PSA drugs

Question 1

What is an important interaction to consider when prescribing an SSRI?

Answer 1

SSRI are contraindictated with someone whom is taking an NSAID due to an increased risk of ulceration.

Question 2

Why should you not prescribe an SSRI in someone also taking a triptan?

Answer 2

due to the increased risk of serotonin syndrome as triptans are 5HT receptor agonists

Question 3

What’s the deal with Anti-Ds and warfarin?

Answer 3

don’t prescribe SSRI with Warfarin or heparin due to an increased risk of bleeding.

Prescribe mirtazapine but pre-empt an increase in INR at commencement of tx

Question 4

What is the safest option for rapid tranquilisation?

Answer 4

try oral sedation first
lorazepam or haloperidol + promethazine

then try IM (same again)
lorazepam/haloperidol

Question 5

What drug is most associated with weight gain?

Answer 5

Anti-Ds - mirtazapine

Anti-Ps - clozapine + olanzapine

Question 6

When a patient is on aspirin and they get depressed, what’s the first line treatment?

Answer 6

-SSRI (sertaline) + omeprazole (PPI)

Question 7

When and why should a patient be seen after starting a new anti-D?

Answer 7

After 1 week due to the potential increased risk of suicidality

Question 8

How long is a person recommended to take an anti-D for?

Answer 8

-6 months after the remission of Sx

Question 9

When should you up a dose or change anti-d once at it’s highest dose?

Answer 9

3-4 weeks

Question 10

What is the third line tx for refractory depression?

Answer 10

• combine 2 anti-ds
• augment tx with lithium
• augment tx with atypical antipsychotic (quetiapine)

Question 11

How should you follow someone up following starting a SSRI or SNRI?

Answer 11

after the first weeks

then weekly for the first month

Question 12

When medicated for anxiety, what is the recommended treatment duration?

Answer 12

-1 year

Question 13

What needs to be considered when prescribing hypnotics to dementia patients?

Answer 13

Benzos can increase night time confusion
night time activities is good OR
Zopiclone low dose if needs must.

Question 14

What special considerations should be made when giving haloperidol?

Answer 14

whether oral or IM
A recent ECG should be seen
if not possible and no other options it should be noted CLEARLY that an ECG was not seen

Question 15

What 3 thing should be monitored in clozapine use?

Answer 15

• WCC
• ANC (absolute neutrophil count)
• platelets

Question 16

When should blood monitoring be done for patients on clozapine?

Answer 16

• baseline
• every week for 18 weeks after (4.5 months)
• every 2 weeks for the rest of the year
• monthly after

Question 17

When should one monitor clozapine plasma levels?

Answer 17

• stopping or starting smoking
• illness (pneumonia)
• starting a drug that may potentially interact
• if poor metabolism expected
• if toxicity expected