Antidepressants

Question 1

Drug class: dosulepin

Answer 1

TCA

Question 2

Drug class: tranylcypromine

Answer 2

irreversible MAOI

Question 3

Drug class: Dapoxetine

Answer 3

SSRI

Question 4

Drug class: imipramine

Answer 4

TCA

Question 5

Drug class: bupropion

Answer 5

SNRI

Question 6

Drug class: moclobemide

Answer 6

reversible MAOI

Question 7

Drug class: phenelzine

Answer 7

Irreversible MAOI

Question 8

Drug class: trazadone

Answer 8

TCA

Question 9

Drug class: fluvoxamine

Answer 9

SSRI

Question 10

Drug class: Isocarboxazid

Answer 10

Irreversible MAOI

Question 11

antidepressant of choice for patients with angina/MI

Answer 11

sertraline

Question 12

Issue with TCAs

Answer 12

cardiotoxic
toxic in overdose

Question 13

How often should patients be reviewed after starting antidepressant therapy?

Answer 13

1-2 weeks

Question 14

How long should therapy be continued before switching

Answer 14

4 weeks
elderly = 6 weeks

Question 15

Following remission, how long should antidepressant therapy be continued?

Answer 15

6 months at the same dose

Question 16

Following remission, how long should antidepressant therapy be continued in the elderly?

Answer 16

12 months in the elderly

Question 17

Following remission, how long should antidepressant therapy be continued in patients with GAD?

Answer 17

12 months- high risk of relapse

Question 18

Symptoms of serotonin syndrome

Answer 18

• Neuromuscular- tremor, hyperreflexia, clonus/ myoclonus (spasms), rigidity
• Autonomic- tachycardia, BP changes, Hyperthermia, diaphoresis (cold sweats), shivering, diarrhoea

Question 19

Treatment of anxiety disorders and OCD

Answer 19

Benzodiazepines or buspirone

Question 20

Treatment of chronic anxiety

Answer 20

antidepressants
in combo with benzo’s until antidepressant takes effect

Question 21

Treatment of GAD

Answer 21

psychological treatment prior to initiation of antidepressant

Question 22

Treatment pathway GAD

Answer 22

1. SSRI

     Licensed- escitalopram, paroxetine 
   
     Unlicensed- sertraline  

2. SNRI

       Duloxetine 
   
       Venlafaxine 

3. Pregabalin

Question 23

Treatment pathway panic disorders

Answer 23

SSRIs

Clomipramine HCL (unlicensed) or imipramine HCL (unlicensed)

Venlafaxine

Question 24

Treatment pathway OCD/PTSD/Social anxiety disorder

Answer 24

SSRIs

Clomipramine – OCD

Moclobemide- SAD

Question 25

sedating TCAs

Answer 25

Amitriptyline Clomipramine Dosulepin Doxepin Mianserin Trazadone Trimipramine

Question 26

less sedating TCAs

Answer 26

Imipramine Lofepramine Nortriptyline

Question 27

Which TCA has a lower incidence of S/Es and less dangerous in overdose

Answer 27

Lofepramine

Question 28

Which TCA has more antimuscarinic S/Es than other TCAs

Answer 28

Imipramine

Question 29

Which TCAs are particularly dangerous in overdose

Answer 29

Amitriptyline Dosulepin

Question 30

Which SSRI is given for children and what is the licensing?

Answer 30

Fluoxetine 8+

Question 31

When should TCAs be stopped in the elderly?

Answer 31

Dementia, narrow angle glaucoma, cardiac conduction abnormalities, prostatism, history of urinary retention when given as first line treatment- switch to SSRI or SNRI

Question 32

Which MAOI is most likely to cause hypertensive crisis?

Answer 32

Tranylcypromine

Question 33

which MAOI should be reserved for 2nd line treatment

Answer 33

moclobemide

Question 34

When should you see an effect when taking MAOIs

Answer 34

3 weeks or more

Question 35

MAOI --> other antidepressants - how long should you wait before starting

Answer 35

2 weeks 3 weeks for clomipramine or imipramine

Question 36

MAOI --> MAOI - how long should you wait before starting

Answer 36

2 weeks

Question 37

MAOI --> TCA - how long should you wait before starting

Answer 37

7-14 days 3 weeks for clomipramine or imipramine

Question 38

MAOI --> SSRI - how long should you wait before starting

Answer 38

1 week 5 for fluoxetine