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53 Finals > IC12 Depression > Flashcards

IC12 Depression Flashcards

(56 cards)

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1
Q

RF for suicide

A

poor, elderly, lonely, man, comorbidities, previous attempts, triggering events, access to meds/firearms

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2
Q

Monoamine hypothesis

A

decrease NT in the brain — norepinephrine (NE/NA), serotonin (5HT), dopamine (DA)

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3
Q

medical conditions causing depression

A
  • Endocrine disorders: hypothyroidism, T2DM (depression and T2DM affects each other)
  • Deficiency states: anemia
  • Infections
  • Metabolic disorders: electrolyte imbalance, hepatic encephalopathy
  • CV: CAD, HF, MI (MI pt more likely to have depression)
  • Neurological: Alzheimer, Epilepsy, Pain, Parkinson, post-stroke
  • Malignancy
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4
Q

drug induced depression

A
  • Psychotropics: CNS depressants (benzodiazepines, opioids, barbiturates)
  • Withdrawal from alcohol and stimulants
  • Systemic corticosteroids
  • Isotretinoin (very potent vit A)
  • Interferon-ß-1a
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5
Q

Clinical Presentation of depression

A

In.SAD.CAGES
- Interest decr
- Sleep decr
- Appetite decr
- Depressed mood
- Concentration decr
- Activity decr
- Guilt
- Energy low
- Suicide

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6
Q

Dx of depression

A

A. ≥5 out of 9 sx for at least 2 weeks (of which one of them must be depressed mood or lost of interest)
B. significant distress/ functional impairment
C. not caused my other medical condition/ substance use

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7
Q

Adjustment disorder

A

sx occurs within 3mths of onset of stressor. sx do not persist if stressor is removed (eg booking in)

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8
Q

Acute stress disorder

A

sx occurs within 1mth of a traumatic event

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9
Q

what medical condition should be excluded before starting on antidepressants

A

mania

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10
Q

Depression vs deliruim/dementia

A
  • cyclical onset (good and bad days)
  • consciousness not impaired
  • no memory loss
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11
Q

Goals to tx

A

remission, suicide prevention
- assessment tool = PHQ-2/9

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12
Q

Non-pharm

A

sleep hygiene, psychotherapy, neurostimulation (for severe depression)

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13
Q

When is antidepressants indicated

A

moderate to severe depression
- mild depression no need antidepressants

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14
Q

first line antidepressant

A

mirtazapine, SSRI, SNRI, bupropion

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15
Q

acute phase tx: what is an adequate duration?

A

4-8 weeks

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16
Q

physical sx of depression (sleep and appetite) improves in…

A

1-2 weeks

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17
Q

mood sx of depression improves in…

A

4-8 weeks

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18
Q

total duration of antidepressant tx

A

6-12mths

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19
Q

why does mood sx takes longer to improve?

A

takes time for presynaptic autoreceptor to down-regulate to have unopposed secretion of NT (intended effect)

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20
Q

eg of TCA

A

Amitriptyline, Clomipramine, Nortriptyline

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21
Q

eg of SSRI

A

Fluoxetine, Paroxetine, Sertraline, Fluvoxamine, Citalopram, Escitalopram

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22
Q

eg of SNRI

A

Venlafaxine, Duloxetine

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23
Q

MOA of mirtazapine

Study These Flashcards
A

NaSSA: increase 5HT and NE

24
Q

eg of MAOI used for depression

Study These Flashcards
A

MAO-AI: moclobemide

25
MOA of bupropion
Block reuptake of NE and DA (no effect of 5HT)
26
bupropion should be avoided in which pt
psychosis (increase dopamine worsens psychosis), seizure, 2D6 substrates (bupropion is a 2D6 inhibitor)
27
which antidepressants have short half life
paroxetine, venlafaxine
28
which antidepressants have long half life
bupropion, fluoxetine
29
which antidepressant should be taken with food to increase absorption
sertraline
30
SE of TCA
- GI, sexual dysfunction - M1: anticholinergic - H1: sedation, weight gain - a1: orthostatic hypotension - arrhythmia, seizure
31
SE of SSRI
GI, sexual dysfunction
32
which SSRI has most anticholinergic SE
most anticholinergic, sedating, weight gain, short T1/2
33
which SSRI has QTc prolongation
citalopram, escitalopram
34
SE of SNRI
GI, sexual dysfunction - venlafaxine: increase BP
35
SE of mirtazapine
increase appetite sedation, weight gain, reverse GI and sexual SE of SSRI/SNRI
36
does bupropion has GI/sexual SE?
no (no activity with 5HT)
37
adjunct for MDD
- SGA: Aripiprazole, Brexpiprazole, Quetiapine XR (for tx resistant/ bipolar depression: olanzapine + fluoxetine) - Esketamine - PRN hypnotics
38
Can St John Wort be used for depression
avoid due to DDI with antidepressants (St John Wort is a 3A4 inducer)
39
when should antidepressant be swithced?
Adequate trial for 2 weeks & no improvement → switch medications (no need to wait for 4-8 weeks)
40
Mx of partial/no response
- Switching antidepressants (washout period for MAOI necessary) - Augmentation with antidepressant with different MOA (mirtazapine, bupropion) or SGA
41
Define tx resistant depression
no response ≥2 adequate trials of antidepressants
42
special populations mx
see specialist - elderly (avoid TCA) - hyponatremia usually occur with elderly (highest risk with SSRI)
43
pt <24yo should be counselled for
suicide
44
drug of choice: underweight + depression
mirtazapine
45
drug of choice: neuropathic pain + depression
duloxetin
46
serotonin syndrome
agitation, myoclonus, diaphoresis, confusion, coma
47
which antidepressants has highest risk of bleeding?
SSRI
48
avoid taking antidepressants with..
other CNS depressants, alcohol (space apart by 4-6hrs), anticholinergic drugs
49
1A4 inhibitors
fluvoxamine
50
2C19 inhibitors
fluvoxamine
51
2D6 inhibitors
fluoxetine, paroxetine, bupropion
52
3A4 inhibitors
grapefruit juice
53
3A4 inducer
rifampicin, carbamazepine, phenytoin, St John Wort
54
Antidepressants with the fewest DDI
mirtazapine, escitalopram, venlafaxine, desvenlafaxine, vortioxetine
55
Antidepressant discontinuation syndrome (this is NOT withdrawal) sx
FINISH - Flu like sx (lethargy, fatigue, headache, sweating) - Insomnia - Nausea - Imbalance (dizziness) - Sensation tingling - Hyperarousal (anxiety)
56
how to avoid Antidepressant discontinuation syndrome
gradually tapering of short acting drugs (paroxetine, venlafaxine) - long acting drugs no need gradual taper (bupropion, floxetine)

53 Finals (10 decks)

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