NAPLEX > Depression > Flashcards

Depression Flashcards

(109 cards)

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1
Q

persistent feelings of hopelessness

A

MDD

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2
Q

NTs believed to be involved in MDD

A

5HT
DA
NE
Epi
glutamate
ACh

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3
Q

meds that can cause/worsen depression

A

atomoxetine
indomethacin
NNRTIs
INSTIs
BBs
hormonal contraceptives
anabolic steroids
systemic steroids
interferones
benzos
ethanol
varenicline

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4
Q

conditions that can contribute to depression

A

parkinsons, dementia, MS, hypothyroidism, low vit D, metabolic conditions, malignancy, OAB, stroke

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5
Q

diagnosis of MDD

A

symptom assessment w/ DSM5
HDS / Ham-D depression assessment scale

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6
Q

for depression diagnosis, at least 5 of which symptoms must be present

M SIG E CAPS

A

MOOD- DEPRESSED
Sleep - inc/dec
INTEREST/PLEASURE - diminished
Guilt or feeling worthless
Energy- decreased
Concentration- decreased
Appetite- inc/dec
Psychomotor agitation
Suicidal ideation

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7
Q

what needs to be ruled out when diagnosing MDD

A

BPD- don’t want to induce mania or rapid cycling

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8
Q

what should NOT be used alone if anxiety is present with depression

A

BZDs

SUD, dependence, withdrawal, respiratory depression, death

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9
Q

natural products for depression

A

SJW
SAMe
5-HTP

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10
Q

DDI concern with SJW

A

enzyme inducer

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11
Q

safety concern with natural products for DM

A

serotonin syndrome

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12
Q

initial drug treatment choice is based on

A

AE profile, patient specific factors

usually SSRI or SNRI first

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13
Q

how long to effect with AD treatment

A

physical symptoms improve 1-2 weeks
psych symptoms may take 1 month or longer

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14
Q

when should treatment be reassessed for failure

A

no work after 4-8 weeks
one or more med trials may be needed

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15
Q

first line for depression treatment during PREGNANCY

A

psychotherapy

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16
Q

if a pregnant patient needs medication, what is preferred? what is its risk?

A

SSRIs
warning for PPHN

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17
Q

avoid which SSRI in pregnancy

A

paroxetine - cardiac effects

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18
Q

preferred treatment for postpartum depression

A

SSRIs

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19
Q

safety issue with antidepressants

A

serotonin syndrome

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20
Q

symptoms of serotonin syndrome

A

nausea, diarrhea, tachycardia, dizziness, HA, agitation, hallucinations, muscle rigidity

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21
Q

how to discontinue antidepressant? exception?

