Mngt Depression + Anxiety - Cases Flashcards
JY is a 27yo M. He came across a near-miss life-threatening incident 2 months ago when he got involved in a traffic accident. He experiences flashbacks and also recurrent dreams of the same accident ever since and has not been able to sleep well or eat well.
He is currently taking PO Paracetamol 500mg QDS for his post-operative pain. He is otherwise a healthy individual. NKDA.
Which of the following is/are appropriate actions for JY? You may select more than one answer
A. Initiate PO Lorazepam as short-term relief for his sx B. Initiate Fluoxetine C. Suggest JY to attend exposure therapy D. Initiate Mirtazapine E. Initiate Buspirone
Ans: B, C
- A: PTSD CANNOT use BZD
- D: Mirtazapine is 2nd line
- E: Buspirone is only suitable for GAD
TQ is a 76yo M. Recently, his wife passed away and he was aggrieved by his loss. He is diagnosed with Major Depressive Disorder. Currently, he has loss his appetite, and is unable to sleep well. His daughter requests to get something for him to help him sleep. NKDA
PMH: DVT, HTN, HLD, DM, Chronic Muscoskeletal pain Meds: - Warfarin 5mg OD - Amlodipine 5mg - Atorvastatin 10mg - Metformin 850mg TDS - Glipizide 20mg BD - Paracetamol 500mg QDS PRN
Which of the following are the most appropriate tx to initiate TQ? Can select more than one options
A. Escitalopram + Esomeprazole B. Fluoxetine + Omeprazole C. Duloxetine D. Hydroxyzine 25mg PRN E. Zolpidem 5mg HS PRN
Ans: C, E
- Main reason: Chronic muscoskeletal pain COMPELLING indication for Duloxetine
- A: Risk Qtc prolongation, not preferred
- B: Possible, but due to main reason, not the best option
- D: Has anti-M SE, hence not recommended
MT is a 29yo Male who presents with depressive symptoms. He got retrenched from his job recently and is very dejected. He is diagnosed with MDD. When asked, he wishes to have his second child. He is otherwise healthy. He is allergic to Chlopheniramine.
Which of the following is the most appropriate treatment to initiate for MT?
A. Lorazepam B. Fluoxetine C. Mirtazapine D. Amitriptyline E. Venlafaxine
Ans: C
- A: BZD is adjunct, not used as monotherapy
- B, D, E: May cause sex dysfunc
BN is a 17yo F who was diagnosed with depression. She has been administered Fluoxetine and Lorazepam.
Which of the following are appropriate counselling points for BN?
A. If you feel worsening condition or self-harm, contact the doctor asap
B. Do not take medications with alcohol
C. Do not drive or operate any machinery
D. Avoid consuming grapefruit juice while on this therapy
E. Your mood will improve in 3 weeks
Ans: A, B
- C: Inappropriate, patient too young
- D: Fluoxetine and Lorazepam not 3A4 metabolised
- E: Mood improvements only 6 weeks onwards
FT is a 28yo M who was diagnosed with GAD. He was taking some medications where the doctor told him that “We must gradually decrease the dose to prevent any SE from precipitating”
Which of the following is/are possible drug(s) that FT is taking?
A. Pregabalin B. Midazolam C. Mirtazapine D. Fluoxetine E. Prazosin
Ans: A, C, D
- B: Midazolam not used in anxiety
- E: Prazosin not used in Anxiety
(recall: PREGABALIN also need taper!)
PL is a 66yo F who presents with symptoms of anxiety. She repeatedly sweeps and mops her house floor even though she has done it a few times in a day. She also tidies her grandson’s table up, complaining about how messy is it, even though the table is generally neat.
Which of the following statements is appropriate in managing PL’s anxiety?
A. Eye movement desensitisation and reprocessing is beneficial for PL
B. Sleep Hygiene is appropriate for PL
C. ECT is appropriate for PL
D. Full response from Fluoxetine onsets after 1 month
E. Serum Na should be monitored before initiating Agomelatine
Ans: E
- Although Agomelatine has lower risk of SIADH, still need to MONITOR (bef ini, 2nd wk, 4wk then q3m)
- A: EMDR is for PTSD
- B: Sleep Hygiene is for MDD
- C: ECT is only for severe cases of anxiety
- D: Full response for anxiety is THREE months
