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NAPLEX > Anxiety / Depression / Bipolar > Flashcards

Anxiety / Depression / Bipolar Flashcards

1
Q

Benzo’s

Long acting
Intermediate acting
Short acting

A

Long 25-100H- Diazepam, chlordiazepoxide, clonazepam , flurazepam

Intermediate 10-20 H - Lorazepam , temazepam, estazolam

Short <12H - Triazolam , alprazolam, oxazepam, midazolam, remimazolam

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2
Q

Which benzo’s are recommended for elderly?

A

Lorazepam (doesn’t produce an active metabolite)
Oxazepam
Temazepam

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3
Q

Which benzo is recommend for insomnia?

A

Temazepam

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4
Q

What is the reversal of benzos?

A

Flumazenil IV over 30 seconds

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5
Q

Buspirone

Brand
MOA
Dose / max
Onset

A

Buspar

5HT1A and D2 agonist

start 7.5mg BID up to 60mg/d

4 weeks

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6
Q

5HT1 involved in ..
5HT2 ..
5HT3

A

Depression

Causes sexual dysfunction

GI upset

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7
Q

How do SSRI’s relate to bleeding?

A

They can reduce platelet aggregation and increase risk of GI bleeding

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8
Q

SSRI ADE

A

Weight gain
GI effect
Sexual dysfunction
Headache
HypoNa+
Orthostatic HYPOtension
Bone fractures
Ocular effects
Anticholinergic effects (paxil only)
Pregnancy category C

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9
Q

Which SSRI’s are

  1. 2D6 inhibitors
  2. 2D6 and 3A4 substrate
  3. 3A4 substrate
  4. 1A2 inhibitor
A
  1. fluoxetine and paroxetine
  2. Vortioxetine
  3. Vilazodone
  4. Fluvoxamine
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10
Q

Citalopram

Brand
Class
Indication
Form
Max dose / range

A

Celexa

SSRI

MDD

Tabs, solution

10-40mg/day

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11
Q

Escitalopram

Brand
Class
Indication
Form
Max dose / range

A

Lexapro

SSRI

MDD, GAD

Otab

10-20mg/day

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12
Q

Fluoxetine

Brand
Class
Indication
Form
Max dose / range
Alternative dose
Contraindication

A

Prozac, sarafem

SSRI

MDD, OCD,PD,Bulimia, PMDD

Capsule , solution

10-80mg/day AM
Sarafem for PMDD - 20-80mg/d

Can do weekly for MDD
90mg ER / weekly

MAOI within FIVE WEEKS

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13
Q

Fluvoxamine

Brand
Class
Indication
Form
Max dose / range

A

Luvox

SSRI

OCD

tabs , ER caps

50-300mg / d HS

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14
Q

Paroxetine

Brand
Class
Indication
Form
Max dose / range
Pregnancy category

A

Paxil, pexeva, brisdelle

SSRI

MDD,GAD, OCD, PD, PMDD, PTSD

Paxil CR - 12.5 -75mg/d
Paxil / paxeva - 10-40mg/d
Brisdelle - 7.5mg/d for hot flashes

Category D

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15
Q

Sertraline

Brand
Class
Indication
Form
Max dose / range

A

Zoloft

SSRI

MDD,OCD, PTCSD, PD, PMDD

25-200mg/d PO

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16
Q

Which SSRI..

  1. most weight gain
  2. Most GI upset
  3. most OH
A
  1. Paroxetine
  2. Sertraline
  3. Paroxetine
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17
Q

Vortioxetine

Brand
Class
Indication
Form
Max dose / range
Contraindication

A

TRintellis

SRI, serotonin receptor agonist and antagonist

MDD

5-20mg/PO QD

MAOI within 21 DAYS

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18
Q

SNRI ADE

A

Headache
HypoNa+
Ocular effects
Bone fractures
Suicidal thinking
GI upset
Sweating
Increased BP
Increased HR

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19
Q

Venlafaxine

Brand
Class
Indication
Form
Max dose / range

A

Effexor

SNRI

MDD, GAD, PD

25-375mg/d with FOOD

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20
Q

Desvenlafaxine

Brand
Class
Indication
Form
Max dose / range

A

Succinate - Pristiq
Base - Khedezla

SNRI

Depression

25-400mg / d PO

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21
Q

Duloxetine

Brand
Class
Indication
Form
Max dose / range

A

Cymbalta , irenka

SNRI

Depressipn, GAD, Fibromyalgia, chronic OA pain

30-120mg/d PO

22
Q

Milnacipran

Brand
Class
Indication
Form
Max dose / range
Use is ESRD?

A

Savella

SNRI

Fibromyalgia

12.5 - 200 mg /d PO

Not for ESRD

23
Q

Levomilnacipran

Brand
Class
Indication
Form
Max dose / range
Use in ESRD?
What to avoid?

