Anxiety & Depression

Question 2

What is the primary medication class used for acute treatment of anxiety?

Answer 2

Benzodiazepines

Always short-term use on the lowest effective dose.

Question 3

List four SSRIs used in the chronic treatment of anxiety.

Answer 3

• Sertraline
• Citalopram
• Escitalopram
• Fluoxetine

Question 4

What medication is used to alleviate physical symptoms of anxiety, such as tremors?

Answer 4

Propranolol

Question 5

Which benzodiazepines are considered long-acting?

Answer 5

• Diazepam
• Alprazolam
• Chlordiazepoxide hydrochloride
• Clobazam

Question 6

Which benzodiazepines are considered short-acting and preferred for patients with hepatic impairment?

Answer 6

• Lorazepam
• Oxazepam
• Midazolam

Question 7

True or False: Benzodiazepines can cause paradoxical effects like aggression and excitement.

Answer 7

True

Question 8

What is the maximum duration of use for short acting benzodiazepines

Answer 8

2-4 weeks

Question 9

Do long acting or short acting benzodiazepines carry a greater risk of withdrawal symptoms?

Answer 9

short acting

Question 10

can patients have alcohol with benzodiazepines?

Answer 10

No as it can cause increased sedation

Question 11

Which benzodiazepines have legal driving limit?

Answer 11

• Clonazepam
• Oxazepam
• Lorazepam
• Diazepam
• Flunitrazepam
• Temazepam
  (COLD FT)

Question 12

What is a common treatment for benzodiazepine overdose?

Answer 12

Flumazenil

Question 13

What are signs of benzodiazepine withdrawal?

Answer 13

• Anxiety
• Sweating
• Weight loss
• Tremors
• Loss of appetite

Question 14

Fill in the blank: The first line treatment for mild depression is _______.

Answer 14

[Cognitive Behavioural Therapy (CBT)]

Question 15

What is the duration for which antidepressants should be taken after achieving remission?

Answer 15

6 months (1 year in elderly, 2 years in recurrent)

Question 16

how long should an antidepressant be taken before it can be deemed as ineffective?

Answer 16

4 weeks.
pts may feel worse in the first 1-2 weeks

Question 17

What is the 1st line treatment for depression?

Answer 17

SSRI

Question 18

Which SSRI is best for patients with bleeding disorders and bleeding risk?

Answer 18

Mirtazepine

Question 19

If a patient shows no improvement on an SSRI, what are two possible next steps?

Answer 19

• Increase dosage
• Change SSRI

still no improvement - look to add another class e.g lithium or antipsychotics

Question 20

What are common side effects of SSRIs?

Answer 20

• GI disturbances
• Appetite/Weight gain
• Sexual dysfunction
• Risk of bleed
• Insomnia
• QT prolongation (especially Escitalopram and citalopram)

Question 21

which SSRI is better tolerated and safer in overdose?

Answer 21

Sertraline

Question 22

which SSRI can be used in children aged 17 and under?

Answer 22

fluoxetine

Question 23

What does serotonin syndrome include in terms of cognitive effects?

Answer 23

• Headache
• Agitation
• Hypomania
• Coma
• Confusion

Question 24

What are some neuromuscular excitation symptoms of serotonin syndrome?

Answer 24

• Myoclonus
• Tremor
• Teeth grinding

Question 25

What are some autonomic effects or serotonin syndrome?

Answer 25

sweating, hyperthermia, nausea, diarrhoea

Question 26

Which tricyclic antidepressants are considered sedating?

Answer 26

* Clomipramine * Trazodone

Question 27

What are the side effects associated with tricyclic antidepressants?

Answer 27

* Cardiac events * Anti-muscarinic effects (dry mouth, constipation) * Seizures * Hallucinations

Question 28

Which tricyclic antidepressants are less sedating and better for withdrawn and apathetic patietns?

Answer 28

imipramine, lofepramine and notriptyline

Question 29

What are the potential interactions of MAO-Inhibitors?

Answer 29

* Hepatotoxicity * Hypertensive crisis * Avoid Tyramine-rich foods

Question 30

if a patient is on a MAO - inhibitor which OTC medication should they avoid due to hypertensive crisis?

Answer 30

pseudoephedrine

Question 31

Which MAO-I and TCA have a fatal interaction?

Answer 31

tranylcypromine (MAO-I) and clomipramine (TCA)

Question 32

After starting MAO-I, how long must a patient wait before starting an antidepressant

Answer 32

2 weeks (3 weeks for clomipramine or imipramine)

Question 33

List two drugs that can cause QT prolongation.

Answer 33

* Amiodarone * Sotolol

Question 34

What is the recommendation for using SSRIs in children aged 17 and under?

Answer 34

Use Fluoxetine

Question 35

What is the recommended approach for benzodiazepine withdrawal?

Answer 35

* Convert to once nightly dose of equivalent diazepam * Reduce by 1-2mg every 2-4 weeks * Reduce further (0.5mg near the end)