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NAPLEX 2021 > Depression/Anxiety > Flashcards

Depression/Anxiety Flashcards

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1
Q

Which neurotransmitters are believed to be inovled in depression?

A

serotonin, glutamate, ACh, dopamin, norepinephrine, and epinephrine

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2
Q

Drugs that can worsen depression

A 
Atomoxetine (ADHD) 
indomethacin (analgesic)
Efavirenz, Rilpivirine (NNRIS) 
propranolol 
contraceptives 
anabolic sgteroids 
varenicline
ethanol
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3
Q

DSM-5 Criteria

A 
M SIG E CAPS! 
mood
sleep
interest 
guilt/ feelings of worthlessness
energy - decreased
concentration - decreased
appetite - in or decreased
psychomotor agitation
suicidal ideation
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4
Q

What prompts a diagnosis of depression

A

experiencing 5 of the DSM-5 symptoms within the same two week period

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5
Q

What is rapid cycling and how can it occur

A

rapid switch between mania and depressive episodes in bipolar patients. Can occur if a bipolar patient is misdiagnosed and given an antidepressant

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6
Q

What is the role of BZDs in depression?

A

can be used when anxiety is also present, but NOT first-line and not as monotherapy.
They can worsen/mask depression and can be problematic in patients with substance abuse disorder

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7
Q

Natural products to treat depression

A

st. john’s wort
SAMe (s-adenosyl-L-methionine)
valerian

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8
Q

St. John’s Wort and SAMe increase risk of _____

A

serotonin syndrome

DO NOT USE WITH SEROTENERGIC AGENTS

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9
Q

What is a suitable trial period for depression tx

A

4-8 weeks at therapeutic dosing

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10
Q

What severity of depression requires medication treatment

A

moderate - severe

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11
Q

Main preferred first line agents

A

SSRI, SNRI, are main, but can consider mirtazapine, bupropion based on patient-specific symptoms and side effect profile

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12
Q

MAO inhibitor role

A

restricted to patients unresponsive to other treatments

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13
Q

list of MAOi

A

phenelzine
tranylcypromine
isocarboxazid

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14
Q

Risk of _____ is very high with MAOi use

A

serotonin syndrome

dose dependent

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15
Q

Symptoms of serotonin syndrome

A 
nausea
dizziness
headache
diarrhea
agitation 
tachycardia 
hallucinations
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16
Q

How to d/c an antidepressant

A

TAPER over several weeks

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17
Q

which antidepressants have highest risk of withdrawal

A

paroxetine

venlafaxine

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18
Q

Which antidepressant self tapers due to a long half-life?

A

fluoxetine

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19
Q

What drugs can be used to augment antidepressants for better response?

A

buspirone
low dose atypical antipyschotic (aripiprazole, olanzapine + fluoxetine, ER quetiapine)
lithium
T3 (thyroid hormone)

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20
Q

Initial choice of antidepressant in pregnancy

A

SSRI

*EXCEPT paroxetine

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21
Q

Why is paroxetine not an option in pregnancy

A

cardiac effects

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22
Q

Risk of _____ is warned about with SSRI use in pregnancy

A

persistent pulmonary hypertension of newborn (PPHN)

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23
Q

What antidepressants are preferred in breastfeeding

A

SSRI or tricyclics EXCEPT doxepin

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24
Q

What is required to be dispensed with all antidepressants

A

MEDGUIDE!

