Depression/Anxiety

Question 1

If you have a patient that struggles with depression and anorexia, what drug should be considered?

Answer 1

Mirtazapine (increased appetite)

Question 2

Which SSRI has strict dosing?

Answer 2

Citalopram (should no exceed 40mg/d for anyone, should not exceed 20mg/d for most pts >60yo or those on CYP2C19 inhibitors)

Higher doses = increased risk of QT

Question 3

CI of Bupropion

Answer 3

Pts with seizure history

Question 4

T/F: orthostasis is common with tertiary and secondary amine TCAs

Answer 4

True

Question 5

What is FINISH syndrome? What drug is it worse with?

Answer 5

Flu-like symptoms
Insomnia
Imbalance
Sensory disturbances
Hyperarousal

Paroxetine

Question 6

Which SNRI should you not use for pts with liver disease due to hepatotoxicity risk?

Answer 6

Duloxetine

Question 7

If a pt presents with atypical MDD with hyperphagia or hypersomnia, what class of meds should be considered?

Answer 7

Monoamine Oxidase A Inhibitors

Question 8

Which SNRI is most associated with dose dependent HR/BP increase?

Answer 8

Venlafaxine

Question 9

Which TCA should be considered for migraine prophylaxis?

Answer 9

Amitriptyline

Question 10

Which SSRI has a long half life?

Answer 10

Fluoxetine

Question 11

Which BZD is good for seizure disorders?

Answer 11

Clonazepam

Question 12

Priapism = what AD?

Answer 12

Trazadone

Question 13

What meds are short term/intermittent use for anxiety?

Answer 13

Benzo’s

Question 14

What are the SNRIs? (4)

Answer 14

Venlafaxine
Desvenlafaxine
Duloxetine
Milnacipran/Levomilnacipran

Question 15

Which 3 benzo’s come in IV formulation?

Answer 15

Lorazepam
Diazepam
Midazolam

Question 16

What medication is usually the drug of choice for anxiety?

Answer 16

SSRI/SNRI (venlafaxine)

Question 17

If your patient is trying to quit smoking and has depression, what should you use?

Answer 17

Bupropion

Question 18

What is the monoamine oxidase B inhibitor? Pts with what neurologic condition may benefit due to the patch formulation?

Answer 18

Selegiline

Parkinson’s pts who cannot swallow

Question 19

What are the 2 secondary amine TCAs?

Answer 19

Desipramine

Nortriptyline

Question 20

Which SSRI has a very short half life and concerns for withdrawal?

Answer 20

Paroxetine

Question 21

Which SNRI is best for pain from diabetic peripheral neuropathy/fibromyalgia/chronic MSK pain?

Answer 21

Duloxetine

Question 22

When should a TCA be considered?

Answer 22

Intolerant or refractory to SSRI/SNRI, or for pain syndromes

Question 23

Which SSRI is best for kids?

Answer 23

Fluoxetine

Question 24

Which amines have more sedation, wt gain, and anticholinergic effects?

Answer 24

Tertiary > secondary

Question 25

What AD is safe for pregnancy?

Answer 25

Sertraline

Question 26

What BZD is used for status epilepticus?

Answer 26

Lorazepam

Question 27

What are the 5 BZD's?

Answer 27

``` Alprazolam Clonazepam Lorazepam Diazepam Midazolam ```

Question 28

What are the 4 tertiary amine TCAs?

Answer 28

Imipramine, Clomipramine, Doxepin, and Amitriptyline

Question 29

What are the 3 Monoamine Oxidase A Inhibitors?

Answer 29

Isocarboxazid Tranylcypromine Phenelzine

Question 30

Which two drugs are SSRIs and partial 5-HT receptor agonists?

Answer 30

Vilazodone | Vortioxetine

Question 31

T/F: Benzo's are safe during pregnancy

Answer 31

False

Question 32

What screening must be completed when putting pts on TCAs?

Answer 32

Screen for cardiac conduction abnormalities, monitor regularly

Question 33

What are the SSRIs? (5)

Answer 33

``` Fluoxetine Paroxetine Sertraline Citalopram Escitalopram ```

Question 34

If you have a patient that struggles with depression and insomnia, what drug should be considered?

Answer 34

Trazadone

Question 35

What class of meds is consistently linked to dementia?

Answer 35

BZDs

Question 36

Classic signs for TCA overdose

Answer 36

The Three C's: Convulsions Cardiac arrhythmias/cardiac arrest Coma

Question 37

If your patient is having sexual function concerns with their current AD, what should you consider next?

Answer 37

Bupropion

Question 38

Which AD should you avoid if anxiety is present?

Answer 38

Bupropion

Question 39

Which SNRI is most associated with discontinuation/FINISH syndrome?

Answer 39

Venlafaxine

Question 40

Red flags for dependency on BZDs

Answer 40

Long term use (>1 month) Rebound anxiety and insomnia on withdrawal Strong desire to use them Driving under influence of BZDs Use of BZDs despite falls Use of them in addition to other hypnotics (ETOH, opioids) Continuing to use despite recommendation to stop

Question 41

Other than minimal sexual dysfunction, what are two other benefits of bupriopion?

Answer 41

Minimal sedation | Minimal weight gain

Question 42

Which 2 BZDs are used for conscious sedation?

Answer 42

Diazepam | Midazolam