What
45 yo female depression, presents with overly drowsy, very tired, meets criteria for SIGECAPS (dx w/depression. What would you give this fine young lady?
Sertraline or fluxetine (most activating)
PT anxious, dose meet depression criteria, has trouble sleeping at night, depressed. What drugs do you give them?
Paroxetine or fluvoxamine (OCD)
Depressed pt, suicidal, what meds do you want to steer away from?
Imitryptiline, northriptyline, doxepine (amit, clmi, dose, lmi) (TCA's)
You switch pt from one med to another and they go rigid, high temp, and stops responding. Whats it called and What do you do?!
serotonin syndrome. (treat by pulling them off the meds) Can still happen when switching medication depending on half-life.
30 year old pt, depressed dx, prescribe esitalipram, comes back in 4 weeks and he says the meds aren't working, he wants to switch meds. What do you switch him too?
YOU DONT SWITCH! he has to come back in another 4 weeks. (8 week minimum!)
51 year old depressed pt, currently setalipram causing ED. What can you options do you have to get his little weeny to start working again?
Bupropion (do not use in seziures)
Peroxetine making pt tired and weight gain. What can you switch them too?
Fluoxetine or sertarline (keep in SSRI for 1st line option, then buproprion)
In the clinic, police bring in a guy who said he got arresting after spending all his money, fight, now broke, he was feeling depressed for most of the year. Now hes feeling great. What do you give him?
Lithium, clearly bipolar manic episode.
PT comes to your office, he’s feeling depressed most of the year, but between episodes hes trying drugs, he goes through this cycle 5 or 6 times this year. What do you give him?
Valproic acid,rapid cycling.
PT comes in depressed, 3 episodes cycles of mania and depression. What class of antidepressant should you give him?
NONE! For pt’s who have manic episodes (IT MAKES IT WORSE!!)
Pt is exhausted all the time and depressed. What do you give them?
Fluoxetine or sertraline – SSRI, Activating
PT is depressed and awake at night with jitters and anxiety. What would you give them?
Paroxetine
PT comes in with suicidal thoughts, what class should you NOT use??
No TCA
PT has tried meds for 3 weeks and wants to switch. What do you switch them too?
NONE! Give the meds more time!
PT is still depressed after week 11, still at 75-80% symptoms. What do you switch them to?
A different SSRI
70 year old with diabetes and asthma gets diagnosed with parkinson’s. What is first line tx?
L. dopamine (because old and comorbidties)
PT has movement problems, medicine is wearing off (same pt from “70 year old with diabetes and asthma gets diagnosed with parkinson’s.”). What do you give them?
MAO inhibitor- maybe reduce levodopa
50 year old with parkinsons, what will we do? Sx doesn’t bother me, just thought I would get looked at.
Let it be, reserve treatment as long as you can or come back, symptomatic ->ldopa
Treatment of acute intermediate off episodes which causes severe nausea and vomiting
Apomorphine
A 17 year old female presents to your clinic shortly after beginning lamotrigine treatment for seizures. She complains of a painful itchy rash that has recently developed. How do you treat this PT?
Discontinue lamotrigine immediately
PT with parkinsons that is old and frail. What do you put them on?
Levadopa
PT with parkinsons that is young and happy. What do you put them on?
Selegaline
You diagnose a 46 year old female with generalized anxiety disorder. Which medication out of the following is the most appropritate? Bupropion, selegiline, amitriptyline, sertraline, or rasagiline?
Sertraline
You diagnose a 46 year old female with major depressive disorder. She has a past medical history of significant for seizures. Which of the following medications is contraindicated for use in pt? Amitriptyline, bupropion, selegiline, rasagiline, or sertraline?
Bupropion
You meet a 46 year old female with major depressive disorder. She has been experiencing sedation, dry muscus membranes, constipation and sexual dysfunction. Which of the following medications is the PT most likely taking? Sertraline, selegiline, rasagiline bupropion, or amitriptyline?
Amitriptyline