Depression

Question 1

depression disorders

Answer 1

MDD
adjustment disorder and depressed mood
seasonal affective disorder
substance-ind mood disorder

Question 2

depression causes medical

Answer 2

hypothyroidism
anemia
HIV/AIDS
autoimmune disease
CV disease
neurologic disorders (epilepsy, huntingtons, parkinsons, alzheimers, post-stroke)

Question 3

depression causes med-induced

Answer 3

BBs, CCBs, OCs, steroids, topiramate, levetiracetam, opioids, stimulants

Question 4

MDD DSM5 criteria for dx

Answer 4

5 or more of the following in same 2-eek period
1. depressed mood most of day, nearly every day
2. marked dec in pleasure and interest in all or almost all activities
3. significant weight loss (>5% in 1mo)
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation
6. feeling worthlessness or excessive or inappropriate guilt
7. dec ability to think or concentrate
8. recurrent thoughts of death

Question 5

SSRIs includes …

Answer 5

citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

Question 6

SNRIs includes …

Answer 6

desvenlafaxine, duloxetine, levominacipran, venlafaxine, milnacipran

Question 7

serotonin modulators includes …

Answer 7

trazodone, fefazodone, vilazodone, vortioxetine

Question 8

TCAs includes …

Answer 8

amitriptyline, nortriptyline, protriptyline, doxepin, amoxipine, clomipramine, desipramine, trimipramine, maprotiline

Question 9

MAO-i s includes …

Answer 9

phenelzine, tranylcypromine
rasagiline, selegiline

Question 10

misc ADs

Answer 10

brexanolone, bupropion, esketamine, mirtazepine

Question 11

ADs and BPD warning

Answer 11

unopposed use of AD in BPD may precipitate a manic/mixed episode

Question 12

first line ADs

Answer 12

SSRIs, SNRIs, bupropion, mirtazepine, vorioxetine

Question 13

an adequate trial is________. After this a pateint can _____

Answer 13

4-8weeks
switching or augmenting w different MOA

Question 14

D/C SSRi can cause

Answer 14

electric shock sensations (except prozac d/t long half life)

Question 15

SSRi rare but serious AE

Answer 15

hyponatremia and SIADH. monitor for inc lethargy, AMS, Na <135

Question 16

SSRis and which serotonergic drugs should not be used due to serotonin syndrome

Answer 16

triptans
fentanyl, tramadol
zofran, reglan
buspar
linezolid
ritonavir

Question 17

citalopram
MDD
dose adjustments
forms
FDA warngin

Answer 17

> 40mg not recommended
MDD 20mg for : elderly, hepatic impairment, 2C19
FDA - QTc warning
ODT, tab

Question 18

escitalopram

Answer 18

no dose adjustments or QTc like citalopram does
MDD 10mg for hepatic impairment

Question 19

fluvoxamine
elderly?
DDI?
use

Answer 19

caution in elderly - most sedating and anticholinergic AE
many DDI via 1A2
only for OCD

Question 20

fluoxetine
pearls
AE
uses

Answer 20

only approved one for qweek admin
available as liquid
inhibits 2D6 (TCAs), 3A4 (CBZ)
AE: anorexia, anxiety and insomnia
uses: MDD, OCD, bulimia nervosa, panic disorder, PMDD, TRD, BPD-I

Question 21

paroxetine
pearls
AE
uses

Answer 21

avoid in pregnancy!!
akasthisia
sedating and anticholinergic –> careful in elderly
uses: MDD, OCD, PD, GAD, SAD, PTSD, PMDD, VSM
dose adjustments for severe hepatic and renal impairment

Question 22

sertraline
uses

Answer 22

MDD, OCD, PD, SAD, PTSD, PMDD

Question 23

only SSRIs that can be used for GAD

Answer 23

lexapro and paxil

Question 24

only SSRI indicated for bulimia nervosa and BPI depressive episode

also only med indicated for adolescent depression in down to 8yo

Answer 24

fluoxetine

Question 25

venlafaxine use pearl

Answer 25

MDD, GAD, PD, SAD take w food 2D6 interactions BP changes at higher doses

Question 26

SNRI indicated only for MDD

Answer 26

Levomilnacipran

Question 27

only SNRI that can be used for panic disorder and social phobia

Answer 27

venlafaxine (other indications include MDD GAD)

Question 28

TCAs indications

Answer 28

MDD, insomnia, nocturnal enuresis (imipramine)

Question 29

TCAs AE

Answer 29

"CA" = cardiac adverse effects switch letters --> "AC" = anticholinergic AE CV ventricular tachycardia and heart block cognitive impairment, urinary retention also... weight gain sexual dysfunction 2D6 interactions

Question 30

TCAs withdrawl s/sx

Answer 30

insomnia weight gain abd pain diarrhea myalgias nausea

Question 31

only TCA indicated for depression AND insomnia

Answer 31

doxepin

Question 32

MAO-i switching to MAO-i instructions

Answer 32

after d/c interacting agent, wait 4-5 t1/2 to initiate MAOi f;uoxetine and vortioxetine have longest t1/2s at 5 and 3 weeks!! no tyramine!! monitor BP AE: postural hypotension, diarrhea, anticholinergic drying effects, sexual dysfunction

Question 33

MAOis + _______ are a concern for hypertensive crisis MAOis + _______ are a concern for serotonin syndrome

Answer 33

amphetamines, decongestants, methylphenidate dextromethorphan

Question 34

selegiline is available in what dosage forms

Answer 34

po, ODT, TD patch

Question 35

escitalopram approved for what ages

Answer 35

12+

Question 36

SSRI options in OCD

Answer 36

fluoxetine, paroxetine, sertraline, fluvoxamine

Question 37

which TCAs can be used for MDD in peds and what age range

Answer 37

amitriptyline, nortriptyline and doxepin in 12-17 yo

Question 38

ADs safe to use in pregnanacy

Answer 38

typically SSRis EXCEPT PAROXETINE

Question 39

what qualifies a pt as refractory/tx resistant depression and waht are options

Answer 39

non response to 2 separate trials of different ADs of adequate dose and duration switch, combo, augment combos include SSRI/SNRI + bupropion/mirtazepine augmentation: lithiumtriiodothyronine, SGAs

Question 40

lithium is usually augmentation of

Answer 40

TCAs for major depressive episodes in MDD and BPD

Question 41

NMS (neuroleptic malignant syndrome) s/sx causes

Answer 41

DA antagonists onset 1-3d HTN, tachyc, hyperthermia, hypersalivation, diaphoresis, pallor, lead pipe rigidity in all muscle groups, hyporeflexia, normal pupils, normal or dec bowel sounds, mental status variable

Question 42

serotonin syndrome s/sx causes

Answer 42

serotonin agents onset <12hHTN, tachyc, hyperthermia, hypersalivation, diaphoresis, inc tone in lower extremities, hyperreflexia, dilated pupils, hyperactive bowel sounds, mental status variable

Question 43

NMS vs SS

Answer 43

NMS onset is much longer than SS (1-3d vs <12h NMS has muscle rigidity in ALL muscle groups, SS is just lower extremities SS has dilated pupils and hyperactive bowel sounds. NMS does not NMS has hyporeflexia, SS has hyperreflexia