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Psych rotation > Antidepressants (Fluoxetine) > Flashcards

Antidepressants (Fluoxetine) Flashcards

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1
Q

Length of antidepressant treatment for 1st time depressed

A

6 months- 1 year

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2
Q

Length of antidepressant treatment for 2nd time depressed

A 
2 years
(70% chance of relapse)
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3
Q

Length of antidepressant treatment for 3rd+ time depressed

A

Lifetime

>90% chance of relapse

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4
Q

Response rate of antidepressants

A

50-65%

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5
Q

Remission rate with antidepressants

A

30-40%

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6
Q

What side effect do ALL antidepressants have

A

Lower seizure threshold

SSRIs, SNRIs, bupropion can trigger a first time seizure in some patients

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7
Q

Black box warning for ALL antidepressants

A

Suicidal thoughts/ behaviors in children, adolescents, young adults (up to age 24)

(monitor weekly for first month, every two weeks for second month, then again in one month)

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8
Q

When is suicide risk the highest with use of antidepressants

A

First 9 days of treatment and with higher starting doses

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9
Q

Withdrawal symptoms most associated with which antidepressants

A

Short half-life antidepressants

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10
Q

Withdrawal symptoms from which antidepressants may include cholinergic side effects

A

TCAs

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11
Q

To diagnose MDD, depressive symptoms must be present for how long

A

≥ 2 weeks

depressed mood OR loss of interest/ pleasure PLUS ≥ 4 SIGECAPS sxs

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12
Q

What does SIGECAPS stand for

A 
Suicide
Interests
Guilt
Energy
Concentration
Appetite
Psychomotor
Sleep/ sex
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13
Q

Recurrence rate of MDD 1 year after 1st episode?

Recurrence rate of MDD 1 year after 2nd episode?

A

1st episode- 25%

2nd episode- 41%

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14
Q

Recurrence rate of MDD 2 years after 1st episode?

Recurrence rate of MDD 2 years after 2nd episode?

A

1st episode- 42%

2nd episode- 59%

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15
Q

Recurrence rate of MDD 5 years after 1st episode?

Recurrence rate of MDD 5 years after 2nd episode?

A

1st episode- 60%

2nd episode- 74%

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16
Q

What 3 things does serotonin regulate

A

Mood, emotions, feeding behavior

17
Q

How do SSRIs increase levels of serotonin

A

Binding/ inhibition of SERTs (serotonin reuptake transporters)

18
Q

What liver enzymes are inhibited by Fluoxetine

A

Cytochrome P450

when combined with drugs that are metabolized by cytochrome P450 enzymes, reduced rate of elimination and build-up

19
Q

What is the active metabolite of Fluoxetine

A

Norfluoxetine

20
Q

What is the half life of the active metabolite of Fluoxetine (Norfluoxetine)

A

2 weeks

21
Q

What is the half life of the parent drug (Fluoxetine)

A

2-3 days

22
Q

What are the indications of Fluoxetine (7)

A

MDD, bipolar depression (w/ olanzapine), bulimia, OCD, panic disorder, PMDD, treatment resistant depression

23
Q

Dose availability of Fluoxetine

A

10, 20, 40 mg

24
Q

Usual dose of Fluoxetine for depression/ anxiety

A

20-80 mg

25
Q

Usual dose of Fluoxetine for bulimia

A

60-80 mg

26
Q

Starting dose of Fluoxetine

A

10-20 mg QD

or lower @ 5-10 mg in patients with anxiety who are more sensitive to overstimulation effects

27
Q

Time to onset of Fluoxetine

A

2-4 weeks

(slow acting because it takes time for serotonin to accumulate within synaptic cleft)

(if no effect in 6-8 weeks, may require dosage increase or may not be effective at all)

28
Q

Once symptoms are gone, continue treating with Fluoxetine for how long

A

1 year for 1st episode

Indefinite for 2nd+ episodes

29
Q

Max dose of Fluoxetine

A

80 mg

30
Q

Major side effects of Fluoxetine (13)

A 
Sexual dysfunction
N/D
Anorexia
Anxiety
Nervousness
Drowsiness
Fatigue
Insomnia
HA
Tremor
SIADH
Suicidal ideation (esp if 18-24 yo)
Serotonin syndrome
31
Q

How can increasing serotonin cause emotional flattening, cognitive slowing, apathy

A

Diminished dopamine release

32
Q

What side effects are not expected with Fluoxetine

A

Weight gain, sedation

33
Q

Contraindications of Fluoxetine (4)

A

MAOI use, bipolar, 1st gen anti-psychotic use, pregnant/ nursing

Psych rotation (2 decks)

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