CNS Pt 2

Question 1

What is the one SSRI used to treat bipolar depression

Answer 1

Fluoxetine and do not use as mono-therapy

Question 2

What should you do prior to diagnosing bipolar disorder?

Answer 2

File out mimicking conditions like substance use, schizophrenia, dementia, hypothyroidism, HF

Question 3

What drug classes are used for acute mania?

Answer 3

Antipsychotics and mood stabilizers

Question 4

What is the common maintenance therapy if bipolar disorder?

Answer 4

Lithium with or without valproate and quetiapine

Question 5

How should fluoxetine be dosed?

Answer 5

Avoid at night due to sleep impairment

Question 6

How long does is take depression to respond to fluoxetine?

Answer 6

6 months at most

Question 7

How should SSRIs be discontinued?

Answer 7

Dose should be gradually reduced

Question 8

What are the FLUSH symptoms from SSRI withdrawal

Answer 8

F- flu like
L- lighthead
U- uneasiness
S- sleep disturbance
H - headache

Question 9

What is the most selective SSRI with less side effects?

Answer 9

Citalopram

Question 10

What is the active enantiomer of escitalopram

Answer 10

Citalopram

Question 11

When is sertraline indicated?

Answer 11

MDD, OCD, Panic disorder, PTSD, PMDD, social anxiety

Question 12

What drug does sertraline interact with?

Answer 12

Cimetidine

Question 13

What are the AEs of sertraline

Answer 13

Male sexual dysfunction , drowsiness, GI complaints, insomnia

Question 14

What SSRI has less risk in pregnancy?

Answer 14

Fluoxetine

Question 15

Which SSRI has more pregnancy risk

Answer 15

Paroxetine

Question 16

What are the TCAs?

Answer 16

Amitriptyline and nortriptyline

Question 17

How do TCAs work?

Answer 17

The block neuronal reuptake of norepinephrine and serotonin

Question 18

What are TCAs in?

Answer 18

Depression, bipolar, neuropathic pain, chronic insomnia, ADHD, panic disorder, OCD, and nocturnal enuresis

Question 19

What are the AEs of TCAs

Answer 19

Over dose, anticholinergic symptoms , QRS widening, arrhythmias , and cardiac arrest

Question 20

What do TCAs interact with

Answer 20

MAOI, epinephrine, vasoconstrictors , anyicholinergics, CNS depressants, SSRIs, and bupropion

Question 21

What does the combo of bupropion and TCAs cause?

Answer 21

Seizures

Question 22

What patients is TCAs contraindicated in?

Answer 22

MI, conduction blocks, hepatic and renal impairment, glaucoma, urinary dysfunction, and thyroid disease

Question 23

What can TCAs cause in patients with thyroid disease?

Answer 23

Cardiac dysrhythmias

Question 24

What should patients taking TCAs be educated on?

Answer 24

Take at bedtime due to sedative effects, sexual dysfunction, and anticholinergic effects may cause urinary retention or worsening BPH

Question 25

In what condition should you consider a TCA over a SSRI

Answer 25

Neuropathic pain

Question 26

What are patients using fluoxetine for bipolar depression able to switch to once weekly dosing?

Answer 26

After being successfully treated with 20 mg daily for at least 13 weeks, they can switch to once weekly 90 mg delayed release capsules

Question 27

How should you initiate bipolar patients taking fluoxetine into their long acting fluoxetine

Answer 27

7 day after their last dose of a 20 mg daily pill

Question 28

Which SSRI has the least potential for withdrawal syndrome

Answer 28

fluoxetine

Question 29

Which SSRI is more likely to cause moderate sedation and is used for OCD and social anxiety

Answer 29

Fluvoxamine

Question 30

Which SSRI is more serotonin specific than others and has less potential for drug interactions

Answer 30

Citalopram

Question 31

What is setraline indicated for?

Answer 31

Major depressive disorder, obsessive, compulsive disorder, panic disorder, PTSD PMDD and social anxiety disorder

Question 32

Which SSRI have the least risk in the most risk during pregnancy

Answer 32

Fluoxetine appears to have the least amount of risk and paroxetine has the most

Question 33

Which two SSRI are indicated for major depressive disorder

Answer 33

Escitalopram and fluoxetine

Question 34

Which three SSRI are used to treat OCD

Answer 34

Fluoxetine, fluvoxamine and sertraline

Question 35

What is the medication of choice for generalized and anxiety disorder?

Answer 35

Duloxetine

Question 36

What do monoamine neurotransmitters are blocked by TCA

Answer 36

Norepinephrine and serotonin

Question 37

What are the major downsides to using TCA’s?

Answer 37

They have anticholinergic effects and easily overdosed as the lethal dose is only eight times the average daily dose

Question 38

What time of day should TCAS be dosed versus SSRI’s?

Answer 38

TCA should be taken at bedtime due. It’s sedating side effects and SSRI should be taken before the evening.

Question 39

Which disease type is our SSRI less effective than TCA’s?

Answer 39

Chronic neuropathic pain

Question 40

What medication can be used for ADHD and recess and chronic pain in what drug class does it belong to?

Answer 40

Imipramine and it is a TCA