Exam 1 Flashcards
1
Q
Criteria to diagnose depression
A
Symptoms cause significant distress/impairment, episode not attributable to substance or other medical condition
2
Q
Which is not a lab test used to rule out reversible causes of depression.
- TSH
- BMO
- Cortisol
- CRP
A
CRP
3
Q
Serotonin is responsible for
A
Memory, emotions, sleep/wake
4
Q
Dopamine is responsible for
A
Motivation, movement, attention, cognition
5
Q
NE responsible for
A
Wakefulness, arousal, fight or flight
6
Q
Antidepressant mechansm
A
Antidepressants block the NT reuptake pump causing more NT to be in the synapse
7
Q
Antidepressant time to clinical effect for depression
A
2-4 weeks: Energy
4-6 weeks: Mood
8
Q
Antidepressant efficacy directly results from
A
Decrease in receptor sensitivity
9
Q
Drug Class: Isocarboxazid
A
MAOI
10
Q
Drug Class: Phenelzine
A
MAOI
11
Q
Drug Class: Selegiline
A
MAOI
12
Q
Drug Class: Tranylcypromine
A
MAOI
13
Q
MOAIs pose significant risk for
A
Serotonin syndrome and hypertensive crisis
14
Q
MAOIs require a washout period of
A
10-14 days
15
Q
How long do you have to wait to start an MAOI after discontinuing fluoxetine
A
5 weeks
16
Q
Which antidepressant has dietary restriction
A
MAOIs, foods with tyramine
17
Q
Drug Class: Amitriptyline
A
TCA
18
Q
Drug Class: Desipramine
A
TCA
19
Q
Drug Class: Doxepin
A
TCA
20
Q
Drug Class: Imipramine
A
TCA
21
Q
Drug Class: Nortiptyline
A
TCA
22
Q
Secondary Amines of TCAs
A
Desipramine, Nortriptyline
23
Q
Tertiary amines of TCAs
A
Amitriptyline, Doxepin, Imipramine (IDA)
24
Q
Amitriptyline can also be used for
A
Migraine prophylaxis
25
Desipramine other indication
Urinary incontinence
26
Doxepin other indication
Insomnia at low doses
27
TCAs use in elderly
Avoid due to high risk of sedation
28
Rank antidepressants classes in order of tolerance from least to greatest
MAOI, TCA, SNRI, SSRI
29
Drug Class: Duloxetine
SNRI
30
Drug Class: Venlafaxine
SNRI
31
Drug Class: Desvenlafaxine
SNRI
32
Duloxetine indications
Depression, diabetic neuropathy, fibromyalgia, skeletal muscle pain
33
Duloxetine inhibits
CYP2D6
34
Which SNRI has a renal cutoff
Duloxetine, avoid if CrCl<30
35
Duloxetine has risk of
Hepatotoxicity, monitor LFTs
36
Which SNRI has very difficult discontinuation
Venlafaxine
37
Venlafaxine MOA in regards to dosing
Low doses (<150), inhibit 5HT reuptake,
NE at high doses
38
Drug Class: Citalopram
SSRI
39
Drug Class: Escitalopram
SSRI
40
Drug Class: Fluoxetine
SSRI
41
Drug Class: Fluvoxamine
SSRI
42
Drug Class: Paroxetine
SSRI
43
Drug Class: Sertraline
SSRI
44
Citalopram dose cutoff
Doses >40g not recommended due to risk of QTc prolongation
45
Citalopram dosing patients >60YO
20 mg
46
Which SSRI can be used in children
Escitalopram, fluoxetine
47
SSRI with longest half life. And what does it mean
Fluoxetine has the longest half life so it self-tapers
48
Which SSRI is a strong CYP2D6 inhibitor
Fluoxetine, paroxetine
49
Which SSRI has most significant activating effects
Fluoxetine
50
Which SSRI can be combined for treatment-resistant depression
Fluoxetine + olanzapine
51
Fluvoxamine indication
OCD
52
Which SSRI has significant DDIs
fluvoxamine
53
Which SSRI should be avoided in pregnancy
Paroxetine
54
Least well tolerated SSRI. Why?
