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Therapeutics III > Exam 5 (final) - Ott depression > Flashcards

Exam 5 (final) - Ott depression Flashcards

1
Q

DSM-5 diagnostic criteria says at least one of the symptoms needed to see to diagnose with depression is __________ or ___________

A

depressed mood, loss of interest or pleasure in doing things

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2
Q

(in diagnostic criteria) SIGE stands for:

A

sleep (too much or too little)
interest decreased
guilt/worthlessness
energy loss/fatigue

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3
Q

(in diagnostic criteria) CAPS stands for:

A

concentration difficulties
appetite change (increase or decrease)
psychomotor agitation
suicidal ideation

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4
Q

PHQ-9 is for

A

primary care setting
-used repeatedly to determine efficacy of treatment
5=minimal
10=mild
15=moderately-severe
20=severe

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5
Q

MDQ is for

A

used to rule out BPD
-5 questions
positive score of BPD is when >7 yes responses occur

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6
Q

boxed warning for ALL antidepressants aged 24 or younger

A

suicidality
-especially relevant in first 1-2months of therapy and after any dose changes

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7
Q

citalopram clinical pearls (SSRI)

A

QTc prolongation
2C19 and 3A4 substrate

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8
Q

fluoxetine clinical pearls (SSRI)

A

long t1/2 (96-144 hrs)
2D6 inhibitor, 3A4 inhibitor

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9
Q

fluvoxamine clinical pearls (SSRI)

A

inhibitor of 1A2 and 2C19

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10
Q

paroxetine clinical pearls (SSRI)

A

must taper due to anticholinergic effects
-weight gain, sedation
birth defect to septal wall of fetus
inhibitor of 2D6 and 2B6

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11
Q

sertraline clinical pearls (SSRI)

A

GI upset (more than other antidepressants)

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12
Q

SSRI SE

A

weight gain (most with paroxetine)
weight loss (most with fluoxetine)
sexual dysfxn
hyponatremia
increased bleed risk (platelet inhibition)

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13
Q

desvenlafaxine clinical pearls (SNRI)

A

active metabolite of venlafaxine
nausea is big issue
no major CYP interactions

14:1, 5HT:NE

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14
Q

duloxetine clinical pearls (SNRI)

A

titrate up to avoid nausea
warning for hepatotoxicity (monitor LFTs)
inhibitor of 2D6

10:1

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15
Q

levomilnacipran clinical pearls (SNRI)

A

adjust dose for:
-renal impairment
-strong 3A4 inhibitors
3A4 substrate

1:2

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16
Q

venlafaxine clinical pearls (SNRI)

A

must be >150mg/day to get NE effects
2D6 inhibitor at high doses

30:1

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17
Q

SNRI SE

A

increased BP
nausea

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18
Q

TCAs inhibit _______

A

reuptake of DA, 5HT, NE
-block DAT, SERT, NET

19
Q

amitriptyline (Elavil) dose range

A

50-300mg/day
-lower doses used for neuropathic pain

20
Q

TCAs CNS SE

A

reduce seizure threshold
confusion

21
Q

TCAs anticholinergic SE

A

blurred vision
urinary retention
constipation

22
Q

TCAs CV SE

A

orthostatic hypotension
tachycardia

23
Q

TCAs other SE

A

weigh gain
sexual dysfxn

24
Q

why does amitriptyline have a narrow therapeutic index

A

cardiac arrhythmias or seizures in doses as low as 1000mg

25
Q

MOAi clinical pearls

A

-2 week wash out period before switching to this from other antidepressants (5 weeks if fluoxetine)
-require tyramine diet
-caution due to hypertensive crisis and serotonin syndrome

26
Q

selegiline patch does not require _______ like other MAO inhibitors

A

tyramine diet

27
Q

bupropion _______ (does or does not) affect serotonin

A

does not

28
Q

bupropion MOA

A

DA and NE reuptake inhibitor

29
Q

bupropion clinical pearls

A

2D6 inhibitor
CI in active seizure disorders and eating disorders
can be used in combo w/ SSRIs and/or SNRIs

30
Q

mirtazapine (Remeron) clinical pearls

A

warnings: agranulocytosis, increased cholesterol
can be used in combo w/ SSRIs and/or SNRIs

31
Q

mirtazapine (Remeron) dosing and reason for dosing

A

7.5-45mg/day
-sedation and increased appetite occur with doses <15mg/day

32
Q

trazodone (Desyrel) dosing for depression

A

150-600mg

33
Q

trazodone (Desyrel) SE

A

orthostatic hypotension
risk of priapism (prolonged erection)
sedation? - H1 receptor antagonist

34
Q

Vilazodone (Viibryd) MOA

A

primarily SSRI
-may have some anxiolytic properties due to 5HT1a agonism

35
Q

Vilazodone (Viibryd) clinical pearls

A

-DO NOT use with SSRIs and/or SNRIs
-take with food (to decrease nausea and increase bioavailability)
-3A4 substrate

36
Q

vortioxetine (Tritellix) MOA

A

primarily SSRI with some 5HT1a agonism and 5HT3 antagonism

37
Q

vortioxetine (Tritellix) clinical pearls

A

-DO NOT use with SSRIs and/or SNRIs
-possibility of sexual dysfxn
-2D6 substrate

38
Q

vortioxetine (Tritellix) SE

A

N
-also V and C

39
Q

serotonin syndrome treatment

A

-stop offending agent
-wait (70% of pts recover in 24hrs)

40
Q

only antidepressant with no risk of withdrawal

A

fluoxetine

41
Q

augmentation agent options (antipsychotics)

A

aripiprazole (Abilify)
brexpiprazole (Rexulti)
cariprazine (Vraylar)
quetiapine (Seroquel)

42
Q

Ott’s favorite augmentation agent and the dose she uses

A

aripiprazole with dose of 2-5mg (for pt already on SSRI and almost to remission)

43
Q

steps to manage depression

A
  1. dose optimization
  2. switch antidepressant agents
  3. combine antidepressants
  4. augmentation
  5. esketamine, ECT/VNS/TMS

Therapeutics III (22 decks)

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