Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Therapeutics 2 > Antidepressants/Anxiolytics > Flashcards

Antidepressants/Anxiolytics Flashcards

1
Q

main 2 sx’s for dx of major depressive episode?

A

depressed mood, lack of enjoyment in pleasurable activities (anhedonia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is persistent depressive disorder (dysthymia)?

A

depressed mood for more days than not for at least 2 years

these pts are depressed but still do things vs major depressive they don’t do anything

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is NOT recommended as first line tx for bipolar depression?

A

SSRIs/SNRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what can antidepressants cause in bipolar patients?

A

increase mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what MUST you screen for before initiating an antidepressant as mono therapy?

A

Bipolar disorder

-need to screen for mania in their hx b/c they won’t present when manic, only present when depressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what has a dramatic impact of moving a person on continuum to high risk of suicide?

A

substance use - makes them act more on their suicidal thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the mortality of depression?

A

suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what can happen with suicide and tx of depression with antidepressants?

A

antidepressants can worsen someone’s suicidality when it’s supposed to reduce their suicidal thoughts (paradoxical rxn)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is bereavement?

A

Depressive symptoms which occur after the loss of a loved one

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is adjustment d/o?

A

Development of emotional and/or behavioral symptoms w/in 3 months after an identifiable stressor

-Patient not coming out of their depression after a trigger occurs (ex: spouse dies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

do bereavement and adjustment d/o require tx?

A

not really, they do need counseling tho

may start antidepressants with adjustment d/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what meds MUST BE R/O as they can induce depressive sx’s ?

A

Steroids

Monotherapy with Benzo’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what tx is effective for mild depressions monotherapy? when is it good for moderate to severe depression?

A

psychotherapy (CBT and interpersonal therapy)

good for mod-severe depression when added to meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the most commonly used meds for depression? recommended as FIRST LINE tx in what population?

A

SSRIs

-recommended as FIRST LINE tx in older depressed pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the generic SSRIs?

A

Fluoxetine, Paroxetine, Sertraline, Fluvoxamine, Citalopram, Escitalopram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the 2 SSRI and Serotonin Receptor Modulators?

A

Vilazodone and Vortioxetine

-these are NOT generic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what serotonin receptors are involved with anxiety and depression?

A

5-HT1 and 5-HT2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are 2 important differences b/w the SSRIs?

A

Relative rates of adrs (same adrs, but some more than others)

Elimination half-lives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are adrs of SSRIs?

A

diarrhea, nausea/vomiting, headache, somnolence, sexual dysfunction, weight gain, QTc risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the adrs of SSRIs that the patient will gain a tolerance to?

A

all adrs EXCEPT sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the only adr of SSRIs that doesn’t go away?

A

sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what SSRI causes the MOST sexual dysfunction?

A

Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what SSRI causes the most weight gain?

A

Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what do you want to find out about patients when starting SSRIs?

A

their baseline weight - if go past their baseline while on SSRI then can blame the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what SSRI has the great risk of QTc increase?

A

Citalopram - 10msec increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what other meds that are used to treat depression have twice the impact on QTc than SSRIs?

A

TCAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what should you get for patient in terms of watching out for QTc risk for SSRIs?

A

baseline EKG (can be months before prescribing the SSRI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

which two SSRIs last the shortest amount of time in the body?

A

Paroxetine and Fluvoxamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what SSRI lasts the longest amount of time in the body?

A

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are the withdrawal symptoms of SSRIs?

A

flu-like symptoms, insomnia, dizziness, irritability, ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

when do withdrawal symptoms from SSRIs occur after abrupt cessation and how many days can they last up to?

A

Occurs within 1-10 days after abrupt cessation and can last up to 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what 2 SSRIs inhibit CYP2D6?

A

Fluoxetine and Paroxetine

also Sertraline, but not as much

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what CYP enzyme do Fluoxetine and Paroxetine inhibit?

A

CYP2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what 2 SSRIs are the safest and have the least potent DDIs?

A

escitalopram and sertraline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what 2 SSRIs have the most potent DDIs?

A

Paroxetine and Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

when would you use Vilazodone or Vortioxetine for depression? what’s their side effect profile like compared to SSRIs

A

if SSRIs didn’t work

have greater side effects than SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Trazodone adrs?

A

sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

other effects of Trazodone? what’s it good to use for?

A

promoter of good sleep (b/c block 5-HT2)

used as a hypnotic more than as an SSRI (Better to give than Xanax for sleep)

good for insomnia patients that also require SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

when do you use the SNRIs?

A

for severe depression (replace SSRI with SNRI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what must be monitored for when using SNRIs that’s not monitor for when using SSRIs?

