Psych

Question 1

Depression first-line medication classes

Answer 1

1. SSRIs
2. SNRIs

Question 2

Which two SSRIs are generally safe in older adults?

Answer 2

Sertraline (Zoloft)
Escitalopram (Lexapro)

Question 3

Which SSRI should be avoided in older adults?

Answer 3

Fluoxetine (Prozac)

Question 4

Which SSRI is most sedating?

Answer 4

Paroxetine (Paxil)

Question 5

Which SSRI should be avoided in those with anxiety?

Answer 5

Fluoxetine (Prozac)

Question 6

Which SSRI is best for pediatric patients?

Answer 6

Fluoxetine (Prozac)

Question 7

SNRI examples

Answer 7

Duloxetine (Cymbalta)
Venlafaxine (Effexor)

Question 8

Which patients should SNRIs be avoided in?

Answer 8

Uncontrolled HTN

Question 9

How long until noticeable effects from SSRI/SNRI are seen?

Answer 9

4-6 weeks

Question 10

SNRI and SSRI common side effects

Answer 10

GI issues (nausea, diarrhea)
Sexual dysfunction
Weight gain

Question 11

How long do we prescribe SNRI/SSRIs for?

Answer 11

6-12 months after symptoms are under control

Question 12

Tricyclic antidepressant (TCA) examples

Answer 12

Amitriptyline
Nortriptyline

Question 13

TCA side effects

Answer 13

Weight gain
ECG changes

Avoid in older adults due to anticholinergic effects

Question 14

Wellbutrin (Bupropion) drug class

Answer 14

Norepinephrine dopamine reuptake inhibitor

Question 15

Bupropion additional indications

Answer 15

Smoking cessation
Seasonal affective disorder
ADHD (off-label)

Question 16

What patients should avoid using Bupropion?

Answer 16

Patients with anxiety and insomnia

Question 17

When Bupropion is added to SSRI therapy, it can reduce:

Answer 17

Sexual dysfunction side effects

Question 18

Supplement for depression

Answer 18

St. John’s wort

Question 19

What medications cannot be used with St. John’s wort?

Answer 19

Serotonin medications (SSRI, SNRI, Triptans)

Question 20

Serotonin syndrome signs and symptoms

Answer 20

Shivering, seizures, tremors, tachycardia, agitation

EMERGENCY!

Question 21

Anxiety first-line treatment

Answer 21

SSRIs or SNRIs

Question 22

Anxiety adjunct options

Answer 22

Buspirone (Buspar)
Benzodiazepines for situational anxiety/short term bridge while waiting for other medications to work

Question 23

PTSD treatment

Answer 23

Medication (SSRI) or CBT

Question 24

Insomnia treatment

Answer 24

1. Patient education about sleep hygiene
2. CBT
3. OTC sleep aids (Benadryl, melatonin)

Caution when prescribing medications like Ambien

Question 25

Bipolar disorder treatment

Answer 25

Lithium

Question 26

Lithium narrow therapeutic range

Answer 26

0.6-1.2 Lithium toxicity: 1.5+ (N/V, tremors, hyperactive reflexes, confusion, vision changes)

Question 27

What gland do we monitor with lithium?

Answer 27

Thyroid

Question 28

Antipsychotics

Answer 28

Typical (first generation): Haloperidol (Haldol) Atypical (second generation): Zyprexa, Quetiapine (Seroquel)

Question 29

Antipsychotic side effects

Answer 29

Metabolic (weight gain, hyperglycemia, hyperlipemia)

Question 30

CYP2C19 enzyme

Answer 30

Common deficiency in Asian populations Can decrease efficacy of SSRIs

Question 31

CYP34A enzyme

Answer 31

Can decrease efficacy of medications such as warfarin or digoxin that use same enzyme

Question 32

Medications are metabolized in the liver via these enzymes

Answer 32

CYP450 - CYP34A - CYP2C19