Naplex 2025 😭 > Depression > Flashcards

Depression Flashcards

(48 cards)

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1
Q

What is Depression?

A
  • Presistent feeling of hopelessness, rejection, constant worry, poor concentration, lack of energy, sleep problems and sometimes suicidal tendencies
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2
Q

What is the cause of depression/

A
  • Neurotransmitter imbalences of serotonin, norepi, epi, dopamine, glutamate, acetylcholine
  • Serotonin being the more important one
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3
Q

What is the way we diagnosis depression?

A
  • DSM-5
  • HAM-D
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4
Q

What is the DSM-5 Criteria for Depression diagnosis?

M SIG E CAPS

A
  • Mood - depressed
  • Sleep - increased or decreased
  • Interest - decreased
  • Guilty or worthless feeling
  • Energy - decreased
  • Concentration - decreased
  • Appetite - increased or deacreased
  • Psychomotor agitation
  • Sucidial thoughts
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5
Q

What are some ADHD Medications that could worse depression?

A
  • Atomoxetine (strattera)
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6
Q

What are some Analgesics Medications that could worse depression?

A
  • Indomethacin
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7
Q

What are some Antiretrovirals (NNRTIs) Medications that could worse depression?

A
  • Efavirenz (in Atripla)
  • Rilpivirine (in Complera, Odefsey)
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8
Q

What are some Cardiovascular Medications that could worse depression?

A
  • Beta-blockers (mainly propranlol)
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9
Q

What are some Hormone Medications that could worse depression?

A
  • Contraceptives
  • Anabolic steroids
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10
Q

What are some other important Medications that could worse depression?

A
  • Benzos, Systemic steroids, Interferons, Varenicline, Ethanol
  • Methylphenidate (& other stimulants), Methadone (possibly other chronic opioids), Clonidine, Methyldopa, Procainamide, Cyclosporine, Isotretinon

NEED TO KNOW

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11
Q

What are some natural products that can help with depression?

A
  • St Johns Wort, 5-HTP, Valerian

becareful for serotonin syndrome

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12
Q

What is the recommended treatment for someone experiencing depression in pregnancy and postpartum depression?

A
  • Psychotherapy is 1st line
  • SSRIs (citalopram or sertaline] are best if needing a medication (Watch out for Presistent Pulmonary Hypertension of the Newborn [PPHN])
  • Avoid Paroxetine - cardic risks
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13
Q

What are some agents that could have an additive serotonin risk?

A
  • SSRIs/SNRIs
  • Mirtazapine
  • Trazodone
  • Opioids
  • Tramadol
  • Lithium
  • Buspirone
  • Tripans
  • Dextromethorphan
  • St. Johns Wart
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14
Q

What aer some boxed warnings to keep in mind about ALL antidepressants?

A
  • increased suicidal thoughs in some kids, teens or yound adults
  • MedGuides ARE required
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15
Q

What is the lag effects for the antidepressants/

A
  • Must be used daily and will take time to work [1-2 weeks to a month]
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16
Q

What are the drug classes that are used for depression?

A
  • SSRIs
  • SNRIs
  • Tricyclics (TCAs)
  • Bupropion (Dopamine/Norepi reuptake inhibitor)
  • MAOi
  • Mirtazapine
  • Trazadone
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17
Q

What is the MOA for the SSRIs?

A
  • Increases serotonin levels by inhibiting the reuptake in the synapse
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18
Q

What are the SSRIs that are used for depression?

A
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
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19
Q

What are some contraindations for the SSRIs used in depression?

A
  • DO NOT use with MAOi or Linezolid or IV Methylene Blue Or Pimozide
  • Brisdelle (Paroxitine): DO NOT use in pregnancy
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20
Q

What are some warnings for the SSRIs used in depression?

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A
  • QTc Prolongation (DO NOT exceed 20 mg/day Celexa and 10 mg/day Lexapro)
  • Hyponatremia, Fall Risk
  • Bleeding (caution with Anticoags, antiplates, NSAIDs)

MAX: 40 mg/day of Celexa & MAX: 20 mg/day of Lexapro

21
Q

What are some side effects for the SSRIs used in depression?

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A
  • Sexual Side Effects (decreased Libido, ejaculation difficulites, ED)
  • Somnolence, insomnia, Nausea, Dry Mouth, Diaphoresis, Weakness, Tremor, Dizziness, Headache

Because of the serotonin

Prozac - most ACTIVITING; Paxil - most SEDATING

22
Q

What are some additional notes for the SSRIs used in depression?

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A
  • Fluoxtine & Paxil CR are FDA approved for PMDD
  • Sertaline is best for those with Cardiac risks
23
Q

What is the MOA for the SNRIs?

