Anxiety, Depression, Sleep disorders Flashcards
whats the actue and chronic treatment options for anxiety?
acute = benzodiazepines
chronic = sertaline, citalopram, escitalopram, fluoxetine or propranolol to alleviate symptoms
whats the risks of long term use of benzodiazapines? Is it longer with long or short acting?
hepatic coma - risk is greater with long acting
name 4 long acting benzos
diazepam
alprazolam
chlordiaepoxide
clobazam
name 2 short acting benzos
lorazapam
oxazepam
what class of benzos is preferred in patients with hepatic impairment?
short
what class of benzos are preferred in elderly?
short
what are the risks of short acting benzos?
how long are they usually used for?
greater risk of withdrawal
2 - 4 weeks
how could someone present if they have too much benzo in their system?
- paradoxical effects - aggression, hostile, anxious, talkative (opposite effects of what you’d expect)
- sedation - this is increased with concurrent use of alcohol, CNS depressants or CYP inhibitors
whats used to treat overdose of benzos? (paradoxical effects)
flumazenil
what benzos have legal driving limits? COLD FT
clonazepam
oxazepam
lorazapam
diazepam
flunitrazepam
temazepam
what are the symptoms of benzo withdrawal?
sweating, weight loss, anxiety, tremour
how do you withdraw someone of benzos? (3 steps)
- convert to a once nightly dose of diazepa,
- redcue by 1 - 2mg (1/10th for larger doses) every 2 - 4 weeks - can be longer if pt still has withdrawal symptoms
- reduce further by 0.5mg until stop
what are the first line options for mild and moderate-severe depression?
mild - CBT
moderate-severe = antidepressants
how long do antidepressants need to be taken before deemed ineffective?
is this the same for the elderly?
for 4 weeks - if still not working then considered ineffective
in elderly needs to be at least 6 weeks
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)
6 months
elderly - 1yr
recurrent - 2 yrs
what are the main side effects of SSRIs?
GI disturbances
increased appetite, weight gain
insomnia
QT proglongation with citalopram/esitalopram
increased bleeding
what drugs do you need to look out in terms of interactins with SSRIs? CHiCQS
CYP inhibitors - avoid grapefuit
Hyponatraemia (carbamazepine, diuretics)
CYP inducers - reduce effectiveness
QT prolongation drugs (amiodarone, quinolone, sotalol)
Serotonin syndrome
what are the cognitive, autonomic, and neuromuscular symptoms of serotonin syndrome?
cognitive = confusion, agitation, headache
autonomic = sweating, hyperthermia, nausea, diarrohea
neuromuscular = tremour, teeth grinding, myoclonus
what drugs can interact and cause serotonin syndrome?
SSRIS
TCA
MAOI
Lithium
Triptans
Tramadol
what TCAs are sedating so good for agitated pts?
amitriptyline
clomipramine
doseulepin
trazadone
what TCAs are less sedating?
imipramin
lofpramine
nortriptyline
what TCAs are dangerous in overdose and are not recommended for depression?
amitriptyline and dosulepin
what are the interactions you need to look out for with TCAs? (CHiCQS)
same as SSRIs but addition of interaction with anti muscarininc drugs too
what TCA and MAOI can have a fatal reaction if given together?
tranylcypromine and clomipramine
what MAOIs can cause hepatotoxicty?
phenelazine + isocarboxoid
how long should you wait to take another antidepressant after taking a MAOI?
2 weeks - 3 weeks for clomipramine or imipramine
how long is the washout if you were already on a MAOI and switch to another one?
whats the exception?
2 weeks
0 weeks if were originally on meclobemide
how long is the washout if you were taking a TCA and want to start MAOI?
1 - 2 weeks unless was taking clomipramine or imipramine which needs a 3 week washout
how long is the washout if a patient is on SSRI and wants to switch to MAOI?
1 week unless fluoxetine which you need to leave 5 weeks for
what type of benzo maintains sleep?
long acting
what type on benzo is used for onset of sleep?
short
do short or long acting benzos have greater risk of withdrawals?
short
how long until dependency develops for z-hypnotics?
3 - 14 days
how should people take z-hypnotics to avoid dependency?
inttermittently, so not taking consecuetive nights
what the maximum supply of z-hypnotics?
4 weeks
