Flashcards in Depression Deck (98):
Depression diagnosis criteria?
DSM-5 criteria - at least 5 of the ff sx during the same 2 wk period
Marked diminished interest/pleasure
Significant weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue of loss of energy
Feelings of worthlessness
Diminished ability to concentrate
Recurrent Suicidial ideation
T/F? Pt needs instructions on how to respond to worsened mood, critical for adolescents and young adults?
What condition need to be rule-out prior to starting antidepressant therapy?
List medications that cause or worsen depression
Beta-blockers, particularly propranolol
Clonidine, Corticosteroids, Cyclosporine
Isotretinion, Indomethacin, Interferons
Methadone, Methyldopa, Methylphenidate/ADHD meds/Atomoxetine
OCPs, anabolic steroids (Pt and medication specific)
Statins (pt specific)
List medical conditions that can cause or worsen depression
Thyroid disorders (esp, hypothyroidism)
Low Vit D levels
Metabolic conditions (hypercalcemia), Multiple sclerosis, Malignancy
What's the lag effect ass with antidepressant?
Physical sx (such as low energy) improve within a few weeks
Psychological sx (such as low mood) may take a month or longer
What Grp of antidepressant is pregnancy cat C? Exception?
Paroxetine (Cat. D)
Paroxetine is usually pregnancy cat D, which formulation of paroxetine is preg cat. X?
What's the new warning ass with SSRIs?
Bcuz of potential risk of persistent pulmonary hypertension of the newborn (PPHN)
What grp is the second recommended for pregnancy and depression?
Which natural pdts may be helpful for depression?
St. John's wort or SAMe (S-adenosyl-L-methionine)
What's the issue with using St. John's wort?
Can't use with other serotonergic agents
Broad-spectrum CYP450 enzyme inducer and has many significant drug interactions
It's photosensitizer and serotonergic
What's a medical food pdt used for depression?
List SSRIs (Selective Serotonin Reuptake Inhibitors) agents
Escitalopram (Lexapro - S-enantiomer of citalopram)
What's the brand name of Fluoxetine (SSRIs)?
What's the brand name of Paroxetine (SSRIs)?
What's the brand name of Sertraline (SSRIs)?
What's the brand name of Citalopram (SSRIs)?
What's the brand name of Escitalopram (SSRIs)?
Lexapro (S-enantiomer of citalopram)
CI to SSRIs use?
Potentially lethal DI with MAOIs
General SE of SSRIs?
Sexual SE: reduced libido, ejaculation difficulties, anorgasmia
Headache (may help for migraines if taken continuously)
SE specific to Fluoxetine?
Fluoxetine may be activating. Take dose in AM to prevent this
Which SSRIs SE is of more concern in elderly?
What may cause an increase in bleeding while using SSRIs?
Concurrent use of:
Which SSRI has FDA warning of QT prolongation? In what grp? At what dose?
At > 40mg/day
60+ years - > 20mg/day
How do u switch from fluoxetine daily to fluoxetine weekly?
Start 7 days after last daily dose
Weekly fluoxetine is dosed at 90mg/week
What agent is the SSRI and 5-HT1A partial agonist?
Is food a consideration when using Vilazodone (Viibryd), a SSRI and 5-HT1A Partial Agonist?
Use with food
SEs of Vilazodone (Viibryd), a SSRI and 5-HT1A Partial Agonist?
Reduced libido (but less sexual SEs compared to SSRI and SNRIs)
Bleeding risk and Vilazodone (Viibryd)?
Same as SSRIs (increased bleeding risk with concurrent use of anticoagulants, antiplatelets, NSAIDs, gingko, thrombolytics
List agent that's SSRI, 5-HT3-1D, 5-HT7 receptor antagonist; 5-HT1A Agonist; and Partial 5-HT1B agonist
SEs of Vortioxetine (Brintellex)?
Same as SSRIs and Vilazodone (increased bleeding risk with concurrent use of anticoagulants, antiplatelets, NSAIDs, gingko, thrombolytics
All SSRI req a 2-wk washout period when going to an MAOI or from an MAOI to an SSRI, except?
Req a 5-week washout period (due to long half-life of at least 7days)
Whats the top choice for antidepressant in cardiac pts?
How should sertraline oral concentrate be used?
Must be diluted before use
Don't use with disulfiram
List Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs ) agents
Venlafaxine (Effexor, Effexor XR)
What's the brand name of Venlafaxine (SNRIs)?
What's the brand name of Duloxetine (SNRIs)?
What's the brand name of Desvenlafaxine (SNRIs)?
CI to SNRIs use?
Potentially lethal DI: SNRIs and MAOIs (2 wks washout req)
In addition to SEs similar to SNRIs, what other SE is a concern for SNRIs?
Increase in BP
In what SNRIs is the increase in BP risk greatest?
Venlafaxine when dosed > 150mg/day
SNRIs and bleeding risk?
Same as SSRIs, Vortioxetine (Brinand Vilazodone (increased bleeding risk with concurrent use of anticoagulants, antiplatelets, NSAIDs, gingko, thrombolytics
SNRIs, SSRIs, Tricyclics and MAOI?
Same as SSRIs.....2 wk wash out if going to or from MAOI
Fluoxetine req 5 wk wash
Linezolid or methylene blue IV and SSRI, SNRIs, Vilazodone (Viibryd), Vortioxetine (Brintellex)?
Avoid staring SSRIs, etc if pt is on Linezolid and methylene blue IV
What med decreases the effectiveness of Duloxetine?
T/F? Duloxetine is a 2D6 inhibitor?
What counseling pt is unique to Desvenlafaxine and bowel movements?
