Exam 3 - Depression

Question 1

What are the SSRIs? (6)

Answer 1

citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft)

Question 2

What are the SNRIs? (5)

Answer 2

desvenlafaxine (Pristiq), duloxetine (Cymbalta, Irenka), levomilnacipran (Fetzima), milnacipran (Savella), venlafaxine (Effexor)

Question 3

What are the serotonin modulators? (4)

Answer 3

nefazodone (Serzone), trazodone (Desyrel), vilazodone (Viibryd), vortioxetine (Trintellix)

Question 4

What are the TCAs? (10)

Answer 4

amitriptyline, amoxapine, clomipramine (Anafil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), maprotiline, nortriptyline, protriptlyine, trimipramine

Question 5

What are the MAO-Is? (4)

Answer 5

phenelzine, tranylcypromine, selegiline, rasagiline

Question 6

What are the miscellaneous antidepressants? (4)

Answer 6

brexanolone, bupropion, esketamine, mirtazapine

Question 7

What is Auvelity a combination of?

Answer 7

dextromethorphan and bupropion

Question 8

What are contraindications for Auvelity? (3)

Answer 8

seizure, bulimia or anorexia nervosa, MAO-Is within 14 days (excluding fluoxetine)

Question 9

What are first line medications for depression? (5)

Answer 9

SSRIs, SNRIs, bupropion, mirtazapine, vortioxetine

Question 10

What is considered a response to depression treatment?

Answer 10

reduction of symptoms by 50%

Question 11

What should be done if symptoms persist after an adequate trial of 4-8 weeks?

Answer 11

switch to alternate antidepressant or augment with an alternative MOA, SGA, or psychotherapy

Question 12

What are two depression rating scales?

Answer 12

Hamilton Depression Rating scale (HAM-D) and Montgomery-Asberg Depression rating scale (MADRS)

Question 13

What are non-pharmacologic approaches to treating depression? (6)

Answer 13

psychotherapy, vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) electroconvulsive therapy (ECT), bright light therapy, lifestyle interventions (improved diet (protein), exercise, adequate sleep)

Question 14

What are AEs of SSRIs? (5)

Answer 14

insomnia/sedation, sexual dysfunction, serotonin syndrome, QTc prolongation, increased bleed risk

Question 15

What are special considerations for citalopram (Celexa)? (2)

Answer 15

> 40mg not recommended, QTc prolongation

Question 16

What are special considerations for fluvoxamine (Luvox)? (2)

Answer 16

caution in elderly, CYP1A2 interactions

Question 17

What are special considerations for escitalopram (Lexapro)? (1)

Answer 17

like citalopram but potentially better

Question 18

What are special considerations for fluoxetine? (2)

Answer 18

only SSRI requiring once weekly administration, also available as a liquid

Question 19

What are special considerations for paroxetine (Paxil)? (4)

Answer 19

caution in elderly, avoid in pregnancy, akathisia, bone fractures (?)

Question 20

What is the only indication for fluvoxamine (Luvox)?

Answer 20

OCD

Question 21

What are the indications for escitalopram (Lexapro)? (2)

Answer 21

MDD and GAD

Question 22

What is the only indication for citalopram (Celexa)?

Answer 22

MDD

Question 23

What is the only indication sertraline (Zoloft) is NOT approved for?

Answer 23

GAD

Question 24

Which SSRI is approved for nearly all depressive-related disorders?

Answer 24

paroxetine (Paxil)

Question 25

What are special considerations for desvenlafaxine (Pristiq)? (3)

Answer 25

hyperlipidemia, eosinophilic pneumonia and interstitial lung disease

Question 26

What is the only indication for desvenlafaxine (Pristiq)?

Answer 26

MDD

Question 27

What are special considerations for venlafaxine (Effexor)? (3)

Answer 27

pediatric alerts, eosinophilic pneumonia, dose adjustments (hepatic and renal)

Question 28

What are the indications for venlafaxine? (4)

Answer 28

MDD, GAD, PD and SAD

Question 29

What are special considerations for duloxetine (Cymbalta)? (3)

Answer 29

avoid in renal or hepatic dysfunction, urinary retention, hypotension

Question 30

What are the indications for duloxetine (Cymbalta)? (4)

Answer 30

MDD, GAD, diabetic neuropathy, fibromyalgia and musculo-skeletal pains

Question 31

What are special considerations for levomilnacipran (Fetzima)? (2)

Answer 31

urinary retention and increased HR

Question 32

What is the only indication for levomilnacipran (Fetzima)?

Answer 32

MDD

Question 33

What are the indications for TCAs? (3)

Answer 33

MDD, insomnia, nocturnal enuresis

Question 34

What are AEs of TCAs? (3)

Answer 34

anticholinergic and CV effects, cognitive impairment, urinary retention

Question 35

How long must one wait after using a MAO-I before trying a new drug with a potential interaction?

Answer 35

4-5 half-lives of drug or active metabolite

Question 36

What are examples of tyramine-containing foods? (4)

Answer 36

aged, smoked, pickled products and yeast extracts

Question 37

What are AEs of MAO-Is? (4)

Answer 37

postural hypotension (or other hypertensive crises), anticholinergic effects, sexual dysfunction, serotonin syndrome

Question 38

Which serotonin modulator has a boxed warning for hepatic failure?

Answer 38

nefazodone (Serzone)

Question 39

What are special considerations for trazodone (Desyrel)? (3)

Answer 39

sedation, priapism, more anticholinergic and bleed risks than nefazodone

Question 40

What are special considerations for bupropion? (2)

Answer 40

seizure risk in patients with eating or substance abuse disorders, hypertension

Question 41

What are the requirements for starting esketamine (Spravato)? (2)

Answer 41

failure of at least two other drugs and used in combination with an antidepressant

Question 42

What are AEs for esketamine (Spravato)? (3)

Answer 42

hypertension, cognitive impairment (machinery risk), avoid in pregnancy

Question 43

What is a boxed warning for esketamine (Spravato)?

Answer 43

sedation, abuse, suicidal ideation (REMS)

Question 44

What is the MOA of brexanolone (Zulresso)?

Answer 44

positive allosteric modulation of GABA-a receptors

Question 45

How is brexanolone (Zulresso) administered?

Answer 45

IV infusion over 60 hours

Question 46

What is the best and worst treatment choice for depression in an elderly patient, respectively?

Answer 46

best = SSRI, worst = TCA (delirium)

Question 47

What are augmentation agents for depression? (5)

Answer 47

lithium, triiodothyronine, SGAs, buspirone, stimulants

Question 48

Which augmentation agent is first line for depressive episodes that fail?

Answer 48

lithium

Question 49

What characteristics are most likely to signify NMS? (6)

Answer 49

dopamine antagonists, onset 1-3 days, lead pipe rigidity, hyporeflexia, normal pupils, normal or decreased bowel sounds

Question 50

What characteristics are most likely to signify serotonin syndrome? (5)

Answer 50

serotonin agents, onset < 12 hrs, hyperreflexia, dilated pupils, hyperactive bowel sounds