Depression

Question 1

Diagnosing MDD SIGECAPS

Answer 1

sleep disturbances
interest reduced
guilt and self blame
energy loss and fatigue
concentration problems
appetite changes
psychomotor changes
suicidal thoughts

Question 2

Med management

Answer 2

First line: SSRI
Serious side effects are rare
Much safer than TCAS

Question 3

What critical information should be given to a patient when starting meds for MDD

Answer 3

4-6 week therapeutic effect
Continue medication for a minimum 6-12 months

Question 4

when do you consider medication management indefinitely

Answer 4

More than 2 prior episodes of MDD consider

Question 5

Rebound is when

Answer 5

stopping abruptly especially with short half lives
Prozac has a longer half-life

Question 6

which medication has a particularly short half life

Answer 6

Sertraline

Question 7

What medication is most likely to have the least amount of sexual dysfunction

Answer 7

mirtazapine

Question 8

Wellbutrin is contraindicated for

Answer 8

for seizure hx or eating disorder (increases seizure risks) electrolyte imbalances cause seizure increase

Question 9

When client is depressed, low energy, fatigue what is a good medication option

Answer 9

NDRI Wellbutrin

Question 10

S/E of SSRI (3) (SSS)

Answer 10

stomach upset
sexual dysfunction
serotonin syndrome

Question 11

SSRIs can also be used for (4)

Answer 11

panic
OCD
anxiety
PTSD

Question 12

common drug for panic disorder

Answer 12

paroxetine

Question 13

common drug for compulsion

Answer 13

citalopram

Question 14

EFFECTIVE FOR SADNESS PANIC COMPULSIONS

Answer 14

Effective- escitalopram
For-Fluoxetine Fluvoxamine
Sadness-Sertraline
Panic-Paroxetine
Compulsions-Citalopram

Question 15

Duloxetine is a ()

Answer 15

SNRI

Question 16

SNRI’s can help with

Answer 16

neuropathic pain

Question 17

Second line for depression is

Answer 17

TCAs

Question 18

TCA potential risks 156 (4)

Answer 18

electrocardiogram changes
cardiac dysrhythmias possible
monitor EKG before tx and annually for older adults

Question 19

TCA should not be d/c abruptly because of

Answer 19

risk of discontinuation syndrome

Question 20

avoid TCA prescription for clients at high risk of

Answer 20

SI

Question 21

Black box warning for antidepressants

Answer 21

all antidepressants carry a black box warning for increased SI, agitation, aggression

Question 22

ECT is indicated for (2)

Answer 22

MDD with psychotic features and treatment-resistant depression

Question 23

Contraindications of ECT (4)

Answer 23

Cardiac disease
compromised pulmonary status
Hx of brain injury or tumor
anesthesia medical compliations

Question 24

Safety plan includes and is not a

Answer 24

not a contract
includes crisis number
support system
provider to call
coping skills
case manager
CHART SAFETY PLAN

Question 25

Prozac can effect sleep by? What should you do if client reports sleep distrubances?

Answer 25

Can cause insomnia, advise them to take it in the morning

Question 26

How does depression manifest for adolescents? (2)

Answer 26

anger, irritability

Question 27

What neurotransmitters are involved in depression?

Answer 27

Dopamine, NE, Serotonin

Question 28

Parts involved in depression (3)

Answer 28

Amygdala (enlarged), hippocampus, thalamus (reduced)

Question 29

If a client with depression is on chemo-medication what depression medications should you choose? (3)

Answer 29

Citalopram, escitalopram, sertraline (SSRIs less chance of reactions)

Question 30

What type of drugs should you use for a client with chronic neuropathic pain (Fibromyalgia) (2)

Answer 30

SNRIs and TCA

Question 31

For chronic neuropathic pain what drugs can you give a client with depression (2)

Answer 31

Gabapentin and pregabalin (PGR) (alpha delta ligands)

Question 32

Rare side effect of serotonin- norepinephrine inhibitors

Answer 32

Interstitial lung disease

Question 33

What do you need to monitor for clients taking SNRIs like Duloxetine or venlafaxine

Answer 33

BP

Question 34

SSRIs like citalopram and SNRIs duloxetine can cause

Answer 34

hyponatremia

Question 35

symptoms of duloxetine-induced hyponatremia (8)

Answer 35

onset is days after starting or up to months fatigue weakness lethargy headache nausea dizziness aloc seizure

Question 36

What type of drugs can cause sexual problems (4)

Answer 36

SSRIS, SNRIs, TCAs, MAOIs

Question 37

what drugs are less likely to cause sexual dysfunction (2)

Answer 37

wellbutrin and remeron

Question 38

If client is depressed, has low energy, fatigue (anergia) what type of medication may be best for them

Answer 38

Wellbutrin because it increases energy levels

Question 39

Wellbutrin contraindications (3)

Answer 39

seizure d/o contraindications that can increased seizure risk such as anorexia or bulimia

Question 40

Why does wellbutrin increase seizure risk

Answer 40

by decreasing seizure threshold

Question 41

antidepressants used for insomnia include (4)

Answer 41

trazodone, mirtazapine, amitriptyline, doxepin

Question 42

5-HT2C receptor is a subtype of _____

Answer 42

serotonin receptor

Question 42

5-HT2C receptors play a role in regulating (3)

Answer 42

mood, anxiety, and can influence response to antidepressants

Question 43

if a client has a genetic dysfunction regarding the 5HT2C receptor it can

Answer 43

impact the serotonin signaling pathways- making tx less effective

Question 44

What medications to consider if client has 5HT2C genetic dysfunction and SSRIs are not effective (3)

Answer 44

SNRIS- venlafaxine, duloxetine atypical antidepressants Remeron (mirtazapine) or bupropion (Wellbutrin) TCAs such as amitriptyline and nortriptyline

Question 45

What medications can cause depression?

Answer 45

Steroids*** can also cause psychosis (flonase/prednisone) liothyronine beta-blockers interferon isotretinoin (accutane) some retroviral drugs antineoplastic drugs benzodiazepines progesterone

Question 46

SSRIS can cause what in older adults

Answer 46

increase anxiety