Depression

Question 1

Dose a monoamine oxidase inhibitors

Answer 1

Phenelzine 15mg once daily

Question 2

Dose a tricyclic antidepressant

Answer 2

Amitriptyline 150mg once a day at bedtime

Question 3

Dose a selective serotonin reuptake inhibitor

Answer 3

Sertraline 100mg once daily

Question 4

Dose a serotonin/norepinephrine reuptake inhibitor

Answer 4

Cymbalta 60mg once daily

Question 5

If depression is left untreated, 15% of patients

Answer 5

commit suicide

Question 6

Diagnosis of depression needs

Answer 6

depressed mood or loss of interest for at least 2 weeks + at least 4 of the following in the same period:
change in sleep pattern
change in appetite/weight
fatigue
psychomotor agitation or retardation
feelings of worthlessness/guilt
diff thinking/concentrating/ indecisiveness
recurrent thoughts of death, suicidal ideation, plans or attempts

Question 7

What guidelines do we use to diagnose mental disorders

Answer 7

DSM-5

Question 8

What monoamine oxidase inhibitors is available as a patch?

Answer 8

Selegeline

Question 9

ADRs or monoamine oxidase inhibitors

Answer 9

Suicidal thinking/behavior
Dizzy, lightheaded
Drowsy, fatigue, weakness
BP effects
Hypoglycemia possible

Question 10

MOA of monoamine oxidase inhibitors

Answer 10

Monoamine levels rise in nerve endings, synapses, etc.

Question 11

monoamine oxidase inhibitors include

Answer 11

Tranylcypormine
isocarboxazid
phenelzine
selegeline (targets MOA-B)

Question 12

secondary amines of tricyclic antidepressants include

Answer 12

nortriptyline

desipramine

Question 13

tertiary amines of tricyclic antidepressants include

Answer 13

amitriptyline
clomipramine
doxepin
imipramine
trimipramine

Question 14

tetracyclic amines of tricyclic antidepressants include

Answer 14

Maprotiline

Question 15

How do you dose tricyclic antidepressants?

Answer 15

Based on observation, not plasma levels. So side effects and clinical response

Question 16

ADRs of tricyclic antidepressants

Answer 16

Histamine receptor blockade= sedation
Alpha adrenergic blockade= postural hypotn
anticholinergic= clurred vision, dry mouth, constipation
cardiac= arrhythmias, sinus tachy, prolongation of conduction time

Question 17

How often should tricyclic antidepressant be dosed?

Answer 17

Most effective once a day, single dose at bedtime

Question 18

Differences for tricyclic antidepressants

Answer 18

Elderly don’t tolerate well, Nortriptyline is best. Younger pts it doesn’t matter

Question 19

MOA of tricyclic antidepressants

Answer 19

Block many receptor sites (leading to many side effects)

Question 20

Selective serotonin reuptake inhibitors include

Answer 20

citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
vilazodone
vortioxetine

Question 21

What would you not want to prescribe selective serotonin reuptake inhibitors with?

Answer 21

Monoamine oxidase inhibitors

Additive effect to result in serotonin syndrome (st johns wort, etc)

Question 22

MOA of SSRI

Answer 22

block reuptake of serotonin

Question 23

differences in SSRI categories

Answer 23

side effect profiles

paxil- decreased libido

Question 24

When do SSRIs need to be dose adjusted?

Answer 24

Not renally

maybe in severe liver impairment

Question 25

ADRs of SSRIs

Answer 25

``` Increased fall risk Lower bone mineral density sexual dysfx SIADH Constipation, diarrhea, n, dizzy, HA, insomnia, etc etc ```

Question 26

serotonin/norepinephrine reuptake inhibitors include

Answer 26

``` desvenlafaxine duloxetine levomilnacipran milnacipran venlafaxine ```

Question 27

Are SSRIs okay in pregnancy?

Answer 27

No reason to think unsafe | risk vs. benefits

Question 28

SNRIs MOA

Answer 28

serotonin and norepinephrine reuptake blockade, increasing levels of both

Question 29

What SNRI can be used for neuropathic pain?

Answer 29

Duloxetine

Question 30

What patient would Effexor be a poor choice?

Answer 30

HTN, can raise BP

Question 31

ADRs of venlafaxine

Answer 31

``` raises BP higher rate of emergent mania dose dependent wt loss insomnia HA ```

Question 32

Highest risk of withdrawal issues for SSRIs and SNRIs

Answer 32

paroxetine and venlafaxine

Question 33

withdrawals symptoms of SSRI and SNRI include

Answer 33

``` nausea HA dizziness lethargy flu-like symptoms ```

Question 34

ADRs of bupropion/ Wellbutrin

Answer 34

seizure lowering threshold (don't use in bulimic pt) | anaphylactic reactions

Question 35

MOA of bupropion

Answer 35

norepi/dopamine reuptake inhibitor

Question 36

Benefit of bupropion

Answer 36

fast onset of action

Question 37

A serotonin antagonist is

Answer 37

Mirtazapine (Remeron)

Question 38

ADRs of mirtazapine

Answer 38

appetite increase (wt gain) drowsiness cholesterol increase

Question 39

Nefazodone can cause

Answer 39

hepatotoxicity

Question 40

ADRs to serotonin modulators

Answer 40

drowsiness hypertension weight gain

Question 41

Serotonin modulators include

Answer 41

``` trazodone vilazodone nefazodone (don't write for) ```

Question 42

Overall efficacy of antidepressants

Answer 42

only 60-70% response rate, should see around 1-2 weeks with max effect seen in 4 to 6 weeks

Question 43

What age group is at an increased risk of suicide? decreased risk?

Answer 43

65 decreased risk of suicide

Question 44

Preferred agents for depression in elderly

Answer 44

Sertraline Bupropion (extended release) Citalopram (less drug interxns)