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Clin Therapeutics II (Spring 2018) > Exam 4: Depression and anxiety > Flashcards

Exam 4: Depression and anxiety Flashcards

1
Q

Define major depressive disorder

A

Significant impairment of social, academic, and occupational function for ≥2 weeks with 5 or more sx. Depressed mood or lack of enjoyment in pleasurable activities must be included.

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2
Q

Persistent Depressive Disorder aka?

A

Dysthymia

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3
Q

Persistent Depressive Disorder definition

A

Depressed mood for more days than not for at least 2 years

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4
Q

Define bereavement

A

Depressed symptoms occur after loss of loved one

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5
Q

Define adjustment disorder

A

Develpment of emotional and/or behavioral symtpoms within 3 months of an identable stressor

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6
Q

Major Depressive Disorder lasts for at least how long?

A

≥2 weeks

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7
Q

Persistent Depressive Disorder lasts for at least how long?

A

2 years

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8
Q

Adjustment Disorder develops when? (hint: time from something)

A

Within 3 months of an identifable stressor

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9
Q

Psychotherapy as effective as what for mild to moderate depression?

A

Drugs

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10
Q

What must screen for before using antidepressant monotherapy meds?

A

Bipolar disorder

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11
Q

Which class of antidepressants is most effective?

A

None. They’re all equally effective.

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12
Q

Selecting an antidepressant med depends on what?

A

PT specifics

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13
Q

Most commonly rx med for depression?

A

SSRI

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14
Q

SSRI indicated for which levels of depression?

A

Mild to moderate

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15
Q

SSRI MOA?

A

Increases 5-HT time in synapse resulting in neuronal adaptation

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16
Q

What explains why SSRIs take a while to work?

A

neuronal adaptation

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17
Q

Which two 5-HT receptors are most likely involved in anxiety and depression?

A

5-HT 1

5-HT 2

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18
Q

ADR of 5-HT1?

A

HA

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19
Q

Two ADRs of 5-HT2?

A

Somnolence, sexual dysfunction

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20
Q

ADR of 5-HT3?

A

Nausea and vomiting

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21
Q

ADR of 5-HT4?

A

Diarrhea

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22
Q

Which SSRI is worst for sexual side effects and weight gain?

A

Paroxetine

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23
Q

Paroxetine side effects due to what?

A

Inhibition of nitric oxide synthase

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24
Q

QTc risk and SSRIs?

A

Minimal

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25
Q

Which SSRI has biggest QTc risk?

A

Citalopram 10mg

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26
Q

What has greater risk for QTc than SSRIs?

A

TCAs x2

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27
Q

Abrupt cessation of SSRIs can cause what?

A

Withdrawal symptoms

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28
Q

Withdrawal symptoms from SSRIs lasts for how long?

A

1-10days

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29
Q

Are withdrawl sx from SSRIs life-threatening?

A

Nope

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30
Q

Which two SSRIs have worst withdrawal symptoms?

A

Fluvoxamine>Paroxetine

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31
Q

Which 2 SSRis have fewest drug-drug interactions?

A
  1. Escitalopram

2. Sertaline

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32
Q

SNRIs indicated for what type of depression?

A

SEVERE

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33
Q

SNRI MOA?

A

Serotonin and Norepinepherine reuptake inhibitor

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34
Q

SNRI has same MOA as what other class?

A

TCAs

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35
Q

SNRI and what type of hesitation?

A

Urinary hesitation

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36
Q

TCAs are considered SNRIs with what else?

A

Severe side effects

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37
Q

When to use TCAs?

A

Only if other meds has failed.

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38
Q

Who to NEVER use TCAs in?

A

Geriatics

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39
Q

Can fatally OD on TCAs?

A

Yes! ACh receptor OD with one week supply.

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40
Q

TCAs cause risk of orthostatis through what?

A

Alpha-1-antagonism

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41
Q

TCAs and ADRs?

A

Constipation, photosensitivity, arrythmias through Na+ channel block

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42
Q

SSRIs and Tripans cause what type of head pain?

A

Migraines

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43
Q

Serotonin syndrome due to what?

A

5-HT1a and 5-HT2a overstimulation

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44
Q

Serotonin syndrome symptoms?

A

REstless, akathisia, tremor, hypomania, confusion, hyperreflexia, myoclonus, diaphoresis, hyperthermia

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45
Q

Serotonin syndrome and death through what?

