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PHRM 845 Therapeutics > Exam 5 - Lec 69 Depression Ott > Flashcards

Exam 5 - Lec 69 Depression Ott Flashcards

1
Q

risk of recurrence of depression:

1 episode: ___-___%
2 episodes: ___%
3 episodes: ___%

A

50-60%
70%
90%

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2
Q

T or F: risk of recurrence becomes higher over time as duration of remission increases

A

F (lower over time)

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3
Q

T or F: persistent mild sx during remission is a predictor of recurrence

A

T

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4
Q

Which is FALSE about recurrence?

a. risk becomes lower over time as duration of remission decreases
b. persistent mild sx during remission is a predictor of recurrence
c. function deteriorates during the episode and goes back to baseline upon remission

A

a. risk becomes lower over time as duration of remission decreases (not decreases; should be increases)

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5
Q

DSM-5 diagnostic criteria for depression: at least one of the symptoms must be depressed mood or ?

a. insomnia
b. loss of interest/pleasure in doing things
c. fatigue
d. weight or appetite change

A

b. loss of interest/pleasure in doing things

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6
Q

DSM-5 diagnostic criteria mnemonic

A

SIGE CAPS

Sleep
Interest decreased
Guilt/worthlessness
Energy loss/fatigue
Concentration difficulties
Appetite change
Psychomotor agitation/retardation
Suicidal ideation

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7
Q

what are the two self-administered rating scales for depression

A

PHQ-9 and MDQ

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8
Q

which rating scale can be used to rule out bipolar disorder?

a. PHQ-9
b. MDQ

A

b. MDQ

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9
Q

which rating scale was developed for the primary care setting?

a. PHQ-9
b. MDQ

A

a. PHQ-9

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10
Q

look at slide 11 for the 4 goals of tx

A

ok

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11
Q

goal of the acute phase of depression tx

a. induce remission
b. prevent relapse
c. prevent recurrence

A

a. induce remission

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12
Q

goal of the continuation phase of depression tx

a. induce remission
b. prevent relapse
c. prevent recurrence

A

b. prevent relapse

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13
Q

goal of the maintenance phase of depression tx

a. induce remission
b. prevent relapse
c. prevent recurrence

A

c. prevent recurrence

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14
Q

boxed warning for all antidepressant meds

A

suicidality in pts 24 or younger

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15
Q

which of the following SSRIs can cause QTc prolongation?

a. citalopram
b. escitalopram
c. fluoxetine
d. sertraline

A

a. citalopram

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16
Q

which SSRI is a substrate of 2C19 and 3A4?

a. citalopram
b. fluoxetine
c. fluvoxamine
d. paroxetine

A

a. citalopram

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17
Q

which SSRI has the longest half-life and has activating potential?

a. citalopram
b. fluoxetine
c. paroxetine
d. sertraline

A

b. fluoxetine (96-144 hours)

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18
Q

what is the active metabolite of fluoxetine and which CYP does it inhibit?

A

norfluoxetine; 3A4 inhibitor

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19
Q

which SSRI is a 1A2, 2C19 inhibitor?

a. sertraline
b. fluvoxamine
c. fluoxetine
d. paroxetine

A

b. fluvoxamine

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20
Q

which SSRI must be tapered due to anticholinergic effects?

a. paroxetine
b. sertraline
c. citalopram
d. fluvoxamine

A

a. paroxetine

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21
Q

which SSRI is a 2D6, 2B6 inhibitor?

a. citalopram
b. sertraline
c. paroxetine
d. fluoxetine

A

c. paroxetine

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22
Q

which SSRI causes weight gain, sedation, and has a septal wall defect risk to the fetus?

a. sertraline
b. fluvoxamine
c. citalopram
d. paroxetine

A

d. paroxetine

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23
Q

which drug causes more nausea/GI upset than other antidepressants?

a. citalopram
b. fluoxetine
c. paroxetine
d. sertraline

A

d. sertraline

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24
Q

fluoxetine is an inhibitor of which CYP?

