Anxiety & Depression Flashcards
What is the primary medication class used for acute treatment of anxiety?
Benzodiazepines
Always short-term use on the lowest effective dose.
List four SSRIs used in the chronic treatment of anxiety.
- Sertraline
- Citalopram
- Escitalopram
- Fluoxetine
What medication is used to alleviate physical symptoms of anxiety, such as tremors?
Propranolol
Which benzodiazepines are considered long-acting?
- Diazepam
- Alprazolam
- Chlordiazepoxide hydrochloride
- Clobazam
Which benzodiazepines are considered short-acting and preferred for patients with hepatic impairment?
- Lorazepam
- Oxazepam
- Midazolam
True or False: Benzodiazepines can cause paradoxical effects like aggression and excitement.
True
What is the maximum duration of use for short acting benzodiazepines
2-4 weeks
Do long acting or short acting benzodiazepines carry a greater risk of withdrawal symptoms?
short acting
can patients have alcohol with benzodiazepines?
No as it can cause increased sedation
Which benzodiazepines have legal driving limit?
- Clonazepam
- Oxazepam
- Lorazepam
- Diazepam
- Flunitrazepam
- Temazepam
(COLD FT)
What is a common treatment for benzodiazepine overdose?
Flumazenil
What are signs of benzodiazepine withdrawal?
- Anxiety
- Sweating
- Weight loss
- Tremors
- Loss of appetite
Fill in the blank: The first line treatment for mild depression is _______.
[Cognitive Behavioural Therapy (CBT)]
What is the duration for which antidepressants should be taken after achieving remission?
6 months (1 year in elderly, 2 years in recurrent)
how long should an antidepressant be taken before it can be deemed as ineffective?
4 weeks.
pts may feel worse in the first 1-2 weeks
What is the 1st line treatment for depression?
SSRI
Which SSRI is best for patients with bleeding disorders and bleeding risk?
Mirtazepine
If a patient shows no improvement on an SSRI, what are two possible next steps?
- Increase dosage
- Change SSRI
still no improvement - look to add another class e.g lithium or antipsychotics
What are common side effects of SSRIs?
- GI disturbances
- Appetite/Weight gain
- Sexual dysfunction
- Risk of bleed
- Insomnia
- QT prolongation (especially Escitalopram and citalopram)
which SSRI is better tolerated and safer in overdose?
Sertraline
which SSRI can be used in children aged 17 and under?
fluoxetine
What does serotonin syndrome include in terms of cognitive effects?
- Headache
- Agitation
- Hypomania
- Coma
- Confusion
What are some neuromuscular excitation symptoms of serotonin syndrome?
- Myoclonus
- Tremor
- Teeth grinding
What are some autonomic effects or serotonin syndrome?
sweating, hyperthermia, nausea, diarrhoea
Which tricyclic antidepressants are considered sedating?
- Clomipramine
- Trazodone
What are the side effects associated with tricyclic antidepressants?
- Cardiac events
- Anti-muscarinic effects (dry mouth, constipation)
- Seizures
- Hallucinations
Which tricyclic antidepressants are less sedating and better for withdrawn and apathetic patietns?
imipramine, lofepramine and notriptyline
What are the potential interactions of MAO-Inhibitors?
- Hepatotoxicity
- Hypertensive crisis
- Avoid Tyramine-rich foods
if a patient is on a MAO - inhibitor which OTC medication should they avoid due to hypertensive crisis?
pseudoephedrine
Which MAO-I and TCA have a fatal interaction?
tranylcypromine (MAO-I) and clomipramine (TCA)
After starting MAO-I, how long must a patient wait before starting an antidepressant
2 weeks (3 weeks for clomipramine or imipramine)
List two drugs that can cause QT prolongation.
- Amiodarone
- Sotolol
What is the recommendation for using SSRIs in children aged 17 and under?
Use Fluoxetine
What is the recommended approach for benzodiazepine withdrawal?
- Convert to once nightly dose of equivalent diazepam
- Reduce by 1-2mg every 2-4 weeks
- Reduce further (0.5mg near the end)