A

BP, HR, and urinary hesitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what are the 4 SNRIs used for severe depression?

A

Venlafaxine, Desvenlafaxine

Duloxetine

Levomilnacipran

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what are the adrs of Venlafaxine?

A

Nausea, Headache, Insomnia

BP increases (3-15 mmHg systolic) -> d/t adding NE reuptake inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is desvenlafaxine a metabolite of?

A

venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

dexvenlafaxine has more effect on what?

A

HR and BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

effects of Duloxetine on HR and BP? neuropathy?

A

mild HR and BP increases

effective for neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Duloxetine may possibly be toxic to what? seen in who?

A

hepatotoxic - seen in pts with concurrent chronic alcohol dependence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is the easiest SNRI to use?

A

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Levomilnacipran has more of an effect on what compared to the other SNRIs?

A

more effect on NE, a little 5-HT -> NOT A GOOD CHOICE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what SNRI is NOT a good choice to use d/t it’s greater effects on NE vs 5-HT?

A

Levomilnacipran

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what are the TCA medications?

A
  • Imipramine
  • Clomipramine
  • Desipramine
  • Amitriptyline
  • Nortriptyline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

adrs of TCAs?

A

constipation, blurred vision, dry mouth, sedation, headache, sexual dysfunction

cognitive impairment, photosensitivity, arrhythmias, hyperglycemia, lowers seizure threshold

MUCH MORE ADRS THAN SSRIs OR SNRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

TCAs are deadly at what dose?

A

one weeks worth of med can make you OD and die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

when is the ONLY time to use TCAs for depression?

A

when fail other meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are 2 other meds for depression?

A

Mirtazapine and Bupropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

ADRs of Mirtazapine

A

Somnolence (inverse dose relationship) - ceiling effect vs Trazadone doesn’t

Increased appetite (weight gain)

***Hyperglycemia, Hypertriglyceridemia, hypercholesterolemia

Antiemetic (b/c blocks 5-HT3)

56
Q

good and bad about Mirtazapine?

A

Mirtazapine sedates you and gives you good sleep cycles, but has bad metabolic effects

57
Q

MOA of Bupropion? DA chemical is what in the brain?

A

DA and NE reuptake pump inhibitors

-DA is the “getting high” chemical in the brain -> Bupropion has potential for abuse

58
Q

Bupropion has potential for…

A

abuse b/c works on DA

59
Q

what drugs does Bupropion interact with?

A

alpha-1 blocks (terazosin, prazosin, doxazosin, tamsulosin), DA blockers

60
Q

ADRs of Bupropion

A

Agitation (d/t effect on DA)

Insomnia, irritability, dry mouth

Promotes smoking cessation

Useful for drug induced sexual dysfunction

61
Q

does Bupropion treat anxiety? why does it make you MORE irritable and agitated?

A

NO!!! it’s doesn’t treat anxiety b/c it works on DA, not 5-HT

increases DA so make you more agitated and irritable

62
Q

how does Bupropion help with sexual dysfunction?

A

b/c increases DA, so increases libido

63
Q

what meds for depression have a risk for serotonin syndrome?

A

all antidepressants EXCEPT bupropion

64
Q

which med for depression does NOT have a risk for serotonin syndrome?

A

Bupropion

65
Q

what meds can interact with antidepressants to cause serotonin syndrome?

A

St. John’s wort, tramadol, meperidine, tryptophan, dexfenfluramine, isoniazid

66
Q

what effect do Triptans have?

A

cause coronary vasoconstriction, so can cause chest pain -> MUST MONITOR!!!

stimulate 5-Ht to vasoconstrict (used for migraines)

67
Q

Serotonin Syndrome is caused by overstimulation of what 2 receptors?

A

5-HT1a and 5-HT2a

68
Q

what are symptoms of Serotonin Syndrome? what can it cause? when do symptoms occur? when do symptoms resolve?

A

Restlessness, akathisia, tremor, hypomania, confusion, hyperreflexia, myoclonus, diaphoresis, hyperthermia

can cause death

symptoms occur within hours and symptoms resolve after 24hrs once the pro-serotonergic agents are stopped

69
Q

what is the treatment for Serotonin Syndrome?

A

5-HT antagonist cyproheptadine

70
Q

can you use SSRIs in pregnancy?

A

Yes, but it is preferred not to

71
Q

what SSRI is the BEST studied for use in pregnancy, but not necessarily the first choice?

A

Fluoxetine

72
Q

what SSRI should you NOT use in pregnancy?

A

Paroxetine

73
Q

when is it best to start mom on SSRI if she needs it or was already on it while pregnancy?