A

taper over several weeks

fluoxetine does not need taper due to long half life

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22
Q

BBW for all antidepressants

A

inc in suicidal thoughts or actions in children, teens, young adults

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23
Q

required to be dispensed with all antidepressants

A

MedGuide

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24
Q

SSRI examples

A

citalopram, escitalopram, fluoxetine, paroxetine, sertraline

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25
brand name of citalopram
celexa
26
brand name of escitalopram
lexapro
27
brand name of fluoxetine
prozac
28
brand name of paroxetine
paxil
29
brand name of sertraline
zoloft
30
max dose of citalopram? if >60 y/o?
40mg/day if >60 then 20mg/day
31
max dose of escitalopram? in older adults?
20mg/day older- 10mg/day
32
paroxetine comes in a brand capsule (Brisdelle) with what indication
vasomotor sx of menopause
33
contraindication for SSRIs
do not use with MAOIs
34
warnings with SSRIs
QT prolongation (max citalopram & escitalopram doses in older) SIADH/hyponatremia fall risk bleeding
35
AEs of SSRIs
sexual side effects somnolence, insomnia, dry mouth, HA, diaphoresis, weakness, tremor, dizziness
36
which SSRI is most ACTIVATING - take in AM
fluoxetine
37
which SSRI is most SEDATING- take in PM
paroxetine
38
SSRIs approved for premenstrual dysphoric disorder (PMDD)
fluoxetine, paroxetine CR, sertraline
39
preferred SSRI if cardiac risk
sertraline
40
washout period between SSRIs and MAOIs to avoid serotonin syndrome or hypertensive crisis
2 weeks 5 weeks with fluoxetine
41
DDIs with SSRIs
linezolid, IV methylene blue (serotonin syndrome) QT prolonging drugs (cital/escit) bleed risk (anticoag, antiplat, NSAIDs, 5 G's, fish oils)
42
DDIs- fluoxetine & paroxetine are CYP2D6 inhibitors so they decrease efficacy of
tamoxifen (prodrug) use venlafaxine
43
how to take vilazodone (Viibryd)
with food
44
contraindication of SSRI combo products vilazodone (viibryd), vortioxetine (trintellix)
MAOIs
45
SSRI combo products vilazodone (viibryd), vortioxetine (trintellix) has LESS OF WHICH AE
sexual
46
3 main SNRIs
venlafaxine duloxetine desvenlafaxine
47
brand name venlafaxine
Effexor XR
48
brand name duloxetine
Cymbalta
49
brand name desvenlafaxine
Pristiq
50
max dose of IR venlafaxine
375 mg/day
51
contraindication SNRIs
MAOIs
52
warnings with SNRIs
SIADH/hyponatremia fall risk bleeding
53
AEs of SNRIs
similar to SSRIs inc HR, dilated pupils, constipation, excessive sweating, inc BP (especially at higher doses)
54
additional indications for dluoxetine
peripheral neuropathy, fibromyalgia, chronic musculoskeletal pain
55
DDIs with SNRIs
MAOIs washout linezolid, IV methylene blue QT prolonging (VENLAFAXINE) inc bleeding risk duloxetine is mod 2D6 inhibitor
56
class that blocks NE & 5HT reuptake, and blocks ACh and histamine receptors
TCAs
57
TCAs that are MORE SELECTIVE for NE
secondary amines ex) nortriptyline
58
TCAs that are less selective so have HIGHER EFFICACY but MORE ANTICHOLINERGIC AND ANTIHISTAMINE AEs
tertiary amines amitriptyline, doxepin
59
brand name nortriptyline
Pamelor
60
when should amitriptyline and nortriptyline be taken
QHS
61
brand name of doxepin for INSOMINA
Silenor
62
TCAs contraindication
MAOIs
63
cardiotoxic AEs of TCAs
QT prolongation monitor suicidal ideation (overdose = arrythmias) orthostasis
64
anticholinergic AEs of TCAs
dry mouth, blurred vision, urinary retention, constipation, weight gain, fall risk
65
DDIs with TCAs
MAOIs0washout linezolid, methylene blue QT prolonging drugs
66
brand names of bupropion
wellbutrin SR/XL
67
additional indications of bupropion SR
smoking + naltrexone- weight
68
MDD of bupropion? why?
450mg/day seizure risk
69
contraindications bupropion
MAOIs other forms bupropion seizure disorder hx of anorexia/bulimia
70
AEs of bupropion
dry mouth, insomnia, restlessness, tremors/seizures (dose-related), weight loss
71
which AE is RARE with bupropion which may be useful
sexual
72
DDIs with bupropion
MAOIs- HTN crisis linezolid, methylene blue only 1 formulation at a time
73
what can occur from MAO inhibition with increased catecholamines if they increase dramatically
hypertensive crisis
74
4 MAOIs
isocarboxazid phenelzine tranylcypromine selegiline
75
brand name of isocarboxazid
Marplan
76
brand name of phenelzine
Nardil
77
brand name of tranylcypromine
Parnate
78
contraindications with MAOIs
serotonergic drugs, sympathomimetics, or tyramine rich foods
79
80
which MAOI is selective for B
selegiline patch
81
DDIs MAOI
drugs/food that increase 5HT, Epi, NE, DA CI drugs- SSRIs, SNRIs, TCAs, linezolid, lithium, tramadol, opioids, SJW
82
examples of tyramine rich foods
aged cheeses/meats, fermented, or pickled foods
83
2 week washout is required between MAOIs and
SSRIs, SNRIs, TCAs, bupropion
84
5 week washout is required between MAOIs and
fluoxetine
85
option often used for sleep and to increase appetite
mirtazapine
86
brand names mirtazapine
Remeron (SolTab)
87
contraindications of mirtazapine and trazodone
MAOI, linezolid, methylene blue
88
warning mirtazapine
QT prolongation
89
AEs of mirtazapine
sedation, weight gain, inc appetite
90
option mainly used for sleep
trazodone
91
AEs of trazodone
sedation, priapism
92
options that is rarely used due to hepatotoxicity (BBW)
nefazodone
93
avoid using mirtazapine and trazodone with drugs that have additive risk for
QT prolongation
94
option in patient with tobacco use
bupropion
95
option in patient with peripheral neuropathy/pain
duloxetine
96
if patient has seizure history or at risk do NOT use
bupropion
97
activating ADs to take in AM
fluoxetine, bupropion
98
sedating ADs to take at night
paroxetine, mirtazapine, trazodone
99
which ADs have highest risk for sexual dysfunction
SSRIs, SNRIs
100
which ADs have LOWEST risk for sexual dysfunction
bupropion, mirtazapine
101
ADs with QT concern
SSRI, SNRI, TCA, mirtazapine, trazodone
102
APA guidelines to determine treatment failure
4-8 week trial inc dose add adjuvant
103
options to augment AD therapy
atypical APS (aripiprazole, olanzapine/fluoxetine, quetiapine ER) buspirone, lithium
104
brand name aripiprazole
Abilify
105
brand name quetiapine
Seroquel
106
BBW for APS
dementia related psychosis
107
contraindication with olanzapine/fluoxetine
MAOI, methylene blue, linezolid
108
AEs of APD
metabolic, sedation (olanzapine, quetiapine) insomnia, anxiety, akathisia (aripiprazole)
109
nasal spray option given through REMs under provider supercision
esketamine
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