shevyatiwari's version from 2015-04-11 02:00

Section 1

Question Answer
Doxepin is an SSRIF, TCA
Doxepin is the best agent for neurotic excoriationsT
Limited antipruritic effectsF, strong
Metabolised by CYP3A4F, 2D6
There are individual variations in its metabolismT
Serum trough levels are helpfulT
Sedation is only minimal with doxepinF
Interacts with several CYP3A4 inhibitors and inducersT
Limited cardiovascular S/EF, can prolong QT interval
Has anticholinergic S/ET
ECG should be done on all patientsF, older or those with a history of cardiac conduction disturbance, or if used in doses >100mg
Seizure, BPAD are good indications for DoxepinF, can lower seizure threshold, precipitate mania
Vivid dreams can occur on rebound after abrupt withdrawalT
Normalises sleep patternsT
Affinity for H1 is 775 times greater than diphenhydramineT
Affinity for H1 is 10 times greater than fr hydroxyzineF, 56 times
Antipruritic effects are seen in 2 weeksF, almost immediate

Section 2

Question Answer
Fluvoxamine is a good first line SSRIF, numerous CYP interactions
As effective as TCA's but worse S/EF, better S/E
Non selective inhibitors of serotonin uptake F, selective
There is a clear linear relationship between dose and response F
Patients showing no improvement after 6 weeks should have a dose increaseF, swtich to another SSRI/another class
GI S/E are the most commonT
Fluoxetine is the least likely to cause anxiety and insomniaF, most
Sedation is the most common with fluoxetineF, paroxetine
Approx 40% have sexual dysfunctionT
Discontinuation symptoms include dizziness, sensory disturbances, anxiety, agitation, nausea, sweatingT

Section 3

Question Answer
Venlafaxine has advantages over conventional antidepressants - increase response and longer efficacyT
Venlafaxine can cause insomnia, nervousness and anxietyT
Doesn't cause diarrhoeaT, consipation
Causes more sexual dysfunction than the SSRI'sF, less
Can cause hypertensionT
Can have discontinuation symptoms like SSRI'sT

Section 4

Question Answer
Bupropion has more sexual S/E than SSRI'sF, less
Weak inhibitor of dopamine reuptakeT
Common S/E include insomnia, agitation, headache, constipation, dry mouth, nausea, tremorT
Can cause seizuresT
Antipsychotics, antidepressants, theophylline, systemic corticosteroids all cause increased cardiotoxicityF, lower the seizure threshold
Can be used in combination with Zyban to combat insomniaF, C/I
Drug/ETOH is okay with bupropionF, should not be used

Section 5

Question Answer
Pimozide is a common treatment of delusions of parasitosisT
Causes EPST
Most will require 4 months treatmentF, 6
Sudden death is a S/ET, can prolong QT interval

Section 6

Question Answer
Amitriptyline can be useful for sensations of pain cf DoxepinT