Written Exam: APCAT MCQ Summary Depression

WRITTEN EXAM APCAT MCQ SUMMARY: DEPRESSION

Washout periods for antidepressants [1, 2] 10-14 days for fluoxetine, phenelzine, tranylcypromine 2-4 days for TCAs, SSRIs (except fluoxetine), mianserin, mirtazapine 1-2 days for duloxetine, venlafaxine moclobemide, reboxetine

Sexual dysfunction and antidepressants [3] No adverse effect on sexual dysfunction for mianserin, mirtazapine, moclobemide. Remember MMM.

Benzodiazepines: Duration of action [1] Very short duration of action (< 6 hours): midazolam, triazolam Short duration of action: alprazolam, oxazepam, temazepam Medium duration of action: bromazepam, lorazepam Long duration of action (> 24 hours): diazepam, flunitrazepam, nitrazepam, clobazam, clonazepam Rapid onset of action (work within less than an hour): temazepam, diazepam, flunitrazepam, alprazolam, midazolam, triazolam

TCA: Adverse effects and withdrawal symptoms [1, 2] Adverse effects include anticholinergic effects (dry mouth, blurred vision, decreased lacrimation, constipation, urinary retention), weight gain, tachycardia, orthostatic hypotension, sedation) Withdrawal symptoms include cholinergic rebound effects (hypersalivation, runny nose, diarrhoea, sleep disturbance). These are generally opposite to the adverse effects.

Serotonin syndrome [1] Symptoms include hyperreflexia, clonus, tremor, incoordination, mental state changes (confusion, agitation), shivering, sweating, diarrhoea Drugs that may contribute to serotonin toxicity include: - Antidepressants (TCAs, MAOIs, SSRIs, venlafaxine, duloxetine, St Johns wort) - Opioids (tramadol, pethidine, dextromethorphan) - Stimulants (phentermine, sibutramine) - Illicit drugs (eg ecstasy, LSD, cocaine) - Others (selegiline, tryptophan, lithium, linezolid)

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Written Exam: APCAT MCQ Summary Depression

References 1. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2009 2. eTG Complete. North Melbourne: Therapeutic Guidelines Ltd; 2008 3. E-MIMS. 5.0. Sydney: MediMedia Australia Pty Ltd; 2006

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