Depression

Question 1

Neurotransmitters involved with depression…

Answer 1

NE, Dopamine, 5-HT(serotonin)

Question 2

Depression drug good for noncompliant patient?

Answer 2

Long acting SSRI

Fluoxetine-PROZAC

Question 3

Fluoxetine

Answer 3

Prozac

• Morning dosing cause of possible Insomnia
• Good for Weight loss
• WEEKLY DOSING

Question 4

If a patient cannot swallow a tablet well, what drugs can you recommend that have other dosing forms?

Answer 4

Citalopram-Solution
Paroxetine-Solution
Sertraline-Solution
Fluoxetine-Solution

Question 5

Citalopram

Answer 5

Celexa

• Fewest DDI, good for elderly
• FEWEST SEX SE
• QT & CV Problems >40mg
• Over 60/liver probs 20mg

Question 6

If a patient wants a drug for depression with FEWEST sexual SE, what would you give?

Answer 6

Citalopram (CELEXA)
Buprpion (WELLBUTRIN)
Mirtazapine (REMERON)

Question 7

Escitalopram

Answer 7

Lexapro

Question 8

Fluvoxamine

Answer 8

Luvox

• Not approved for MDD
• TAKE AT BEDTIME

Question 9

Paroxetine

Answer 9

Paxil

• Good for underweight
• MOST SEDATION
• NOT SAFE FOR PREGGO
• Solution

Question 10

Sertraline

Answer 10

ZOLOFT

• Preferred for CV and Preggo
• Comes in a solution form too don’t take with Disulfram and must dilute with 4oz water, OJ gingerale etc

Question 11

SSRI Recommended for Pregnancy??

Answer 11

Sertraline (ZOLOFT)

Question 12

SNRI MOA

Answer 12

block reuptake of NE and 5HT

Question 13

SNRI SE

Answer 13

dry mouth, constipation, decreased appetite, insomnia, increased sweating

Question 14

Duloxetine

Answer 14

CYMBALTA
Morning
CI NARROW ANGLE GLAUCOMA*
Can Sprinkle on food
Monitor BP and Liver enzymes

Question 15

Monitoring for Duloxetine

Answer 15

Cymbalta

need to monitor BP and Liver enzymes

Question 16

Monitoring for Miratzapine

Answer 16

Remeron

need to monitor LFT/CBC

Question 17

Venlafaxine

Answer 17

Effexor
Major withdraw
Shortest half life
Not for kids

Question 18

Deslafaxine

Answer 18

Pristiq
GHOST SHELL
over 50mg not effective

Question 19

Monitoring for Deslafaxine

Answer 19

Pristiq

Cholesterol and TG

Question 20

Bupropion

Answer 20

WELLBUTRIN

• NE&Dop
• CI IN SEIZURE DX
• No sex sx
• Give for sex dysfunction, overweight, smoker, fatigued*

-May increase BP
CI: HTN & insomnia too

Question 21

Good Depression Drug choices for weight loss…

Answer 21

Prozac

Wellbutrin

Question 22

Good depression drug choices for weight gain..

Answer 22

Paxil

Remeron

Question 23

Mirtazapine

Answer 23

REMERON
A2,5HT2,5HT3,Histamine
-Higher the dose,less sedation

• INCREASES APPETITE
• Good for Agetation, insomnia, sex, underweight*

-Caution overwieght or hyperlipidemia

Question 24

Depression medications CI in Seizure Dx

Answer 24

Wellbutrin

Viibryd

Question 25

Nefazodone BBW

Answer 25

Hepatotoxicity

Question 26

Vilazodone

Answer 26

``` VIIBRYD SSRI+SRPA CAUSES INSOMNIA CI Seizure Can increase bleeding ```

Question 27

Trazodone

Answer 27

OLEPTRO Causes Sedation, so good for insomnia patients Can SPLIT the ER tabs

Question 28

Amitriptyline

Answer 28

ELAVIL TCA 3rd line Use when pt has pain or HA URINE BLUE GREEN

Question 29

Nortriptyline

Answer 29

PAMELOR TCA 3rd line LONG HALF LIFE

Question 30

Selegiline

Answer 30

EMSAM PATCH MAOI-Last line FOR RESISTANT DEPRESSION

Question 31

SE of MAOIs

Answer 31

Sedation, sexual dysfunction wt gain, HA

Question 32

Tranylcypromine

Answer 32

PARNATE BBW HTN CRISIS WITH TYRAMINE CONSUMPTION

Question 33

If treatment is working, how long do you maintain...

Answer 33

Maintain the effective tx for 4-9 months for continuation, and 12-36 months for maintenance if necessary

Question 34

Esketamine

Answer 34

SPRAVATO | Inhaler for RESISTANT DEPRESSION

Question 35

What can we use to Augment our Depression Therapy?

Answer 35

``` SGAs: Aripriprazole (ABILIFY) Quetiapine (SEROQUEL) Olanzapine-Prozac (SYMBYAX) Brexpiprazole (REXULTI) ``` Buspirone(BUSPAR)

Question 36

When can Lithium be used in Depression?

Answer 36

SEVERE RESISTANT DEPRESSION

Question 37

OTC Therapies for Depression

Answer 37

Omega 3 FA St. Johns Wort SAMe Folate

Question 38

Non Pharm suggestions for Depression

Answer 38

- Therapy - ECT, severe med resistant,not safe for preggo - rTMS, (magnetic stimulator) pt must not respond to 1 adequate med trial - Vagus nerve stimulation, 9-12 months to see results - Bright light therapy, seasonal dx 3-7 days for effect - EXERCISE