Mehl. Depression medications + serotonin syndrome 04-19 (2)

Question 1

SSRI. some names?

Answer 1

Fluoxetine, escitalopram, sertraline, etc.

Question 2

SSRI. adverse regarding sex and sleep?

Answer 2

Cause sexual dysfunction (anorgasmia) and sleep disturbance.

Question 3

SSRI. causes one adverse, that is beneficial for what disease?

Answer 3

The fact that they cause anorgasmia actually makes them the Tx for premature ejaculation.

Question 4

SSRI. do not combine with what drug group?

Answer 4

Do not combine with drugs such as monoamine oxidase inhibitors or St John wort, as this can cause serotonin syndrome (discussed below).

Question 5

SSRI. Do not combine with drugs such as monoamine oxidase inhibitors or St John wort, as this can cause …….??

Answer 5

serotonin syndrome (discussed below).

Question 6

SSRI. unique adverse. sertraline is more likely to cause ??

Answer 6

diarrhea

Question 7

SSRI. unique adverse. fluoxetine?

Answer 7

fluoxetine has a stimulating effect and is more likely to cause insomnia

Question 8

SSRI. unique adverse. citalopram?

Answer 8

citalopram can prolong QT interval at higher doses.

Question 9

SSRI. unique adverse. But USMLE doesn’t give a fuck. xddddd

Answer 9

nu bet vis tiek sukeliau i kortas :D

Question 10

SSRI. Used for a variety of psych conditions external to depression, e.g., fibromyalgia, OCD, etc.

Answer 10

.

Question 11

SSRI. how long it takes to achieve effect?

Answer 11

It can take 4-6 weeks for an SSRI to achieve desired effect.

Question 12

SSRI. what to do if after 4-6 week no effect?

Answer 12

If after this time point the drug isn’t working, the first step is increasing the dose.

Question 13

SSRI. what to do if after 4-6 week no effect -> incr dose -> no effect?

Answer 13

If this doesn’t work, the next step is switching to a different SSRI –> if still not effective –> followed by switching to a different class agent.

Question 14

SNRIs.
Serotonin and norepinephrine reuptake inhibitors.
- Desvenlafaxine, duloxetine, etc.

Answer 14

.

Question 15

SNRIs. what can incr at higher doses?

Answer 15

Can increase blood pressure at higher doses.

Question 16

TCAs. mechanism?

Answer 16

Block reuptake of both serotonin and norepinephrine.

Question 17

TCAs. Amitriptyline, nortriptyline, clomipramine, doxepin, etc.

Answer 17

.

Question 18

TCAs. HY for what pain????

Answer 18

High-yield on USMLE as 1st-line for diabetic neuropathic pain; can also be used for neuropathic pain in general (e.g., from trauma).

Gabapentin is otherwise frequently used.

Question 19

TCAs. what nasty adverse?

Answer 19

Have nasty anti-cholinergic side-effects (anti-DUMBBELSS; see HY Neuro PDF for discussion of anti-cholinergic vs pro-cholinergic effects if you’re confused).

Question 20

TCAs. what nasty adverse. HY 3 cases in nbme.

Answer 20

Three HY anti-cholinergic side-effect vignettes are

1) palpable suprapubic mass in an older male -> full bladder as a result of anti- cholinergic med + BPH.

2) Hot, red, dry patient (as a result of anhidrosis).

3) Confusion + dilated pupils (anti-cholinergic delirium + mydriasis).

Question 21

TCAs. 3 adverse in general?

Answer 21

Coma, convulsions, cardiotoxicity.

Question 22

TCAs. Sometimes the Q can just mention prolonged QT interval in patient on an anti-depressant, and the answer is the TCA, since they’re cardiotoxic.

Answer 22

.

Question 23

TCAs. why in elderly use nortriptiline?

Answer 23

If elderly, use nortriptyline, since decr. BBB penetration and anti-cholinergic side-effects.

