psych

Question 1

diff categories of tx for depression

Answer 1

Pharmacotherapy
 Combination of Pharmacotherapy + Psychotherapy
 Others: ECT, light therapy, vagus nerve stimulation, transcranial magnetic stimulation

Question 2

SSRI agents

Answer 2

Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram

Question 3

AE of SSRIs

Answer 3

GI, anxiety/nervousness, sexual dysfunction

Question 4

AE of SNRIs

Answer 4

Mild to moderate insomnia, nausea, HA,
tremor, anxiety, dry mouth
 Sexual dysfunction common
 May ↑ BP; reports of HF worsening (class
effect)
  TG & LDL reported with De
 Substantial dose titration required (V)
 Do not use in patients with ESRD or hepatic
insufficiency (Du)

Question 5

SNRI agents

Answer 5

Venlafaxine
(Effexor)
Desvenlafaxine
(Pristiq)
Duloxetine
(Cymbalta)
Levomilnacipran
(Fetzima)
[Milnacipran
(Savella): only
approved to treat
fibromyalgia]

Question 6

antidepressant not associated with weight gain or sexual dysfunction

Answer 6

buproprion (wellbutrin)

Question 7

CI of buproprion

Answer 7

eating disorder or seizures and use of mAOI in last 14 days

Question 8

CI of all antidepressants

Answer 8

use of MAOI in last 14 days

Question 9

good antidepressant for someone also dealing with insomnia and/or needs to gain weight

Answer 9

noradrenergic and specific serotonergic antidepressant

Question 10

AE of noradrengergic and specific serotonergic antidepressant Mirtazapine

Answer 10

 High sedative and weight gain effects
 Mild to moderate anticholinergic effects and
dizziness
 Associated with agranulocytosis and
neutropenia

Question 11

pros and cons of TCAs for depression

Answer 11

pros: once daily dosing, useful for other conditions (migraines, neuropathic pain)
cons: high degree of sedation and weight gain, dangerous in overdose, titration req’d

Question 12

which antidepressant can cause priapism?

Answer 12

trazodone

Question 13

1st line meds for depression

Answer 13

SSRIs, SNRIs, NDRIs (buproprion),

Question 14

serotonin syndrome symtpoms

Answer 14

mental status change, agitation, myoclonus, hyperreflexia, fever, diaphoresis, ataxia, diarrhea. CAN PROGRESS TO hyperthermia, seizures, death

Question 15

how do you avoid serotonin syndrome when switching agents?

Answer 15

taper off first agent, wait 5 half lives or a “wash out period” and then start next one

Question 16

how do you avoid serotonin discontinuation period?

Answer 16

TAPER over 4 weeks

Question 17

serotonin discontinuation sx:

Answer 17

Dizziness, nausea, fatigue most commonly seen; vomiting, agitation, insomnia, tremors,
myalgia less common

Question 18

what is risk of GI bleed with SSRIs (and proprably SNRIs)?

Answer 18

3x risk if concurrently taking NSAIDs (for those already at risk of GI bleed)

Question 19

which SSRI has shortest half life and thus a longer taper? what else should be known about it?

Answer 19

paroextine (paxil), btwn dose withdrawal in younger pts, avoid in younger pts

Question 20

which SSRI has most drug intx?

Answer 20

fluvoxamine (luvox)

Question 21

which SSRIs can prolong QT

Answer 21

citalopram and escitalopram

Question 22

acute phase of depression tx lasts how long? (until sx abate?)

Answer 22

usu 6-12 weeks

Question 23

important pt ed for antidepressants

Answer 23

AE may be felt right way, but therapeutic effects on mood may take 2-4 weeks to start and 6-8 wks to be at full effect

Question 24

why does a suicide risk increase in the 1st 1-2 weeks after starting an antidepressant?

Answer 24

energy increase 1st before mood does.

Question 25

adequate trial of antidepressant

Answer 25

adequate dose for at least 4 wks, 8 wks is preferable

Question 26

how long should people be on antidepressants before you can discontinue it?

Answer 26

4-9 months if their 1st or 2nd episodEOF MDD

Question 27

who should be on maintenance antidepressants?

Answer 27

multiple episodes, severe episodes, prior suicide attempts (esp those with comorbid psych conditions or chronic medical conditions)

Question 28

who is at highest risk of suicice on antidepressants?

Answer 28

children, adolescents and young adults--balance with clinical need

Question 29

trade names of SSRIs

Answer 29

``` fluoxetine prozac sertraline zoloft paroextine paxil citalopram celexa escitalopram lexapro ```

Question 30

herbal therapy for depression

Answer 30

st. john's wort

Question 31

common drugs used to augment resistant antidepressant tx

Answer 31

lithium,levothyroxine, atypical antipsychotics

Question 32

is psychotherapy rec'd for bipolar?

Answer 32

yes, or in combo with pharmacotherapy

Question 33

common AE of lithium

Answer 33

thirst, polyuria, cognitive complaints, tremor, weight gain, sedation, diarrhea, nausea (watch for dehydration, which can lead to toxicity), hypothyroidism, transient leukocytosis.

Question 34

T or F: drugs for bipolar have a therapeutic range

Answer 34

T

Question 35

T or F: Lithium can abort a manic episode

Answer 35

T: it takes about 1-2 weeks

Question 36

T or F: Lithium is not effective at preventing gsuicide

Answer 36

F: it may help decrease risk of suicide and suicide attempts

Question 37

1st line mood stabilizers for bipolar disorder

Answer 37

lithium, valproic acid, carbamazepine, lamotrigine

Question 38

AE of valproic acid

Answer 38

tremor, sedation, diarrhea, nausea, weight gain, hair loss, LFT elevations, thrombocytopenia

Question 39

drugs for bipolar to avoid in pregnancy

Answer 39

valproic acid, carbamazepine

Question 40

carbamazepine AE

Answer 40

headache, nystagmus, ataxia, sedation, nausea, cognitive complaints, rash, leukopenia, mild LFT elevations

Question 41

type of patient with bipolar that lamotrigine may be best for

Answer 41

those who are currently presenting with a depressive episode

Question 42

T or F: lamotrigine should be titrated

Answer 42

T to prevent a rash

Question 43

tx for patients w/ bipolar who are unresponsive to meds

Answer 43

ECT

Question 44

tx of mild to moderate depressive episodes in bipolar

Answer 44

Lithium or lamotrigine 1st (reserve antidepressants for those with severe depression)

Question 45

maintenance tx for bipolar

Answer 45

lithium or VPA