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Let’s start our USMLE Review with Drugs of Choice from the Gold Standard USMLE Step 2 Audio Review program.
Play USMLE Audio MP3 20 09 Drugs of Choice OCD Below
What is the classic drug of choice for obsessive-compulsive disorder?
And the trade name for Clomipramine?
And in general, what type of drug is Clomipramine (trade name Anafranil)?
- It is a tricyclic antidepressant.
And it also has what other activity?
- It also has serotonin reuptake inhibition activity.
In general, what class of side effects are patients on Clomipramine (trade name Anafranil) subject to?
- The anticholinergic side effects.
What additional problem with Clomipramine (trade name Anafranil) limit its usefulness in a certain population of patients?
- Because it can lower the seizure threshold, you may not wish to use it in patients who are already prone to seizures.
What alternative medication has recently been approved for the treatment of obsessive-compulsive disorder, which may offer fewer side effects than Clomipramine (trade name Anafranil)?
- This is Fluoxetine.
And the trade name for Fluoxetine?
And in general, what group of drug is Prozac?
- It is a selective serotonin reuptake inhibitor, that is, an SSRI. It is generally used as an antidepressant.
In general, what class of side effects are patients on Fluoxetine (trade name Prozac) liable to?
- The sympathomimetic side effects.
What 2 other SSRIs are similar to Fluoxetine (trade name Prozac), however, they are not officially approved for the treatment of obsessive-compulsive disorder?
- Sertraline and Paroxetine.
What is the trade name for Sertraline?
And the trade name for Paroxetine?
In terms of side effect profile, what small advantage may Sertraline/Zoloft and Paroxetine/Paxil offer over Fluoxetine/Prozac?
- They may have slightly lower risk of causing the agitation portion of the sympathomimetic group of side effects.
In particular, Paroxetine (trade name Paxil) may also be particularly helpful in what type of patient?
- Patients that are prone to temper outbursts in addition to obsessive-compulsive disorder.
And this brings to mind, of course what patient diagnosis?
- Tourette’s Syndrome.
Finally, what is the newest SSRI which is approved specifically for obsessive-compulsive disorder, and which may have less side effects than Fluoxetine (trade name Prozac)?
- This is Fluvoxamine.
And the trade name?
Putting this all together, what is probably the first-line drug of choice for beginning therapy with the obsessive-compulsive patient?
If this is not effective, what are probably the next 2 choices? Either try a different SSRI or switch to Clomipramine.
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