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25
how long do physical symptoms take to improve when starting an antidepressant
1-2 weeks
26
how long do psychological symptoms take to improve when starting an antidepressant
month or longer
27
SSRI MOA
selective serotonin reuptake inhibitors maintain serotonin levels in the neuronal synapse
28
do SSRIs affect NE and DA?
weakly
29
list of SSRIs
``` citalopram escitalopram fluoxetine paroxetine sertraline ```
30
indication of Sarafem
Fluoxetine for premenstrual dysphoric disorder
31
Indication for Brisdelle
paroxetine for severe vasomotor symptoms in menopause
32
Which drugs should NOT be used in combo with SSRIs
MAOi linezolid methylene blue
33
Why should citalopram not be used at >20 mg/day yin elderly?
QT prolongation risk
34
Max dose of citalopram and escitalopram in elderly
citalopram: 20mg/day escitalopram: 10mg/day
35
Warnings of SSRIs
QT prolongation hyponatremia SIADH (too much ADH) bleeding
36
Side effects of SSRIs
sexual dysfunction | somnolence, insomnia,
37
Which SSRI is the most activating and should be taken in the morning
Fluoxetine
38
which SSRI is the most sedating and should be taken in the evening
paroxetine
39
which SSRI is preferred in patients with cardiac risk?
sertraline
40
CYP considerations with fluoxetine and paroxetine
CYP2D6 inhibitors
41
Which antidepressant is preferred when pateint is taking tamoxifen
venlafaxine (SNRI) due to tamoxifen needed CYP2D6 metabolism to convert to its active form
42
What are the two SSRI combo mechanistic drugs on market
Viibryd (SSRI and serotonin partial agonist) | Trintellix (SSRI, 5-HT3 receptor antagonist and 5-HT1A agonist)
43
Benefits of Viibryd and Trintellex in terms of side effect profile
less sexual dysfunction compared to SSRIs and SNRIs
44
SNRI MOA
serotonin and norepi reuptake inhibitors increase NE and 5-HT
45
list of SNRIs
venlafaxine duloxetine desvenlafaxine
46
Fatal risk of hypertensive crises occurs when these two drug classes are used together
SNRIs and MAOi
47
Warnings with SNRIs
SIADH/hyponatermia fall risk bleeding risk
48
Side effects with SNRIs due to increased NE
increased heart rate, dilated pupils, dry mouth, excessive sweating, constipation
49
Which antidepressants would you not want to use as often in HTN patients
SNRIs especially venlafaxine
50
A washout period of ____ is needed when changing between SNRIs and MAOis or MAOis and buproprion
14 days
51
Due to risk of serotonin syndrome don't initiate SNRIs in patients taking _____
linezolid or methylene blue
52
SNRI with highest risk of QT prolongation
venlafaxine
53
Tricyclics MOA
inhibit NE and serotonin reuptake while blocking ACh and histamine receptors
54
which type of tricyclic is selective of NE
secondary amines
55
which type of tricyclic is more effective but has worse side effects?
tertiary amines
56
list of tertiary amines
amitriptyline | doxepin
57
when should amitriptyline be taken
bedtime
58
list of secondary amines
nortiptyline
59
which tricyclic type has increased risk of anticholinergic effects, sedation, and weight gain
tertiary - why amitriptyline should be taken qhs
60
Buproprion MOA
dopamine and NE reuptake inhibitor
61
CIs of buproprion
seizure disorder | hx of eating disorder
62
side effects of buproprion
dry mouth, insomnia, seizures, weight loss
63
MAOi MOA
inhibit breakdown of catecholamines like serotonin, NE, Epi, and DA
64
RIsk of _____ can occur with MAOi use
Fatal HTN crisis
65
What is a food-drug interaction with MAOis
tyramine rich foods: aged cheese, yeast, air dried meats, fermented foods
66
How long of wash out period is needed when switching from fluoxetine to MAOI
5 weeks! *remember, fluoxetine has a long half life
67
mirtazapine MOA
central presynaptic alpha-2 adrenergic effects increasing NE and serotonin
68
side effects of mirtazapine
sedation, weight gain
69
why is nefazodone raraley used
hepatotoxicity
70
Best choice antidepressant in a patient with cardiac risk
sertraline
71
Best choice antidepressant in a patient who smokes
buproprion
72
Best choice antidepressant in a patient with neuropathy
duloxetine
73
Worst choice in a patient with seizure disorder
buproprion
74
Best choice in pregnant patient
SSRIs other than paroxetine
75
Lowest risk of sexual dysfunction with these antidepressants
buproprion | mirtazapine
76
abilify side effects
anxiety, insomnia, akathisia
77
olanzapine and quetiapine side effects
sedation, weight gain, metabolic didsorder
78
Drugs that can cause anxiety
``` albuterol antipsychotics buproprion caffeine pseudoephedrine illicit drugs steroids stimulants ```
79
buspirone side effects
dizziness drowsiness nausea
80
BZD antidote
flumazenil
81
BZDs preferred for anxiety use
``` un-do anxiety with un-CLAD clonazepam lorazepam alprazolam diazapam ```
82
BZDs preferred in elderly patients and those with liver impairment
use a safe LOT lorazepam oxazepam temazepam
83
Role of propranolol in anxiety
stage fright or performance anxiety
84
Anxiety first-line agents
``` escitalopram fluoxetine paroxetine sertraline duloxetine venlafaxine ```

NAPLEX 2021 (28 decks)

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