Pt may see what looks like a tab in their stool. This is the empty shell from the tablet after the medicine was absorbed by your body
Effect of alcohol and Levomilnacipran?
Alcohol may cause the med to be released quickly
How long does it take to feel a benefit from SSRI and SNRIs? To feel the full effect on mood?
MOA of Tricyclics?
What's the difference btw tertiary and secondary amines (Tricyclics)?
Secondary amine - relatively selective for NE
Tertiary amine - may be slightly more effective, but have worse SE profile
What's the dosing of Amitriptyline (Tricyclics)?
Depression - 100-150mg bid
Neuropathic pain/migraine prophylaxis: 10-50mg QHS
What's the dosing of Nortriptyline (Tricyclics)?
Depression: 25mg TID-QID
What's the dosing of Doxepin (Tricyclics)?
Depression: 100-300mg daily
Main SEs of tricyclics?
Cardiotoxicity (esp Orthostasis)
Anticholinergic (dry mouth, blurred vision, urinary retention, constipation)
What's the cardiotoxic SE of Tricyclics?
QT prolongation with overdose
What's the anticholinergic SE of Tricyclics?
Constipation (may use a stool softener or laxative)
What SEs usually go away with time from Tricyclics use?
Anxiety or Insomnia or Vivid dreams
Which antidepressant is a good choice if a pt has both pain and depression?
Which antidepressant is a good choice if a pt has neuropathic pain/ migraine prophylaxis?
Amitriptyline 10-50mg QHS
MOA of MAOIs?
Inhibit enzyme monoamine oxidase, which breaks down catecholamines, including 5-HT, NE, EPU, DA. If these NTs increase dramatically, hypertensive crisis and death can result
List of MAOI agents used in depression
CI to monoamine oxidase inhibitors (MAOI) use?
Not commonly used, but watch out for drug-drug and drug-food interactions
What's the brand name of Isocarboxazid (MAOIs) used in depression?
What's the brand name of Phenelzine (MAOIs) used in depression?
What's the brand name of Tranylcypromine (MAOIs) used in depression?
SEs of MAOIs?
Anticholinergic effect (dry eyes, dry mouth, constipation, urinary retention)
Sedation (except Tranylcypromine (Parnate), which causes stimulation)
Name the MAOI that comes in a patch?
What types of food should be avoided when using MAOIs?
Tyramine-rich foods anything aged, fermented, pickled or smoked
Emsam (Selegiline) patch application?
Change once daily
Pick a time of the day u can remember.
Apply to either outer surface of the upper arm.
Rotate site and don't use same site 2 days in a row
Wash hands with soap after applying
Don't expose to heat
Washout period includes patch
List Dopamine (DA) and Norepinephrine (NE) Reuptake inhibitors agents
What's the brand name of Bupropion used in depression?
Budeprion SR, Budeprion XL,
Wellbutrin SR and XL, Wellbutrin,
CIs to Bupropion use?
Don't exceed 450mg/d due to seizure risk
SEs of Bupropion?
Bupropion has no effect on serotonin (5-HT), effect of this?
No sexual dysfunction
What's the brand name of Mirtazapine (DA and NE Reuptake inhibitor)?
SEs of Mirtazapine (Remeron)?
Increase appetite, weight gain
Whys Trazodone rarely used?
What's a se of Trazodone, that's a medical emergency?
Risk of Priapism
SE of Nefazodone?
Hepatoxicity (t4, rarely used)
CI to bupropion use
Any pt on Buproban or Zyban for smoking cessation; same drug
Any to with seizure hx; Bupropion lowers seizure threshold
What's the max single dose and daily dose of Bupropion?
Max single dose: 150mg
Max daily dose: 450mg
When should Mirtazapine (Remeron) be used?
At night, it's sedating and increases appetites
What must be done to classify depression as tx resistance depression?
Rule-out bipolar disorder
Check if antidepressant is at optimal dose, sometimes use combo standard antidepressants
Augment with various options
List agents that are used in Tx Resistance Depression Only
Aripiprazole (Abilify, Abilify Discmelt)
Quetiapine extended release (Seroquel, Seroquel XR)
What's the brand name of Aripiprazole for Tx Resistance Depression?
What's the brand name of Olanzpine/Fluoxetine for Tx Resistance Depression?
What's the brand name of Quetiapine extended release for Tx Resistance Depression?
What's the warnings associated with agents used in tx resistance depression (Aripiprazole - Abilify, Abilify Discmelt; Olanzapine/Fluoxetine - Symbyax; Quetiapine ext release - Seroquel, Seroquel XR)
Risk of Neuroleptic Malignant Syndrome
Risk of Tardauve Dyskinesia
Risk of Leukopenia, Neutropenia, Agranulocytosis
CI to Olanzapine/Fluoxetine (Symbyax) use?
Don't use Symbyax with:
Other QT prolongating drugs/conditions
SEs of agents used in tx resistance depression (Aripiprazole - Abilify, Abilify Discmelt; Olanzapine/Fluoxetine - Symbyax; Quetiapine ext release - Seroquel, Seroquel XR)?
Metabolic issues e.g. Dyslipidemia, wt gain, diabetes
Which metabolic issue is less with Aripiprazole (Abilify, Abilify Discmelt)?
SE particular to Abilify (Aripiprazole)?
SE particular to Olanzapine?
Increased lipids, glucose
QT prolongation (lower risk)
SE particular to Quetiapine (Seroquel, Seroquel XR)?
Weight gain, increased lipids and glucose
All these are similar to Olanzapine
Little risk of EPS (unlike Olanzapine)
Which SSRI is used in PMDD?