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P&T > Depression > Flashcards

Depression Flashcards

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0
Q

3 important roles of NE

A
  1. sleep and arousal
  2. attention
  3. learning and memory
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1
Q

NMDA antagonist that has recent interest in use in depression

A

Ketamine

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2
Q

2 ways in which catecholamines are metabolized

A
  1. Monoamine oxidases (MAO)

2. catechol-O-methyltransferase (COMT)

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3
Q

Types of NE receptors

A

alpha and beta adrenergic metabolotropic receptors

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4
Q

NE pre-synaptic autoreceptor that is important in feedback inhibition

A

alpha2 receptor

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5
Q

Where the majority of neurons that synthesize serotonin are located

A

raphe nuclei

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6
Q

Serotonin receptor that is a ligand-gated ion channel

A

5HT3

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7
Q

Serotonin receptor that is a pre-synaptic auto-receptor that is important in feedback inhibition

A

5HT1D

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8
Q

Enzyme that metabolizes serotonin within the neuron

A

MAO

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9
Q

Main precursor of serotonin

A

tryptophan

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10
Q

Enzyme involved in the synthesis of both serotonin and NE

A

aromatic L-AA decarboxylase

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11
Q

3 MAO-Is that are exhibit non-selective MAO-A and B irreversible inhibition and increase synaptic 5HT, NE and DA

A
  1. Pheneizine
  2. Transylcypromine
  3. Isocarbazid
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12
Q

MAOI that exhibits selective MAO-A irreversible inhibition and increases synaptic DA

A

Selegiline TS

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13
Q

Cut off below which selegilline does not have dietary restrictions

A

6 mg

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14
Q

Toxicity that can occur if MAOIs are taken with tyramine-containing foods

A

hypertensive crisis

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15
Q

Drug that is used in the case of hypertensive crisis associated with MAOIs

A

Phentolamine

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16
Q

Drug is a non-selective serotonin antagonist that can be used to help reverse serotonin syndrome

A

cyproheptadine

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17
Q

5 tertiary amine TCAs that have NE > 5HT reuptake

A
  1. amitryptyline
  2. imipramine
  3. trimipramine
  4. clomipramine
  5. doxepin
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18
Q

Only TCA that has sig. 5HT reuptake inhibition

A

Clomiptamine

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19
Q

SSRI that has been shown to be safely used post-MI

A

Sertraline

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21
Q

3 secondary amine TCAs that have selective NE reuptake inhibition, less antimuscarinic action, less sedation, and less postural hypotension

A
  1. Desipramine
  2. Nortriptyline
  3. Protriptyline
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22
Q

5 patient populations to use caution with TCAs

A
  1. underlying CV disease
  2. seizure disorder
  3. angle-closure glaucoma
  4. urinary retention
  5. elderly
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23
Q

3 main adverse effects of TCAs

A
  1. atropine-like effects (dry mouth, blurred vision, constipation, urinary retention)
  2. orthostatic hypotension
  3. sedation
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25
Q

5 SSRIs

A
  1. Fluoxitine
  2. Paroxetine
  3. Sertraline
  4. Citalopram
  5. Escitalopram
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26
Initial adult dose of citalopram
20 mg QD
27
Max adult dose/day of citalopram
40 mg
28
Initial adult dose of escitalopram
10 mg QD
29
Highest rate of sexual dysfunction and weight gain of the SSRIs
Paroxitine
30
SSRI that is pregnancy category D
Paroxitine
33
SSRI that has the highest rate of diarrhea
Sertraline
34
Initial adult dose of fluoxitine
10 mg QD
37
Max adult dose/day of escitalopram
20 mg
38
Initial adult dose of paroxitine CR
25 mg QD
39
Max adult dose/day of fluoxitine
80 mg
40
Max adult dose/day of paroxitine CR
62.5 mg
41
SSRI that has the longest half-life
Fluoxitine
42
5 SNRIs
1. Duloxetine 2. Venlafaxine 3. Desvenlafaxine 4. Milnacipran 5. Levomilnacipran
43
SNRI that is only FDA approved for fibromyalgina, not depression
Milnacipran
44
Initial adult dose of duloxetine
20-30 mg BID
45
Max adult dose/day of duloxetine
60 mg
46
Initial adult dose of venlafaxine
25 mg TID or 37.5 mg BID
47
Max adult dose/day for venlafaxine
375 mg
48
Initial adult dose of venlafaxine ER
75 mg QD
49
Max adult dose/day of venlafaxine ER
225 mg
50
2 drugs that are selective serotonin reuptake inhibitors and are partial 5HT1A receptor agonist
1. Vilazodone | 2. Vortioxtine
51
2 drugs that are weak serotonin reuptake inhibitors and 5HT2A and 5HT2C receptor antagonist
1. Trazodone | 2. Nefazodone
52
Black box warning for nefazodone
Rare hepatic failure
53
Drug that inhibits dopamine and NE uptake
Buproprion
54
Initial adult dose of buproprion IR
100 mg BID
55
Max adult dose/day of buproprion IR
450 mg
56
Initial adult dose of buproprion SR
150 mg QD
57
Max adult dose/day of buproprion SR
400 mg
58
Initial adult dose of buproprion XL
150 mg QD
59
Max adult dose/day of buproprion XL
450 mg
60
Drug that is an alpha-2, 5HT2, 5HT3 and H1 antagonist
Mirtazapine
61
Initial adult dose of mirtazapine
15 mg QHS
62
Max adult dose of mirtazapine
45 mg
63
SEs of mirtazapine
sedation and weight gain
64
Neuronal growth factor that antidepressants may cause the upregulation of
BDNF (brain derived neurpotropic factor)
65
Transcription factor that regulates BDNF
CREB (cyclic AMP responsive element binding protein)
66
Typical duration of an untreated MDE
at least 6 months
67
Typical duration of a treated MDE
4-5 months
68
QIDS score that indicates no depression
0-5
69
QIDS score that indicates mild depression
6-10
70
QIDS score that indicates moderate depression
11-15
71
QIDS score that indicates severe depression
16-20
72
QIDS score that indicates very severe depression
>20
73
QIDS score that indicates a response (regardless of starting score)
6-8
74
QIDS score that indicates remission
<6
75
The return of symptoms meeting full criteria within 6-12 months following remission of the index episode
Relapse
76
Occurrence of a new episode following 6-12 months of full and sustained remission from the index episode
Recurrence
77
5 most common residual symptoms
1. Insomnia 2. Fatigue 3. Pain 4. Difficulty concentrating 5. Lack of interest
78
Max adult dose/day of sertraline
200 mg
79
Max adult dose/day of paroxitine
50 mg
81
Initial adult dose of sertraline
50 mg QD
86
Initial adult dose of paroxitine
20 mg QD
97
Main precursor of NE
Tyrosine
99
Where neurons that synthesize NE primarily originate from
locus ceruleus

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