A

Fetzima

SNRI

MDD

40-120mg/ PO QD

Not for ESRD

Avoid with alcohol

24
Q

Bupropion

Brand
Class
Indication
Form
Max dose / range
ADE

A

Wellbutrin , aplenzin, zyban

NDRI

MDD, smoking cessation

300-450mg/d PO
Max aplenzin is 522mg/d

CNS stimulation (so take in AM) , seizures, weight lossT

25
Q

Trazodone

Class
Indication
Form
Max dose / range
ADE

A

Block serotonin reuptake, alpha adrenergic and H1 blockers

MDD, sleep disorders

50-600mg/d PO

Priapism , GI upset, OH, sexual dysfunction

26
Q

Nefazodone

Class
Indication
Form
Max dose / range
BBW

A

Block serotonin reuptake , alpha 1 blocker, 5HT2a blocker

MDD

100-600mg/d

Hepatotoxicity

27
Q

Vilazodone

Brand
Class
Indication
Form
Max dose / range
Benefit

A

Viibryd

Block serotonin reuptake, 5HT1AR blocker

MDD in adults

10-40mg QD with FOOD

No weight gain

28
Q

Mirtazapine

Brand
Class
Indication
Form
Max dose / range
ADE

A

Remeron

Alpha2 antagonist, increased NE and serotonin

15-45mg/ ODT /d

Weight gain, somnolence, anticholingeric effects, QT prolongation

29
Q

What are the 5 tertiary amines + brand name?

A

Amitryptiline (elvail)
Clomipramine (anafranil)
Doxepin (silenor)
Imipramine (tofranil)
Trimipramine (surmontil)

30
Q

What are 5 secondary amines + brand name?

A

Amoxapine
Desipramine (norpramine)
Maprotiline
Nortryptiline (pamelor)
Protriptyline

31
Q

TCA MOA

A

Block reuptake of NE and serotonin
Alpha 1 blocker (OH)
Histaminiergic (weight gain, sedation)
Anticholinergic (Anti-SLUDGE)

32
Q

Which TCA’s are indicated for MDD?

A

All except clomipramine (OCD)

33
Q

Which three MAOi attack MAO a and b?

A

Isocarboxazid (marplan)
Phenelzine (nardil)
Tranylcypromine ( Parnate)

34
Q

MAOi’s indication and ADE

A

MDD

Insomnia, weight gain, anticholinergic, OH , edema, sexual dysfunction

35
Q

MAOi drug interactions

A

Dextromethorphan
Meperidine, methadone, tramadol
Morphine, hydropmorphine,
Sympathomimetics
TCA’s, SSRI’s
Anticholinergics
Tyramine –> HTN crisis

36
Q

Selegiline

Brand
Indication
Class
Form

A

Emsam

MDD

Selective MAOB i

6,9,12mg PATCHES daily

37
Q

What are 4 antipsychotics approved for MDD?

A
  1. Arpiprazole (abilify)
  2. Olanzapine / Fluoxetine (symbyax)
  3. Quetiapine (seroquel XR)
  4. Brexpiprazole (rexulti)
38
Q

When do you use symbyax?

A

Olanzapine/fluoxetine for treatment resistant depression

39
Q

What are 2 OTC meds for depression?

A

SAM-e

St. John’s Wort

40
Q

Brexanolone

Brand
Class
Indication
Form

A

Zulresso

GABA A receptor modulator

Post partum depression

IV over 60hours

41
Q

Zuranolone

Brand
Class
Indication
Form

A

Zurzuvae

GABA A receptor modulator

Post partum depression

Oral for 14 days

42
Q

Esketamine

Brand
Class
Indication
Form

A

Spravato

NMDAR antagonist

Treatment resistant depression

28mg NASAL SPRAY twice weekly x 5 weeks then weekly by a physician

43
Q

Auvelity

Components
Class
Indication
Form

A

Dextromethorphan 45ng and bupropion 105mg

NMDAR antagonist and NDRI

MDD

PO BID

44
Q

Gepirone ER

Brand
Class
Indication
Form
ADE

A

Exxua

5HT1AR agonist

MDD

18.2 - 72.6mg with FOOD

QT prolongation

45
Q

What are the 3 anticonvulsants used for BPD?

A

Divalproex/valproic acid
Lamotrigine
Carbamazepine

46
Q

Lithium

Brand
Indication
Formulations
Therapeutic range
Onset

A

Lithobid

BPD

IR/CR/ER tabs
Syrup

Acute : 0.8-1.2 mEq
Maintenance: 0.6-1 mEq

2-3 weeksLI

47
Q

Lithium ADE

A

GI upset
Hand tremor
Nephrogenic diabetes insipidus
Leukocytosis
Thyroid/parathyroid effects (so check calcium)
weight gain
Bradycardia
Alopecia
Ataxia, blackout, cogwheel rigidity

48
Q

At what levels do you start seeing lithium toxicity and how does it vary as you get higher?

A

> 1.5 mEq - tremor, vomiting, confusion, ataxia

> 2 mEq - CNS depression, arrythmias, seizures

> 3.5mEq - lethal

49
Q

Treatments of acute and chronic lithium toxicity

A

Acute - WBI , gastric lavage

Chronic - hemodialysis

50
Q

What drugs/ conditions can

  1. Increase lithium levels
  2. Decrease lithium levels
A
  1. Thiazides, ACEi, NSAIDs, hypoNa+, renal insufficiency
  2. Increased sodium intake

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