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Therapeutics II > depression > Flashcards

depression Flashcards

1
Q

when to suspect bipolar disorder

A
  • multiple antidepressant tx failures
  • nonresponse or erratic response to antidepressants
  • suboptimal outcomes to antidepressants
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2
Q

effect of SSRI/ SNRIs on bipolar

A
  • NOT recommended firs tline
  • increased mania
  • mood instability
  • erratic/ incomplete/ non-response to depressive sx
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3
Q

SSRIs and suicide in geriatrics

A
  • long term protection against suicide
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4
Q

bereavement

A
  • depressive sx that occur after loss of loved one
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5
Q

adjustment disorder

A
  • dev emotional and/or behavioral sx within 3 mo of identifiable life stressor
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6
Q

major depressive episode

A
  • 5 or more depressive sx for 2 weeks
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7
Q

persistent depressive disorder

A
  • “not as bad as MDD”

- depressed mood for more days than not

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8
Q

general treatment guidelines for depression

A
  • psychotherapy effective monotx for mild
  • mod-severe depression best tx with psychotherapy + pharm tx
  • all classes of pharm tx are equally efficacious
  • generally SSRIs used fist
  • SSRIs first line in geriatrics
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9
Q

name the SSRI drugs

A
  • fluoxetine
  • paroxetine
  • sertraline*- good first line choice
  • fluvoxamine
  • citalopram
  • escitalopram*- good first line choice
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10
Q

SSRI ADRs

A
  • HA
  • somnolence
  • N/V/ D
  • sexual dysfunction
  • wt gain
  • dev tolerance to all except sexual dysfunction
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11
Q

less common ADRs with SSRIs

A
  • QTc prolongation
  • SIADH- elderly
  • excessive bleeding- increase in PUD, caution only if already existing ulcer
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12
Q

withdrawal of SSRIs

A
  • dizziness
  • ataxia
  • flu like sx
  • irritability
  • NOT life treatening
  • can last up to 14 d
  • occurs within 1-20 d of cessation
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13
Q

SSRI drug interactions

A
  • fluoxetine and paroxetine are potent 2D6 inhibitors
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14
Q

vilazodone

A
  • brand: Viibryd
  • partial 5HT1 agonist
  • similar efficacy to SSRI but worse tolerability
  • expensive!
  • ADRs: HA, N/D, decreased libido
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15
Q

vortioxetine

A
  • brand: trintillix
  • partial 5HT1a agonst, 7 antagonist
  • similar efficacy and ADR profile to SSRIs
  • expensive!
  • ADRs: HA, N/D, dizziness, decreased libido
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16
Q

trazodone

A
  • has potent anti-histaminic effect
  • not strong enough blockade for anti-depressant effect
  • used mainly to promote sleep with comorbid depression
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17
Q

name the SNRI drugs

A
  • venlafaxine
  • desvenlafaxine
  • duloxetine
  • levomilnacipram
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18
Q

venlafaxine

A
  • SNRI
  • dose dep effect
  • anything < 150 mg will act as SSRI
  • use as XR
  • ADRs: nausea, HA, insomina, BP increase
19
Q

desvenlafaxine

A
  • SNRI
  • similar CV risk as venlafaxine but more robust
  • good for severe liver impairment
  • don’t require high doses like venlafaxine
20
Q

duloextine

A
  • SNRI
  • possible hepatotoxicity- really only with concurrent chronic alcohol dependence
  • can be used for neuropathy
  • ADRs: HA, nausea, sexual dysfn, insomnia, urinary hestiancy, mild HR and BP increase
21
Q

levomilnacipran

A
  • SNRI
  • closer ration of 5HT to NE
  • not as great for depression
  • can consider for neuropathic pain + depression
22
Q

name the TCA drugs

A
  • imipramine
  • amitryptyline
  • nortriptyline
  • clomipramine
  • desipramine
23
Q

