs

Question 6

This electrolyte imbalance has been associated with ALL types of AD, but more freq with SSRIs

Answer 6

hyponatraemia

Question 7

Hyponatraemia occurs with all ADs but is more frequent with this class

Answer 7

SSRIs

Question 8

Consider this SE in all pt who take AD and develop drowsiness, confusions and convulsions while taking an antidepressant

Answer 8

hyponatraemia

Question 9

A patient who is on AD treatment develops confusion, drowsiness and convulsions. What do you suspect

Answer 9

hyponatraemia

Question 10

The use of antidepressants has been linked with suicidal thoughts and behaviour. Who is particularly at risk?

Answer 10

children
young adults
pt with history of suicidal behaviour
where necessary monitor pt for suicidal behaviour, self harm, or hostility esp at beginning or treatment or if dose is changed

Question 11

serotonin syndrome is a relatively uncommon adverse drug reaction which is caused by

Answer 11

excessive central and peripheral serotonergic activity

Question 12

serotonin syndrome - onset of symptoms which range from mild to life threatening can occur within ..

Answer 12

hours or days following initiation, dose escalation or OD of a serotonergic drug, addition of a new serotonergic drug, or replacement on one serotinergic drug by another without allowing a long enough washout period in between, esp when first drug is an irreversible MAOI or a drug with a long half life

Question 13

Severe toxicity, which is a medical emergency, usually occurs with a combination of serotonergic drugs, one of which is generally an …

Answer 13

MAOI

Question 14

The characteristic symptoms of serotonin syndrome fall into 3 main areas, although features from each group may not be seen in all patients

Answer 14

neuromuscular hyperactivity (such as tremor, hyperreflexia, clonus, myoclonus, rigidity)
autonomic dysfunction (tachycardia, blood pressure changes, hyperthermia, diaphoresis, shivering, diarrhoea)
altered mental state (agitation, confusion, mania)

Question 15

A patient has tremor, tachycardia, shivering, diarrhoea and confusion. What do you suspect they are suffering from

Answer 15

serotonin syndrome

Question 16

Treatment of serotonin syndrome

Answer 16

withdrawal of serotonergic med and supportive care
seek specialist advice

Question 17

Management of acute anxiety generally involves the use of … (2)

Answer 17

BZDPN or buspirone

Question 18

for chronic anxiety (>4 weeks), what would you consider

Answer 18

may be appropriate to use AD
combined therapy with BZDPN may be required until AD takes effect

Question 19

generalised anxiety disorder (form of chronic anxiety) management

Answer 19

offer psychological treatment BEFORE initiating AD
if drug treatment needed, SSRI (escital, parox, sertraline (unlicensed)
SNRIs also licensed
if none of the above can be tolerated or fail to control symptoms, consider pregabalin

Question 20

treatment of panic disorder - 1st and 2nd line and another

Answer 20

SSRIs
2nd line clompramine or imipramine
SNRI Venlafaxine is also licensed

Question 21

Obsessive-compulsive disorder, post-traumatic stress disorder, and phobic states such as social anxiety disorder are treated with…

Answer 21

SSRIs

Question 22

OCD 1st line and 2nd line

Answer 22

1st line SSRIs
2nd line clomipramine

Question 23

Moclobemide is licensed for this anxiety disorder

Answer 23

social anxiety disorder