Paroxetine, lots of anticholinergic, antihistaminergic, and significant discontinuation syndrome
55
SSRI with shortest half-life
Paroxetine
56
Best SSRI for pregnant and lactating patients
Sertraline
57
TCA overdose potential
Due to cardiotoxicity
58
Mirtazapine is also used for
Appetite stimulation and insomnia
59
Trazodone is primarily used for
Insomnia
60
Why can TCAs cause orthostatic hypertension
Alpha 1 antagonism
61
Dopaminergic side effects
Agitation, sedation, movement disorder, psychosis
62
What antidepressant class experiences dopaminergic side effects
MAOIs
63
Adrenergic side effects
Tremor, tachycardia, diaphoresis, jitteriness, hypertension
64
What antidepressant class experiences adrenergic side effects
TCA, SNRI, MAOI
65
Serotonergic side effects
Anxiety, GI upset, sexual dysfunction, sedation, insomnia
66
Which antidepressant classes has serotonergic side effects
All
67
Mirtazapine sedation vs. activation
Sedating at low doses (<15)
Activating at high doses (>30)
68
Mirtazapine side effects
Somnolence and weight gain
69
Which antidepressant can be used in old people who can't sleep
Mirtazapine (<15 mg)
70
Trazodone PRN or scheduled?
PRN
71
Trazodone side effect in men
Boner that doesn't go away, trazobone
72
Trazodone hangover effect
Dissipate with more frequent use
73
Trazodone addictiveness
Less addictive compared to other sleep aids
74
Bupropion effects
No serotonergic effect
75
Which antidepressant has NO serotonergic effects
Bupropion
76
Bupropion side effects
Very activating, can cause agitation
77
Bupropion risk
High seizure risk
78
Bupropion is contraindicated in what patient populations
Eating disorders and head trauma due to seizure risk
79
Viibryd has _____ titration
Rapid titration
80
Viibryd is helpful for
Depression and anxiety
81
Trintellix effects
Pro-cognitive (helps focus and memory)
82
Fetzema indication
Fibromyalgia
83
Esketamine mechanism
Non-selective, non-competitive NMDA receptor antagonist
84
Esketamine place in therapy
Adjunctive therapy for treatment-resistant depression
85
Esketamine control class
Class 3
86
Esketamine therapeutic effect
Decreases severity of depression/suicidality in 2-4 hours
87
Esketamine BBW
Risk of sedation and difficulty with attention, judgment, (has dissociation), high risk of abuse, and suicidal thoughts
88
Esketamine dosing
56 mg on day 1, then 56 or 84 mg twice a week
Maintenance: once a week for weeks 5-8, then once every 2 weeks
89
Esketamine administration
Intranasally in clinics only
90
Brexanolone Mechanism
GABA-A Modulator
91
Brexanolone indication
Post-partum depression
92
Brexanolone control class
C4
93
Brexanolone BBW
Risk of excessive sedation or sudden loss of consciousness
94
Brexanolone monitoring
Monitor for hypoxia
95
Antidepressant augmentation: Additional antidepressant
Low-dose TCA< bupropion, mirtazapine
96
Risk of adding mirtazapine as secondary depressive agent
Serotonin syndrome
97
Most common kind of depression augmentation
Second generation antipsychotic (abilify, rexulti, seroquel)
98
Augmentation options 4
1. Additional antidepressant
2. SGA
3. Mood stabilizer lithium, lamotrigine
4. Other; Modafinil, methylphenidate, triiodothyronine
99
STAR*D trial results 3
1/3 of patients reached remission on 1st medication.
Nonresponse to one agent does not rule out the entire class, and
dose/duration are key to determine effectiveness
100
What is considered a full response in depression
50% reduction in symptoms
101
What is considered a partial response in depression
25-50% reduction in symptoms
102
What to do if partial response after first antidepressant
Maximize dose. If that doesn't work, consider augmentation
103
What is considered a nonresponse in depression
<25% reduction in symptoms
104
TRUE OR FALSE: When a patient has a partial response to an SSRI, augmentation can be considered no matter what treatment stage
TRUE
105
TRUE OR FALSE: When a patient fails initial treatment (non-response) with an SSRI, the next step should be augmentation
False, no point in continuing
106
Serotonin syndrome symptoms
Neuromuscular abnormalities
Autonomic instability (fever, sweaty)
Mental status changes (confusion, instability)
107
Serotonin syndrome treatment
Discontinue serotonergic agent and provide supportive care.
If extreme agitation or neuromuscular issues, can sedate with benzodiazepines and administer serotonin antagonist
108
Serotonin antagonist drug of choice
Cyproheptadine
109
Which side effect results from a drug-drug interaction?
Serotonin syndrome
Tyramine reaction
Discontinuation syndrome
Serotonin syndrome
110
Antidepressant BBW
Risk of increased suicidality highest when <24 and lowest when >65
111
Antidepressant use in pregnancy
The risk to the fetus is acceptable when compared to the risk of undertreated maternal depression
112
Antidepressant risk to fetus
Potential malformations, autism, and ADHD.
Unclear if due to medications or disease state
113
Major DDIs for antidepressants
NSAIDs/Aspirin/anticoagulants: Bleed risk
Triptans: Serotonin syndrome
Linezolid: Serotonin syndrome
