Anxiety and Depression Flashcards
(15 cards)
anxiety crisis treatment
Short term benzodiazepines
- no longer than 4 weeks
chronic anxiety treatment
1st = SSRI (sertraline)
2nd = alternative SSRI or SNRI (duloxetine, venlafaxine)
3rd = pregabalin
Examples of short acting benzodiazepines
Lorazepam
Oxazepam
Temazepam
Examples of long acting benzodiazepines
chlordiazepoxide
diazepam
clonazepam
Side effects of benzodiazepines
- risk of fatal respiratory depression
- use in hepatic impairment may lead to coma
What should be avoided with benzodiazepines?
avoid concomitant use with alcohol/ CNS depressants
What is the paradoxical effect associated with benzodiazapines?
effects: agitation, restlessness, hallucinations
- antidote = flumazenil
What is the process of benzodiazepine withdrawal?
- switch to equivalent dose of diazepam
- reduce by 2-4mg until reaching 20mg
- reduce by 1-2mg until reaching 10mg
- reduce by 1mg until reaching 5mg
5.reduce by 0.5-1mg until stopped
- reductions every 1-2 weeks, symptoms depending
SSRI side effects
sexual dysfunction
suicidal thoughts
appetite changes
insomnia (take in morning)
QT prolongation
hepatic impairment
GI bleeding
serotonin syndrome
seizures
Electrolyte side effect associated with SSRIs?
HypOnatraemia
- People at greater risk include the elderly, people taking diuretics or who are otherwise volume-depleted
Side effect of escitalopram and citalopram
QT prolongation
- especially at higher doses in elderly
Example of sedating TCA’s
amitriptyline, clomipramine, trazodone
Examples of less sedating TCA’s
lofepramine, nortriptyline, imipramine
MOA inhibitors interactions
- tranylcypromine = hypertensive crisis
- hepatotoxic
- avoid alcohol and tyramine rich food (stick to fresh food)
MOA inhibitor washout period
- 2 weeks for MOA, 3 for clomipramine and imipramine
Don’t start MOA for: - 2 weeks after previous MOA
- 1-2 weeks after TCA
- 1 week after SSRI (5 for fluoxetine)
