Passmed Psychiatry - Pharmacological Managements

Question 1

Alcohol withdrawal

Answer 1

Chlordiazepoxide or diazepam

Question 2

Bipolar disorder

Answer 2

Lithium

Question 3

Depression

Answer 3

SSRI
Can add SNRI

Question 4

Rules for switching antidepressants

Answer 4

SSRI to another SSRI = withdraw first completely before starting new one
Fluoxetine to another SSRI = withdraw + leave 4-7 day gap before starting next one
SSRI to TCA = taper down SSRi while tapering up TCA (cross-taper)
SSRI to venlafaxine = cross-taper cautiously
Fluoxetine to venlafaxine = withdraw then start and titrate up slowly

Withdraw = slowly taper down and stop

Question 5

Generalised anxiety disorder

Answer 5

1st - sertraline
2nd - another SSRI or an SNRI
3rd - pregabalin

Question 6

Rule with hypnotics

Answer 6

Cannot prescribe another if there is no response to the first