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PHA333 > Wk 27 - Depression + anxiety in practice > Flashcards

Wk 27 - Depression + anxiety in practice Flashcards

1
Q

What are the symptoms of depression?

A
  • Depressed mood
  • Loss of interest
  • Insomnia
  • Appetite change
  • Fatigue
  • Inc/dec psychomotor activity
  • Guilt or feelings of worthlessness
  • Diminished ability to conc
  • Suicidal ideation
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2
Q

What is considered a diagnosis of depression + subthreshold depression?

A
  • Depression: 5/more

- Subthreshold: 2

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3
Q

What are the NICE guidelines for depressed adults?

A
  • Assessment + management of suicide risk
  • Manage co-morbid conditions: alcohol, substance abuse
  • Discuss solutions contributing to depression
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4
Q

What are the 5 steps to support mental wellbeing?

A
  • Connect
  • Be active
  • Keep learning
  • Give to others
  • Be mindful
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5
Q

Outline low intensity psychosocial interventions for depression

A
  • Individual guided self-help
  • Computerised CBT
  • Structured group physical activity programme
  • For: mild-mod depression + persistent subthreshold
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6
Q

Outline pharmacological interventions for depression

A
  • Antidepressant

- For: Mod-severe depression, Mild-mod depression + persistent subthreshold

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7
Q

Outline high intensity psychosocial interventions for depression

A
  • CBT
  • Interpersonal therapy
  • For: mod-severe depression
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8
Q

Outline the caution for cardiovascular disease + QT prolongation

A
  • Antidepressant cause QT prolongation

- Med history, lab monitoring + baseline ECG needed to identify risk for QT prolongation before starting

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9
Q

Outline the MHRA drug safety for citalopram + escitalopram

A

Avoid in:

  • Congenital long QT syndrome
  • Pre-existing QT interval prolongation
  • Combination w/ other medicines that prolong QT interval
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10
Q

What is recommended in patients w/ mild or moderate hepatic impairment or poor metabolizers of CYP2C19?

A

Dose red in 1st 2 wks

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11
Q

What drugs are associated w/ inc fracture risk?

A

TCAs + SSRIs

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12
Q

Which drugs are associated w. inc risk of postpartum haemorrhage when used in month of delivery?

A

SSRI/SNRI

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13
Q

What are the common adverse effects of antidepressants?

A
  • Initial inc agitation + anxiety
  • Suicidal thoughts in early treatment or after stopping
  • Hyponatraemia
  • Sexual dysfunction
  • W/drawal effect
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14
Q

What is hyponatremia?

A
  • Common in elderly
  • Dizziness, drowsiness, confusion, muscle cramps + seizures
  • Caused by SSRI
  • W/in 30 days of starting
  • Stop if identified + sodium levels normalised w/in 1-2 wks then change antidepressant
  • Urgent care if severe
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15
Q

Outline SSRIs/SNRI + their bleeding risk

A
  • Red uptake of serotonin by platelets
  • Red ability of platelets to aggregate + so inc risk of haemorrhage
  • Esp GI bleeding
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16
Q

Outline factors that increase bleeding when taking SSRIs/SNRIs

A
  • Elderly
  • History of peptic ulcers
  • Excessive alcohol
  • Co-admin NSAIDS, antiplatelet, corticosteroid + warfarin
17
Q

What are monoamine-oxidase inhibitors?

A
  • For: don’t respond to other antidepressants + patient refractory
  • W/drawal symptoms
  • Cause: hepatic impairment
18
Q

What are the interactions of MAOIs?

A
  • High tyramine food + drink - hypertensive
  • SSRI, analgesic, opioids + migraine med - serotonin syndrome
  • Potent NA effect (amphetamine) - synergistic effect on BP
  • OTC decongestants
19
Q

Outline the process of switching from an SSRI to a MAOI

A
  • Washout period for at least 5 HL of SSRI
  • 7 days or 6 wks for fluoxetine
  • 2-3 wks after stopping MAOI
20
Q

Outline the process when taking MAOI and undergoing surgery

A
  • Local anaesthetic: Non-noradrenergic anesthetic agent used

- General anaesthetic: discontinue 10 days prior to surgery

21
Q

What is serotonin syndrome characterised by?

A
  • Altered mental status
  • Neuromuscular hyperactivity
  • Autonomic instability
  • Agitation
  • Confusion
  • Delirium
  • Hallucinations
22
Q

What are neuromuscular features of serotonin syndrome?

A
  • Shivering
  • Tremor
  • Teeth grinding
  • Hyperreflexia
23
Q

What are the autonomic features of serotonin syndrome?

A
  • Tachycardia
  • HT/Hypotension
  • Flushing
  • Vom + di
24
Q

In severe cases, what are the symptoms of serotonin syndrome?

A
  • Coma
  • Seizure
  • Hyperthermia
  • Rhabdomyolysis
  • Renal failure
25
Q

Outline w/drawal symptoms

A
  • Dizziness, nausea, anxiety , di, headache
  • W/in 5 days of stopping
  • Lasts less than 2 wks
26
Q

What happens if discontinuation symptoms are severe?

A
  • OG antidepressant reintroduced + tapered slowly

- Monitor symtpoms

27
Q

Give examples of patient counselling points

A
  • Symptoms of anxiety initially worsen
  • Continue for 6 months following remission of symptoms to red relapse
  • Sleep hygiene

PHA333 (35 decks)

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