Question 24

TCAs. TCAs, such as imipramine, for nocturnal enuresis are wrong on USMLE.

Answer 24

.

Question 25

TCAs. Doxepin is asked on 2CK Psych form, where the Q rides on you knowing it’s a TCA to get it right (i.e., the only drug listed that causes anti-cholinergic effects). I mention this because students get the Q wrong and then are like wtf is doxepin.

Answer 25

.

Question 26

MAOIs. Phenelzine, tranylcypromine.

Answer 26

.

Question 27

MAOIs. why in general avoided as first line?

Answer 27

Avoided 1st-line overwhelming majority of the time because of ­ risk of serotonin syndrome.

Question 28

MAOIs. adverse what syndrome?

Answer 28

­risk of serotonin syndrome. This can be in isolation, but also when commenced too soon following discontinuation of SSRI.

Question 29

MAOIs. what drug used for Parkinson disease?

Answer 29

Selegiline is MAO-B inhibitor used for Parkinson disease. Answer on NBME where they ask which Parkinson med caused serotonin syndrome in a patient.

Question 30

MAOIs. what drug cause serotonin syndrome in parkinson patient?

Answer 30

Selegiline

Question 31

Bupropion. class, what effect has?

Answer 31

Dopamine + norepinephrine reuptake inhibitor; has anti-depressant effects.

Question 32

Bupropion. also affects some receptors, for what condition?

Answer 32

Also antagonizes nicotinic receptors, which disincentivizes smoking, since doing so won’t produce rewarding effects.

Question 33

Bupropion. lowers what?

Answer 33

Lowers seizure threshold. Don’t give to patients with eating disorders (electrolyte abnormalities increase seizure risk).

Question 34

Bupropion. dont give for what patients, what disorder?

Answer 34

Lowers seizure threshold. Don’t give to patients with eating disorders (electrolyte abnormalities increase seizure risk).

Question 35

Bupropion. does not cause what side effects?

Answer 35

Doesn’t cause sexual side-effects, unlike SSRIs.

Question 36

Mirtazapine. what group? for what condition?

Answer 36

a2-antagonist; stimulates appetite; used for patients with depression and anorexia.

Question 37

Trazodone. Serotonin antagonist and reuptake inhibitor (SARI). used in what?

Answer 37

Used for depression, but is frequently used for insomnia due to strong sedative effect

Question 38

Trazodone. can cause what syndrome?

Answer 38

Can cause serotonin syndrome.

Question 39

SEROTONIN SYNDROME. CP?

Answer 39

Flushing, tachycardia, diarrhea following drug-drug interactions (i.e., MAOI + SSRI; SSRI + St John wort) or high-risk drugs in isolation (e.g., MAOI, trazodone, lithium). Lithium sounds unusual, but on new 2CK NBME.

Question 40

SEROTONIN SYNDROME. drug combinations????

Answer 40

MAOI + SSRI; SSRI + St John wort

Question 41

SEROTONIN SYNDROME. what isolated drugs?

Answer 41

high-risk drugs in isolation (e.g., MAOI, trazodone, lithium). Lithium sounds unusual, but on new 2CK NBME.

Question 42

SEROTONIN SYNDROME. Can cause high fever, i.e., 105F+.

Answer 42

.

Question 43

SEROTONIN SYNDROME. how to Dx?

Answer 43

Diagnose with urinary 5-hydroxyindole acetic acid (5-HIAA).

Question 44

SEROTONIN SYNDROME. How to Tx?

Answer 44

Can be treated with cyproheptadine (blocks serotonin receptors).

Question 45

SEROTONIN SYNDROME. Often confused with carcinoid syndrome, which is due to carcinoid tumors (serotonin-secreting tumors) of the lung, small bowel, or appendix. Carcinoid syndrome isn’t due to drugs. Additionally, it can cause tricuspid vegetations, whereas serotonin syndrome does not. It is still diagnosed with urinary 5-HIAA

Answer 45

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