A

after giving birth

74
Q

what 2 SSRIs are the safest to use while breast feeding?

A

Sertraline and Paroxetine

75
Q

when can you increase dose of SSRI upon initial antidepressant therapy?

A

after 4-8 weeks of tx if only partial response (25% reduction in symptoms)

76
Q

when can you switch patient to another antidepressant upon initial antidepressant therapy?

A

if no response after 4-8 weeks of treatment

77
Q

when can you consider depressed patient to be treatment resistant?

A

after 2 trials of medication

-meds SHOULD be from 2 different classes (but can be from same)

78
Q

wha are the treatment options for depressed patient refractory/resistant to meds?

A

(1) Switching to a 3rd antidepressant monotherapy (one from diff pharm class -> most likely SNRI)
(2) Adding a second antidepressant (from diff pharm class)
(3) Augmenting with a non-antidepressant (e.g. Lithium, T3, atypical antipsychotic) - last option b/c more adrs/monitoring with antipsychotics
(4) Non-pharmacologic options (e.g. ECT)

79
Q

what antidepressant meds can you combined?

A

SSRI with Bupropion (more stimulating effect)

SSRI or SNRI with Mirtazapine (more hypnotic effect)

80
Q

after how many days of initiating treatment for depression do you meet with the patient to assess tolerability and safety/suicidal thoughts?

A

after 10-14 days

81
Q

at how many weeks to do you meet with patient to assess efficacy?

A

4 weeks

82
Q

after how many weeks after the 4 week meet for assess efficacy do you meet to measure maximal response?

A

2-4 weeks after (maximal response is 6-8 weeks of therapeutic dose)

83
Q

for how long do you meet every month with patient?

A

for next 4-9 months after assess maximal response at 6-9 week mark

84
Q

if this is patients first episode of depression, can you taper their antidepressant med down after 1 year of use?

A

yes you can taper their meds down -> off when 1st episode of depression

85
Q

if this is patients second or more episode of depression, can you taper their antidepressant med down after 1 year of use?

A

no, you should not

86
Q

what score on children’s depression rating scale indicates depression?

A

> 40

87
Q

what score on children’s depression rating scale indicates remission?

A

< 28

88
Q

for what ages is Fluoxetine approved for in peds?

A

ages 8-17 y/o

89
Q

for what ages is Escitalopram approved for in peds?

A

ages 12-17 y/o

90
Q

what antidepressant is FIRST CHOICE in peds?

A

12-17 y/o

91
Q

what are the only 2 SSRIs are that approved for adolescent depression?

A

Fluoxetine and Escitalopram

92
Q

what SSRI is NOT recommended in adolescents?

A

Paroxetine - d/t lack of efficacy and worse tolerability

93
Q

BBW for what with SSRIs?

A

suicide

94
Q

what is an adr of SSRIs in kids that you MUST monitor? what is the monitoring criteria?

A

Must monitor SUICIDE RISK

-monitor every week x4 weeks -> every other week x4 weeks, by phone if necessary -> after 12 weeks it’s up to the doc

95
Q

for depression in kids, what antidepressant do you start them on for monotherapy?

A

Fluoxetine

96
Q

what is another main tx for depression especially in kids <18 y/o?

A

psychotherapy

97
Q

what comorbid condition is common to have with depression?

A

anxiety

98
Q

how long does anxiety adjustment d/o last?

A

<6 months after the end of the stressor

99
Q

what is the FIRST LINE medication for anxiety?

A

benzo’s

100
Q

MOA of benzo’s

A

Bind to GABA, thus increasing GABA effect

101
Q

use of benzo’s?

A

tx of acute anxiety symptoms

102
Q

what are the main ADRs of benzo’s?

A

Sedation (tolerance develops in 2 weeks of daily use)

Cognitive impairment (long-term use of benzo’s causes permanent memory changes/cognitive impairment)

Respiratory depression (in high doses or when combined w/other CNS depressants like ETOH, opiates, barbiturates)

103
Q

what are risks of using benzo’s?

A

Withdrawal (pretty intense with bad rebound anxiety)

Disinhibition

ED visits (related to combining with ETOH or opiate)

Motor Vehicle Accidents

104
Q

is there a tolerance of benzo’s to anxiolytic or muscle relaxant effects? what does this mean?

A

no!!! - means that patient shouldn’t be coming to ask for dose increase

105
Q

if patient on benzo’s requires frequent dose increase, what is it a possible sign of?

A

misuse of the benzo (abuse or diversion)

106
Q

significant risk of death/OD when combine benzo’s with what other med?

A

opiates

107
Q

are benzo’s commonly abused by themselves or in combo with other drugs?

