QuestionPrescription
QuestionComment
why is fluoxetine incorrect?

61150
User
subscriber
Suture Jargon
QuestionComment
starting sertraline dose in OCD is 50 mg not 25 mg, 25 is for anxiety disorders only

Obsessive-compulsive disorder
By mouth
Adult
Initially 50 mg once daily, then increased in steps of 50 mg at intervals of at least 1 week if required; maximum 200 mg per day.
61668
QuestionComment
Yeah but it's asking for you to prescribe something for her anxiety 
61704
User
subscriber
Epidermis Benign
User
subscriber
Vaccine Complement
QuestionComment
SSRI/SNRI contraindicated with NSAID = upper gi bleed ? 
61716
User
subscriber
Zika Hereditary
Concept
Chapter
2693
4067
Anxiety, Obsessions and Stress Reactions (including OCD)
Topic
173
Psychiatry
# Drug choice feedback

This is a patient with known anxiety and OCD, who has already tried CBT and with ongoing symptoms. For these patients, the next line of treatment is medication, with selective serotonin reuptake inhibitors (SSRI) first line. There are several SSRIs which can be used, with sertraline and escitalopram very popular in the UK.

# Dose/Route/Frequency/Duration feedback

Most of these drugs can be uptitrated if the desired treatment effects are not being witnessed. 2nd line medication treatments include selective serotonin-noradrenaline re-uptake inhibitors (SNRI), such as duloxetine or venlafaxine.  In patients younger than 30 years of age, when initiating SSRI therapy, a follow-up at 1 week should be arranged to review effectiveness and adverse effects as during this initial period there is an increased risk of worsening symptoms. 
18093
PrescriptionAnswer
PrescribeAnswerData
1 tablet
PrescribeAnswerData
citalopram hydrobromide 10 mg tablets
PrescribeAnswerData
7 days
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
1 tablet
PrescribeAnswerData
citalopram hydrobromide 10 mg tablets
PrescribeAnswerData
1 week
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
citalopram hydrobromide 10 mg tablets
PrescribeAnswerData
1 week
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
20 mg
PrescribeAnswerData
paroxetine 20 mg tablets
PrescribeAnswerData
1 week
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
escitalopram 10 mg tablets
PrescribeAnswerData
1 week
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
1 tablet
PrescribeAnswerData
paroxetine 20 mg tablets
PrescribeAnswerData
1 week
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
20 mg
PrescribeAnswerData
paroxetine 20 mg tablets
PrescribeAnswerData
7 days
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
1 tablet
PrescribeAnswerData
paroxetine 20 mg tablets
PrescribeAnswerData
7 days
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
25 mg
PrescribeAnswerData
sertraline 50 mg tablets
PrescribeAnswerData
7 days
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
25 mg
PrescribeAnswerData
sertraline 50 mg tablets
PrescribeAnswerData
1 week
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
escitalopram 10 mg tablets
PrescribeAnswerData
7 days
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
1 tablet
PrescribeAnswerData
escitalopram 10 mg tablets
PrescribeAnswerData
7 days
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
1 tablet
PrescribeAnswerData
escitalopram 10 mg tablets
PrescribeAnswerData
1 week
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
10 mg
PrescribeAnswerData
citalopram hydrobromide 10 mg tablets
PrescribeAnswerData
7 days
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
Case Presentation: A 26-year-old woman presents to the GP complaining of worsening symptoms of anxiety including panic attacks. There has been increased stress due to her job as a corporate lawyer. She has previously tried CBT in the past and currently has private counselling sessions weekly.


## PH

Anxiety, OCD, Menorrhagia, Migraine

## DH

Ibuprofen 400mg PO PRN

NKDA

## On examination

No cyanosis. Normal consciousness but mildly distressed and agitated. Good air entry bilaterally.

Temperature 37.0°C, HR 90, RR 14, BP 110/68, O<sub>2</sub> saturation 96% RA, GCS 15, Weight 70kg

## Investigations

None

# Prescribing Request

Write a prescription for one drug that is most appropriate for managing this patient's worsening anxiety.