MOA of TCAs

A
  • similar to SNRIs
  • 5HT
  • NE
  • anti-muscarinic
  • anti-histaminic
  • alpha 1 blockade
24
Q

ADRs of TCAs

A
  • deadly in OD*
  • seizures*
  • arrhythmias*
  • tachycardia*
  • coma*
  • constipation
  • blurred vision
  • dry mouth
  • sedation
  • HA
  • sexual dysfunction
  • cognitive impairment
  • orthosis
  • photosensitivity
  • hyperglycemia
25
Q

mirtazapine ADRs

A
  • somnolence
  • xerostomia
  • increased appetitie
  • hyperglycemia
  • hyperTG
  • hypercholesterolemia
  • arganulocytosis
  • anti-emetic
26
Q

bupropion

A
  • MOA: DA and NE
  • lowers seizure threshold*
  • promotes smoking cessation
  • useful for drug induced sexual dysfunction
  • INEFFECTIVE for anxiety, may worsen
27
Q

bupropion ADRs

A
  • agitation
  • insomnia
  • irritability
  • dry mouth
  • nausea
  • tachycardia
28
Q

serotonin syndrome causes

A
  • combo of SSRI, SNRI, TCA, MAOIs
  • st john’s wort
  • tramadol
  • meperidine
  • tryptophan
  • isoniazide
29
Q

si/sx of serotonin syndrome

A
  • tremor*
  • akathisia*
  • hypomania
  • confusion
  • hyperreflexia*
  • myoclonus*
  • diaphoresis
  • yperthermia
  • can cause death via anoxia, aspiration, multiple organ failure
30
Q

tx for serotonin syndrome

A
  • cyproheptadine
31
Q

tx of depression in pregnancy/ lactation

A
  • best if no med
  • fluoxetine best studies
  • paroxetine is worst in pregnancy
  • sertraline and paroxetine have negligible levels with breast feeding
32
Q

follow up visits after starting antidepressats

A
  • 10-14 d mark to assess tolerability, safety, SI
  • 4 week mark to assess efficacy
  • 6-8 week mark to measure max response
  • every mo for 4-9 mo during continuation phase
33
Q

assessing response of antidepressants

A
  • if at 4-8 weeks of tx and only partial response increase dose
  • if at 4-8 weeks of tx and no response switch med
  • after 2 trials pt is “tx resistant”
  • usu SSRI -> SSRI -> SNRI
34
Q

treatment refractory options

A
  • switch to third monotx
  • add second antidepressant from dif class
  • can augment with Li, T3, atypical antipsychotics
35
Q

common antidepressant combos

A
  • SSRI + bupropion
  • SNRI + mirtazapine
  • bupropion: stim effect
  • mirtazapine: hypnotic effect
  • can do SSRI + antipyschotic but less effective, onset of 2 weeks, risk of mvmt disorders
36
Q

antipsychotics that can be used as adjunct antidepressant

A
  • apriprazole
  • olanzapine
  • quetiapine
37
Q

tx for OCD in peds

A
  • clopiramine
  • fluvoxamine
  • sertraline
38
Q

tx for GAD in peds

A
  • duloxetine
39
Q

tx for enuresis in peds

A
  • imipramine
40
Q

DOC for depression in peds

A
  • fuloxetine

- then escitalopram

41
Q

tx algorithm for depression in peds

A
  • placebo/ supportive care just as effective in kids < 12 as drugs
  • supportive care + pharm tx for best outcomes
  • monitor carefully for SI after initiating pharm tx for 3 mo
  • tx for at least a year
42
Q

suicide risk in peds

A
  • youths 2X more likely to have SI
  • BBW on antidepressants for suicidality
  • acutal data suggests that states with hight anti-depressant rates have few suicides
  • CAN prescribe antidepressants to peds but must monitor closely
43
Q

ADRs for SSRIs in peds

A
  • insomnia
  • somnolence
  • jitteriness
  • GI pain
  • flu like sx
  • suicide risk

Therapeutics II (8 decks)

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