A

benzo’s are NOT commonly abused by themselves, they are more commonly added to other drugs to enhance or prolong the ‘high’ (ex: opiates)

108
Q

what are the 2 main factor for benzo selection?

A

Potency (high vs low)

Duration of action

109
Q

the smaller the dose (mg) for benzo’s, the higher the ___

A

potency

110
Q

what 2 benzo’s have the highest potency?

A

triazolam > clonazepam

111
Q

what is generalized anxiety disorder (GAD)?

A

Excessive anxiety and worry more days than not for at least 6 months

112
Q

what meds can be used for GAD?

A

antidepressants, buspirone (Buspar), benzo’s, pregabalin

113
Q

what antidepressants can be used for GAD?

A

SSRIs, Duloxetine, Venlafaxine

114
Q

what are the MAIN antidepressants (that the professor likes) to treat GAD?

A

escitalopram, sertraline, duloxetine

115
Q

dosing for antidepressants in anxiety is similar to dosing in ___

A

depression

116
Q

what anxiety disorder is Buspirone ONLY used to treat?

A

GAD (not panic d/o b/c not strong enough)

117
Q

what are the 4 advantages of treating GAD with Buspirone?

A

Almost as effective as benzos for GAD

No sedation, cognitive impairment, respiratory depression, dependence or withdrawal

Lacks abuse potential (takes awhile to kick in)

No sexual dysfunction (vs SSRIs do)

118
Q

what is the disadvantage of treating GAD with Buspirone?

A

onset of effect is about 2 weeks, but can take 6 weeks for full effect (similar to antidepressants)

119
Q

what is the goal dose of Buspirone?

A

40mg/day -> lower than that is NOT effective

120
Q

what SSRIs have the WORST outcomes when treating GAD? SSRIs with best outcomes for treating GAD?

A

Venlafaxine and Paroxetine = worst

Sertaline and Fluvoxamine = best

121
Q

how do you dose the SSRIs when treating GAD?

A

dose low to start as they may initially worsen anxiety if dose is too high b/c serotonin will go up abruptly and acutely

122
Q

what are the Guideline Recommendations for tx of GAD in the Acute Phase?

A

Start SSRIs and add BZD if necessary

123
Q

why do you add BZD to SSRI in acute phase tx of GAD or Panic d/o?

A

as a bridge b/c of the delayed effect of SSRIs (once SSRIs kick in, don’t need BZDs)

124
Q

what are the Guideline Recommendations for tx of GAD in the Prophylaxis Phase?

A

***SSRIs, SNRIs

or

Buspirone, Pregabalin

125
Q

what SSRI is preferred in the ppx phase of GAD?

A

sertraline

126
Q

if sertraline is ineffective in ppx phase of GAD, what can you do for the patient?

A

offer a different SSRI or an SNRI

127
Q

when would you consider putting patient on pregabalin for GAD ppx? what’s bad about pregabalin?

A

if patient can’t tolerate SSRI/SNRI

but want to stay away from Pregabalin b/c it has street value

128
Q

what are the Guideline Recommendations for tx of Panic Disorder in the Acute Phase?

A

SSRIs or SNRIs and BZD if necessary (again, to bridge for first 4-6 weeks of tx only)

129
Q

what are the Guideline Recommendations for tx of Panic disorder in the Prophylaxis Phase? when do you use TCAs?

A

***SSRIs

-use TCAs if multiple SSRIs fail

130
Q

why is it appropriate to treat anxiety with SSRIs/SNRIs?

A

b/c most people with anxiety d/o will develop depression

131
Q

when can you give a patient with anxiety d/o hydroxyzine pamoate, propranolol, clonidine?

A

for both acute response and chronic tx of anxiety d/o

may be better to use these 3 as a bridge to SSRI/SNRI for anxiety d/o vs BZDs b/c these 3 are safer

132
Q

what 2 comorbidities should you screen for in patient with GAD or Panic Disorder?

A

depression and substance abuse

133
Q

what are some non-pharmacologic tx’s for anxiety d/o’s?

A

Cut down on caffeine and other stimulating chemicals

Reduce depressant agents that can result in rebound excitation (e.g. ETOH)

Relaxation techniques rather helpful

Psychotherapy with medication therapy increases efficacy

134
Q

GAD response well to ___?

A

supportive psychotherapy (should be done before prescribe meds - same for mild depression)

135
Q

Panic d/o needs ___ for tx

A

meds

136
Q

if serotonin goes up abruptly and acutely, what can it induce? why is this important?

A

anxiety sx’s

-important b/c want to start low on SSRIs/SNRIs to prevent this

Clinical Therapeutics 2 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions