Anxiety, Depression, Sleep disorders

Question 1

whats the actue and chronic treatment options for anxiety?

Answer 1

acute = benzodiazepines
chronic = sertaline, citalopram, escitalopram, fluoxetine or propranolol to alleviate symptoms

Question 2

whats the risks of long term use of benzodiazapines? Is it longer with long or short acting?

Answer 2

hepatic coma - risk is greater with long acting

Question 3

name 4 long acting benzos

Answer 3

diazepam
alprazolam
chlordiaepoxide
clobazam

Question 4

name 2 short acting benzos

Answer 4

lorazapam
oxazepam

Question 5

what class of benzos is preferred in patients with hepatic impairment?

Answer 5

short

Question 6

what class of benzos are preferred in elderly?

Answer 6

short

Question 7

what are the risks of short acting benzos?
how long are they usually used for?

Answer 7

greater risk of withdrawal
2 - 4 weeks

Question 8

how could someone present if they have too much benzo in their system?

Answer 8

1. paradoxical effects - aggression, hostile, anxious, talkative (opposite effects of what you’d expect)
2. sedation - this is increased with concurrent use of alcohol, CNS depressants or CYP inhibitors

Question 9

whats used to treat overdose of benzos? (paradoxical effects)

Answer 9

flumazenil

Question 10

what benzos have legal driving limits? COLD FT

Answer 10

clonazepam
oxazepam
lorazapam
diazepam
flunitrazepam
temazepam

Question 11

what are the symptoms of benzo withdrawal?

Answer 11

sweating, weight loss, anxiety, tremour

Question 12

how do you withdraw someone of benzos? (3 steps)

Answer 12

1. convert to a once nightly dose of diazepa,
2. redcue by 1 - 2mg (1/10th for larger doses) every 2 - 4 weeks - can be longer if pt still has withdrawal symptoms
3. reduce further by 0.5mg until stop

Question 13

what are the first line options for mild and moderate-severe depression?

Answer 13

mild - CBT
moderate-severe = antidepressants

Question 14

how long do antidepressants need to be taken before deemed ineffective?
is this the same for the elderly?

Answer 14

for 4 weeks - if still not working then considered ineffective
in elderly needs to be at least 6 weeks

Question 15

how long do antidepressents need to be taken after remission (no more depressive symptoms)?
what about in elderly?
what about in people with recurrent depression (had antidepressants before)

Answer 15

6 months
elderly - 1yr
recurrent - 2 yrs

Question 16

what are the main side effects of SSRIs?

Answer 16

GI disturbances
increased appetite, weight gain
insomnia
QT proglongation with citalopram/esitalopram
increased bleeding

Question 17

what drugs do you need to look out in terms of interactins with SSRIs? CHiCQS

Answer 17

CYP inhibitors - avoid grapefuit
Hyponatraemia (carbamazepine, diuretics)
CYP inducers - reduce effectiveness
QT prolongation drugs (amiodarone, quinolone, sotalol)
Serotonin syndrome

Question 18

what are the cognitive, autonomic, and neuromuscular symptoms of serotonin syndrome?

Answer 18

cognitive = confusion, agitation, headache
autonomic = sweating, hyperthermia, nausea, diarrohea
neuromuscular = tremour, teeth grinding, myoclonus

Question 19

what drugs can interact and cause serotonin syndrome?

Answer 19

SSRIS
TCA
MAOI
Lithium
Triptans
Tramadol

Question 20

what TCAs are sedating so good for agitated pts?

Answer 20

amitriptyline
clomipramine
doseulepin
trazadone

Question 21

what TCAs are less sedating?

Answer 21

imipramin
lofpramine
nortriptyline

Question 22

what TCAs are dangerous in overdose and are not recommended for depression?

Answer 22

amitriptyline and dosulepin

Question 23

what are the interactions you need to look out for with TCAs? (CHiCQS)

Answer 23

same as SSRIs but addition of interaction with anti muscarininc drugs too

Question 24

what TCA and MAOI can have a fatal reaction if given together?

Answer 24

tranylcypromine and clomipramine

Question 25

what MAOIs can cause hepatotoxicty?

Answer 25

phenelazine + isocarboxoid

Question 26

how long should you wait to take another antidepressant after taking a MAOI?

Answer 26

2 weeks - 3 weeks for clomipramine or imipramine

Question 27

how long is the washout if you were already on a MAOI and switch to another one?
whats the exception?

Answer 27

2 weeks
0 weeks if were originally on meclobemide

Question 28

how long is the washout if you were taking a TCA and want to start MAOI?

Answer 28

1 - 2 weeks unless was taking clomipramine or imipramine which needs a 3 week washout

Question 29

how long is the washout if a patient is on SSRI and wants to switch to MAOI?

Answer 29

1 week unless fluoxetine which you need to leave 5 weeks for

Question 30

what type of benzo maintains sleep?

Answer 30

long acting

Question 31

what type on benzo is used for onset of sleep?

Answer 31

short

Question 32

do short or long acting benzos have greater risk of withdrawals?

Answer 32

short

Question 33

how long until dependency develops for z-hypnotics?

Answer 33

3 - 14 days

Question 34

how should people take z-hypnotics to avoid dependency?

Answer 34

inttermittently, so not taking consecuetive nights

Question 35

what the maximum supply of z-hypnotics?

Answer 35

4 weeks