A

anoxia, aspiraiton, or multiple organ failure

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46
Q

When does Serotonin syndrome resolve?

A

After 24h once proserotogenic agent stopped

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47
Q

How to tx Serotonin syndrome?

A

Cyproheptadine 4mg PRN=5-HT antagonist

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48
Q

Antidepressants and preggers?

A

No meds if possible

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49
Q

Antidepressants and preggers and bupropion?

A

Bupropion safer than SSRIs if no cardiac or seizure comorbidities in mother

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50
Q

Antidepressants and preggers and SSRI?

A

Fluoxetine best studied but not necessarily first choice

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51
Q

Which SSRI to never use in preggers?

A

Paroxetine

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52
Q

Which 2 antidepressants have negligible levels in breastmilk?

A

Sertaline

Paroxetine

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53
Q

Initial antidepressant tx lasts for how long?

A

4-8 weeks

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54
Q

What if only partial response (25%) after 4-8 weeks?

A

Increase dose

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55
Q

If increase dose doesn’t help?

A

Switch to another antidepressant

56
Q

When is PT considered “Treatment resistant”

A

2 trials and failrue to adaquetly reduce symptoms

57
Q

What to do for “Treatment resistant”? 4 options

A
  1. Switch to third antidepressant monotherapy in different class
  2. add second antidepressant from different class
  3. Augment with non-antidepressant (Li, T3, atypical antipsychotics)
  4. Non-pharm options
58
Q

Most common combos?

A

SSRI + Bupropion (stimulant)

SSRI + Mirtazzpine (for sleep)

59
Q

What guides choice for combo selection?

A

By effects of second agent

60
Q

What to never combi SSRI/SNRI/TCA with?

A

MAOI

61
Q

Dose of atypical antipsychotic augmentation is lower than what? Response rate?

A

Schizphrenia dose. 20% response with 2 week onset.

62
Q

When to assess tolerability and safety/suicidal thoughts?

A

10-14 days after starting treatment

63
Q

When to assess efficacy?

A

4 weeks after starting treatment

64
Q

When to measure for maximal dose?

A

6-8 weeks after starting treatment

65
Q

When it “continuing phase”?

A

Every month for next 4-9 months

66
Q

Is MDD-Pediatrics the same criteria as adults?

A

Yes

67
Q

What is different in MDD for adults and peds?

A

Peds may describe different symptoms- poor concentration or procrastination

68
Q

MDD-Peds score for depressed?

A

> 40

69
Q

MDD-Peds score for remission?

A

<28

70
Q

Tx for MDD-Peds age 8-17?

A

Fluoxetine

71
Q

Tx for MDD-Peds age 12-17?

A

Escitalopram

72
Q

Which SSRI to never use in adolescents?

A

Paroxetine. Poor efficacy and worse tolerability.

73
Q

Young age and placebo response?

A

High response

74
Q

Young age and suicide risk?

A

Greatest suicide risk

75
Q

Define Suicidal Ideation

A

Thoughts of harm without any definitive plans

76
Q

Define Suicidal Acts

A

Actual attempts

77
Q

Which SSRI has lowest sick of suicidal ideation?

A

Fluoxetine

78
Q

How often to monitor for suicidal risk with Fluoxetine?

A

Every 4 weeks

79
Q

Tx for mild depression?

A

Supportive care

80
Q

Tx for moderate to severe depressive symptoms?

A

Pharms + Therapy

81
Q

What to 2 to add to SSRI?

A

Bupropion or Mirtazapine

82
Q

How long to treat depression for?

A

1 year minimum

83
Q

Define anxiety

A

Uncomfortable feeling of fear or apprehension accompanied by vague physical feelings (CV and GI)

84
Q

When does anxiety manifest?

A

Daily, under specific circumstances, mild, intense, acute, chronic

85
Q

What percent of General Anxiety Disorder have depression?

A

40%

86
Q

What percent of Panic Disorder have depression?

A

20-90%

87
Q

Define adjustment disorder

A

Development of emotional and/or behavioral symptoms within 3 months after identifiable stressor

88
Q

Sx of Adjustment Disorder?

A

Sleep disturbances, depressed mood, eating disorder, worry/jittery

89
Q

How long to sx of adjustment disorder last for?

A

Less than 6 months after end of stressor

90
Q

First-line tx for anxiety?