A

2D6

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25
Q

which SSRI causes weight loss?

a. paroxetine
b. fluoxetine
c. escitalopram

A

b. fluoxetine

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26
Q

3 bolded AEs of SSRIs to know (slide 17)

A

-inc bleeding risk (platelet inhibition)
-hyponatremia (especially in elderly)
-sexual dysfunction

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27
Q

active metabolite of venlafaxine

A

desvenlafaxine

28
Q

which SNRI has a dose-limiting SE of nausea?

a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. venlafaxine

A

a. desvenlafaxine

(duloxetine also has nausea)

29
Q

which SNRI has no major CYP interactions?

a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine

A

a. desvenlafaxine

30
Q

which SNRI has a FDA warning for hepatotoxicity?

a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine

A

b. duloxetine

31
Q

which SNRI is a 2D6 inhibitor? (2 of them; one is a 2D6 inhibitor at high dose)

a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine

A

b. duloxetine
e. venlafaxine (at high doses)

32
Q

which SNRI must be adjusted in renal impairment or with strong 3A4 inhibitor?

a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine

A

c. levomilnacipran

33
Q

which SNRI is a 3A4 substrate?

a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine

A

c. levomilnacipran

34
Q

which SNRI must be > 150 mg/day to have NE effects?

a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine

A

e. venlafaxine

35
Q

SNRIs AEs (2 of them in bold)

A

BP elevation, nausea

36
Q

with which SNRI should we obtain LFTs at baseline and when symptomatic or every 6 months?

a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine

A

b. duloxetine

37
Q

useful in pain syndrome, musculoskeletal pain, fibromyalgia, and neuropathic pain

a. SSRIs
b. SNRIs
c. TCAs

A

b. SNRIs

38
Q

amitriptyline is a ______ amine

a. secondary
b. tertiary
c. tetracyclic

A

b. tertiary

39
Q

TCAs are more often used for _____ _____ syndromes than depression

A

neuropathic pain

40
Q

look at slide 21 for TCAs AEs

A

you got it

41
Q

TCAs have a narrow therapeutic index and are fatal in overdose as low as _______ mg (4-10 tablets) due to cardiac arrhythmias or seizures

A

1000 mg

42
Q

which MAOI does NOT require a low tyramine diet?

a. isocarboxazid
b. phenelzine
c. selegiline
d. tranylcypromaine

A

c. selegiline

43
Q

how long should the washout period be before switching antidepressants?

A

2 seeks (5 weeks for fluoxetine)

44
Q

T or F: MAOIs should be used with caution due to hypertensive crisis and serotonin syndrome

A

T

45
Q

MOA of bupropion (2 things bolded)

A

-DNRI
-stimulating - insomnia and appetite suppression

46
Q

bupropion is CI in active _____ and _____ disorders

A

seizure; eating

47
Q

bupropion is a ____ inhibitor (CYP)

A

2D6

48
Q

T or F: bupropion and mirtazapine should NOT be used in combo with SSRI/SNRIs

A

F (can be used in combo with SSRIs/SNRIs)

49
Q

for mirtazapine, sedation and inc appetite occur with doses of ___ mg/day or less

A

15 mg/day

50
Q

two warnings for mirtazapine

A

agranulocytosis; inc cholesterol

51
Q

T or F: low doses of trazodone are used for depression

A

F (higher doses needed)

52
Q

SE of trazodone (2 bolded)

A

-orthostatic hypotension
-risk of priapism (medical emergency)

53
Q

vilazodone mechanism

A

primarily SSRI, may have some 5HT1A agonism which may provide anxiolytic effects

54
Q

T or F: vilazodone or vortioxetine should NOT be used in combo with SSRI/SNRIs

A

T

55
Q

vilazodone is a ___ substrate

A

3A4

56
Q

why should vilazodone be taken with food? (2 things bolded)

A

-significant nausea
-bioavailability inc with food

57
Q

which drug’s mechanism is a SSRI + 5HT1A agonist + 5HT3 antagonist?

a. vilazodone
b. bupropion
c. vortioxetine

A

c. vortioxetine

58
Q

AE of vortioxetine (only one bolded)

A

nausea

59
Q

vortioxetine is a ___ substrate

A

2D6

60
Q

T or F: vortioxetine has more sexual dysfunction than other antidepressants

A

F (possibly less)

61
Q

antidepressant withdrawal syndrome is common with ALL antidepressants EXCEPT

a. duloxetine
b. paroxetine
c. fluoxetine
d. sertraline

A

c. fluoxetine

62
Q

T or F: antidepressant withdrawal syndrome is life threatening

A

F

63
Q

antidepressants with __________ activity should be tapered no matter what

A

anticholinergic

64
Q

4 atypical FDA-approved augmentation agents

A

-aripiprazole
-brexpiprazole
-cariprazine
-quetiapine

65
Q

which of the following is FALSE about electroconvulsive therapy?

a. 2-3 times weekly as induction
b. usual course is 6-12 treatments
c. age is not a factor
d. can continue drug therapy
e. unsafe in pregnancy
f. can have temporary memory loss
g. CI in recent MI or hemorrhagic stroke

A

e. unsafe in pregnancy (it is safe)

66
Q
A

PHRM 845 Therapeutics (34 decks)

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