Flashcards in Chapter 4 - Mental Health Deck (158)
Give examples of SSRIs
Give examples of SNRIs
Give examples of TCAs
Give an example of a 5HT1A receptor antagonist
What are some symptoms of anxiety?
Give some examples of anxiety disorders
General anxiety disorder
Name some drugs/substances that can cause anxiety
Some herbal medicines e.g. St Johns Wort, ginseng, ma huang
What drugs are usually used for acute anxiety?
What is first line for chronic anxiety?
Psychological interventions e.g. CBT
When is drug treatment offered in chronic anxiety?
Anxiety not responding to psychological interventions
What are the treatment options for generalised anxiety disorder?
First line - SSRI (sertraline, escitalopram, paroxetine)
Second line - SNRI (duloxetine, venlafaxine)
If these are contraindicated or not tolerated - pregabalin
When should drug treatment in anxiety be monitored?
Initially every 2-4 weeks for the first 3 months
Then every 3 months thereafter
Why is an additional risk associated with SSRIs and SNRIs in <30 year olds?
Increased risk of self harm and suicidal thoughts
When should benzodiazepines be issued for anxiety in primary care?
Short term during crises
When is buspirone indicated?
Short term use in anxiety
What MRHA advice is associated with benzodiazepines?
Use of benzodiazepines with opioids increase the risk of potentially fatal respiratory depression
What are the side effects of diazepam?
Paradoxical side effects
Withdrawal syndrome, tolerance and dependence
What paradoxical side effects may be seen in diazepam?
What are the main interactions with diazepam?
Antihypertensives, vasodilators, diuretics - increased hypotensive effects
Alcohol and opioids - respiratory depression
CYP 450 inhibitors and inducers - affects serum concentrations
Why shouldn’t benzodiazepines be used long term?
Risk of tolerance (reduced effectiveness)
Risk of dependence
What withdrawal symptoms are associated with benzodiazepines?
How are benzodiazepines withdrawn?
Convert to diazepam
What 3 behaviours is ADHD characterised by?
What non-drug treatments are available for ADHD?
Controlling environmental factors e.g. noise, distractions
Giving written rather than verbal requests
In school/work have shorter periods of focus and longer breaks
Who should initiate ADHD drug treatments?
When can a GP be involved in the drug treatment of ADHD?
Once the dose has been stabilised by a specialist
The GP can then continue and monitor drug treatment
Under a shared care agreement
What are the first line drugs for ADHD and what do you do if one doesn’t work after a 6 week trial?
After trialling one for 6 weeks, if there is no improvement try the other
What drug treatments are available for ADHD?
Dexamfetamine (if lisdexamfetamine worked but isn’t tolerated)
What are some advantages of m/r formulations over immediate release formulations in ADHD?
Longer duration of action
Don’t need to take to work/school (reduced stigma, less storage and administration issues)
Reduced risk of drug diversion