Meds_guidlines_5 Flashcards
Percentage of patients who will experience relapse if stopped antidepressants within 6 months after recovery
50%
In refractory depression what medication is recommended for augmentation by NICE?
Quetiapine
Lithium
Why is it so important to manage recurrent depression for long time?
Chances for 3rd and 4th episode increase up to 70%
What antidepressants used in post CVA depression?
SSRI (not if there is risk of GI bleeding)
Nortriptyline
Post CVA antidepressant of choice in a case who is on warfarin
Citalopram and escitalopram
NICE recommendation for 1st line medical treatment of depression in young people?
Fluoxetine
Starting dose for Fluoxetine in a 10 year old patient with moderate depression
10 mg
1st line of treatment in moderate depression in adolescents
individual CBT
1st line treatment for adolescent with mild depression
group CBT
What medication can cause impulsive behavoiurs?
Ropinirole (DAs)
Effects of magic mushrooms are similar to that of…
LSD
Medical treatment for children above 7 with enuresis who did not respond to reward system and alarms
200mcg Desmopressin
A drug that should be avoided in breasfeeding moms
Doxepin(induces resp. depression and sedation in the baby)
An antipsychotic that has antidepressant effect at low dose
Flupentixol
the ssri that suits patients with low mood and liver disease
paroxetine
preferred drug in manic patient with liver impairment
lithium
preferred drug for anxious patient with insomnia and liver impairment
alprazolam, lorazepam, oxazepam and temazepam
ALOT
what is a known side effect of st john’s wort
Potential to cause significant photosensitivity or phototoxicity
St john’s wort and cyp450 system
Causes induction cyp3a4
Another name for st john’s wort
Hypericum perforatum
Herbal remedy with evidence to be helpful in treating depression
St john
Herbal remedy with evidence to be helpful in treating anxiety
Piper methysticum (KAVA)
risk of KAVA
hepatotoxicity (hence not recommended)
Antipsychotic of choice in schizo +HIV
Risperidone
then olan, aripiprazole and quetiapine
Medication that is used in HIV but can cause depression and mania and fatal suicide
Efavirenz
In a patient with schizophrenia in whom osteoporosis is suspected, what is preferred antipsychotic?
Aripiprazole (no effect on prolactine)
A schizophrenia patient on risperidone develope gynecomastia or signs of hyperprolactemia ,what is alternative antipsychotic
Aripirazole
In patients with sexual dysfunction as a result of risperidone, what is alternative if aripiprazole is not available
Quetiapine
A depressed patient on venlafaxine or sertraline stops lactating, what is alternative?
Mirtazapine (NaSSA)
specific serotonergic antidepressant
What else is serious consequence of hyperprolactemia induced by psychotropics that you should let patients know about?
Breast cancer
Anti psychotic choices in parkinson’s
1st clozapine
2nd quetiapine
(low affinity for d2 receptors, hence no blockinh of nigrostriatal pathway)
a benzodiazepine Drug with high chance of interdose withdrawal symptoms
Oxazepam
Artefact for low calcium in elderly
Low albumin
What if hypnotics did not solve insomina in patients who failed to respond to sleep hygiene too?
Stop hypnotics (zoplicone 7.5 mg daily) and do not prescribe anything from that class due to dependency
Who are at more risk of developing benzo dependency?
Patient with history of anxiety
Telorance to hypnotic effects of benzodiazepine?
May happen within days
1st line treatment for insomnia less than 4 weeks
Zopiclone (NICE)
Promethazine (high next day drowsiness)
recommended Rx for insomnia 2 months duration or more
CBT-I
when should prolonged melotonin be given in cases of insomnia
1-2 hrs before bed
Mention a recognised medication for insomnia with minimun next-day sedation effect…
Darido-rexant
Dual Orexin Receptor Agonist (DORA)
Optimal therapeutic range for lithium
0.8-1 mmol/L
Ideal range for lithoum (plasma level) as prophylaxis of bipolar
0.6-0.75
Lithium monitoring in >65 y.o after plamsa level and mood stabilized?
Every 3 months
In adults, how often lithium level is checked after stabilising and abscent of drug interaction??
Every 6 month
In adults, how often lithium level is checked after stabilising and precence of drug interaction??
Every 3 month
Effective mood stabilizer in steroid induced psychosis
Lithium
Sign of toxicity on AMDISEN for lithiun
Myoclonus
Mania can be induced by which Parkinson medication
Levadopa
Selegiline
A drug that is very effective but poorly tolerated in acute mania
Haloperidol
A drug that is effective and well tolerated in acute mania
Olanzapine
Not recommended for acute mania
Topiramate
Not recommended for acute mania
Topiramate
1st line of treatment for depression in Multiple Sclerosis
Sertraline