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A
  • Increases serotonin and norepi levels by inhibiting the reuptake in the synapse
24
Q

What are the SNRIs that are used for Depression?

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A
  • Venlafaxine (Effexor XR)
  • Duloxtine (Cymbalta)
  • Desvenlafaxine (Pristiq)

Effexor - GAD, Panic Disorders, Social Anxiety
Cymbalta - NEURO PAIN, GAD, Chornic muscle pain

25
What are the **contraindications** for **SNRIs**?
- SNRIs and MAOi have a potentally lethal interaction
26
What are the **warnings** for the **SNRIs**?
- Hyponatermia, Falls - Bleeding ## Footnote Same as SSRIs
27
What are the **side effects** for the **SNRIs**?
- **Sexual Side Effects** (decreased Libido, ejaculation difficulites, ED) - Somnolence, insomnia, Nausea, Dry Mouth, **Diaphoresis**, Weakness, Tremor, Dizziness, Headache (because of **Serotonin**) - **Increased HR**, dilated pupils, dry mouth, excessive sweating, constipation (because of **Norepi**)
28
What is the **MOA** for the **TCAs**?
- Primarily inhibit Norepi and Serotonin BUT also **block ACh and Histamine receptors**
29
What are the **Secondary and Tertiary Amine TCAs** used for **Depression**?
- Tertiary: Amitriptylline, Doxepin - Secondary: Nortriptylline (Pramelor) ## Footnote Tertiary: more effective BUT have worst side effects Secondary: more selective to Norepi receptors
30
What are the **contraindications** for the **TCAs**?
- DO NOT use with MAOi, Linezolid, IV Methylene Blue
31
What are the **Cardiotoxicity side effects** for the **TCAs** used for **Depression**?
- **QTc Prolongations** with Overdose (montior suicidal thoughts as overdose = fatal arrhythmias)
32
What are the **anticholinergic side effects** for the **TCAs** used for **Depression**?
- Dry mouth, blurred vision, urinary retention, constipation - Weight Gain, Falls
33
What is the **MOA** for the **Monoamine Oxidase Inhibitors (MAOi)**?
- Inhibits **monoamune oxidase**, which breaks down catecholamines (serotonin, epi, norepi, dopamine)
34
What are the **MAOi** that are used for **depression**?
- Isocarboxazid (Marplan) - Phenelzine (Nardil) - Tranylcypromine (Parnate)
35
What are the **warnings** for the **MAOi**?
- Drug-Drug & Drug-Food interactions that could be fatal - **Hypertensive Crisis & Serotonin Syndrome** (when taken with SSRIs, SNRIs, TCAs & Tyramine Rich foods) | Contraindicated with anything that changes serotonin levels ## Footnote Tyramine Foods: **Aged Cheese, Pickled Herring, Yeast Extract, Air-dried Meats, Saurkraut, Soy Sauce**
36
What are some of the **miscellaneous drugs** that could be used for **depression**/.
- Mirtazapine (Remeron) - Tradodone (mostly for sleep) - Nefazodone (Rarely used)
37
What are the **side effects** for **mirtazapine**?
- Sedation - Increased Appetite - Weight Gain ## Footnote More commonly used in your **nursing facilities** and in **oncology**
38
What are the **Side effects** for **trazodone**?
- Sedation (why its used for sleep)
39
What is the **Boxed warning** for **Nefazodone**?
- Hepatotoxicity (why its rarely used)
40
what is **treatment-resistant depression**?
- Those that do not respond to **two full** treatment trails
41
What should one do if they are **not improving or have an incomplete response** should consider?
- Changing antidepressants - Increase the dose - Augment with Buspirone or low dose atypical
42
what are the **select adjunctive therapy** in **treatment resistant depression** drug classes?
- Antipsychotics (atypicals) - NMDA Receptor Antagonist
43
What are the **antipsychotics** that are used for **treatment resistant depression**?
- Aripiprazole (Abilify) - Quetiapine (Seroquel)
44
What are the **Boxed warnings** for the **antipsychotics**?
- eldery patient with dementia related psychosis are at increased risk of death - increased suicidal thinking
45
What are the **contraindications** for the **antipsychotics**?
- Olanzapine/fluoxetine: DO NOT use with MAOi, Linezolid, IV Methylene blue (QTc Prolongation)
46
What are the **side effects** for **aripiprazole**?
- Anxiety, insomnia, akathisia
47
What are the **side effects** for **Quetiapine**?
- Sedation, Orthostasis, weight gain, increased lipids, increased glucose
48
What medications are used for **treatment resistant depression**
- Aripiprazole (Abilify) + Olanzapine + Fluoxetine (Symbyax) + Quetiapine ER (Seroquel XR)
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