A

BZD

91
Q

BZD MOA?

A

Bind to GABA-alpha receptor and cause GABA to bind more strongly to receptor making GABA more effective

92
Q

What must be present for BZDs to work?

A

GABA

93
Q

When does tolerance to sedation occur with BZDs?

A

2 weeks of daily use

94
Q

When can resporatory depresison occur with BZDs?

A

When mixed with opiated or alcohol

95
Q

What does long-term BZD use do to conginitive function? What is long-term defined?

A

Long-term=180 days

Permanent memory change/impairment

96
Q

Can BZD-caused cognitive impairment get better?

A

Improved within 1 month of cessation but not full recovery

97
Q

What disease does longer BZD use positively correlate with?

A

Alzheimers

98
Q

BZD withdrawal does what to anxiety?

A

Worse anxiety than before

99
Q

BZD withdrawal does what to disinhibition?

A

Impulsive outbursts can happen is predisposed

100
Q

Duration of BZD taper?

A

5 weeks

101
Q

BZD frequent dose increase can be a sign of what?

A

Abuse of diversion

102
Q

Are BZDs used for inducing euphoria?

A

Rarely

103
Q

BZDc can be added to other drugs to achieve what?

A

Prolnged high

104
Q

Is BZD increase dose common?

A

No!

105
Q

What criteria are used for BZD selection?

A
  1. High vs low potency

2. Duration of action

106
Q

Which 2 BZDs have fast onset?

A
  1. Alprazolam

2. Diazepam

107
Q

Define General Anxiety Disorder

A

Excessive anxiety and worry for more days than not for at least 6 months

108
Q

Who gets GAD more commonly? men or women?

A

Female

109
Q

Where is GAD commonly seen?

A

Primary care

110
Q

Sx of GAD in primary care include?

A

HA, palpitations, sweating, GI disturbances (diarrhea)

111
Q

Best TX for GAD?

A

Fluoxetine

112
Q

Fluoxetine and GAD best med for what?

A

Best for response and remission

113
Q

Which GAD med best tolerability?

A

Sertaline

114
Q

Which med is specific to GAD only?

A

Buspirone

115
Q

Buspirone MOA?

A

5-HT1a partial agonist

116
Q

Buspirone onset?

A

2 weeks

117
Q

Buspirone full effect?

A

6 weeks

118
Q

Buspirone and sex dysfunction?

A

Nope!

119
Q

Which 2 meds have worse outcomes for GAD?

A
  1. Venlafaxine

2. Paroxetine

120
Q

What sort of dose to use when treating GAD? Why?

A

Low dose. Higher dose may initially worsen anxiety.

121
Q

What to add for short-term crisis in GAD?

A

BZD

122
Q

GAD tx if cannot tolerate SSRI/SNRI?

A

Pregabalin

123
Q

Define panic attack

A

Period of intense fear with symptoms develop abrutly and peak in minutes

124
Q

Tx for maintenance of Panic Attacks?

A

SSRI or SNRI

125
Q

What to use for bridge in panic attack tx?

A

BZD

126
Q

Venlafaxine (Effexor) and BP?

A

Increases sytolic by 3-15. Can cause HTN crisis.

127
Q

Desvenlafaxine (Pristiq) more effective than other SNRIs?

A

Yes

128
Q

Desvenlafaxine (Pristiq) ADRs compared to Effexor?

A

More CV and BP increase than Venlafaxine (Effector).

129
Q

Bupropion works on which 2 neurotransmitters?

A
  1. Dopamine

2. NE

130
Q

Mirtazapine MOA?

A

Alpha-2 blocker causing increased 5-HT and NE

131
Q

Mirtazapine good for what?

A

Sleep

132
Q

Duloxetine (Cymbalta) good for what neuro problem?

A

Neuropathy

133
Q

Duloxetine (Cymbalta) and liver?

A

Hepatotoxicity with chronic alcohol dependence

134
Q

Trazadone MOA?

A

Serotonin reputake pump inhibitor. Blocks 5-HT2 receptor decreasing anxiety.

135
Q

Trazadone and risk for serotonin syndrome?

A

Can give with another SSRI without worry of serotonin syndrome.

136
Q

Trazadone works to block what other things? (hint: 2)

A
  1. Potent antihistaminic blocker

2. Alpha 1 noradrenergic blocking effect

Clin Therapeutics II (Spring 2018) (11 decks)

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