Behavioral Health Meds 1

Question 1

What are the SSRIs? (6)

Answer 1

1. Sertraline
2. Fluoxetine
3. Citalopram
4. Escitalopram
5. Paroxetine
6. Fluoxetine

Question 2

What is the MOA for SSRIs?

Answer 2

Selective serotonin reuptake in the CNS

Question 3

SSRIs are usually first line for what 5 conditions?

Answer 3

1. Depression
2. PTSD
3. Panic Disorder
4. PMDD
5. Anxiety disorder

Question 4

What are the main benefits of SSRIs?

Answer 4

-Relatively few AEs
-Less toxic in overdose

Question 5

Why are SSRIs lower risk (pathophys)?

Answer 5

-No effects on norepinephrine, acetylcholine, histamine or dopamine

Question 6

What antidepressant is approved for treatment of bulimia?

Answer 6

Fluoxetine

Question 7

What is unique about Fluoxetine (why is it approved for Bulimia)

Answer 7

-Longer half life (2-4 days instead of 1-2), longer washout period for switching to MAOIs

Question 8

How long is the washout period for switching off fluoxetine?

Answer 8

5 weeks

Question 9

What is the washout period for switching off of SSRIS besides fluoxetine?

Answer 9

At least 2 weeks

Question 10

On average, how long do SSRIs take to reach maximum efficacy?

Answer 10

4-6 weeks

Question 11

What is the first response to non-efficacy to an SSRI?

Answer 11

Try a different SSRI before moving to second line

Question 12

What are the main 3 adverse effects of SSRIs?

Answer 12

1. GI
2. Sexual dysfunction
3. Weight changes

Question 13

What are constitutional side effects of SSRIs? (3)

Answer 13

-GI
-Headaches
-Energy changes (fatigue or restlessness)

Question 14

What are mental adverse effects of SSRIs? (2)

Answer 14

-Anxiety
-Insomnia

Question 15

What are chemical side effects of SSRIs? (2)

Answer 15

-SIADH
-Serotonin syndrome

Question 16

What is the black box warning for SSRIs?

Answer 16

Increased suicidality in children / young adults

Question 17

What is a specific side effect of Citalopram?

Answer 17

QT prolongation

Question 18

What are the SNRIs? (3)

Answer 18

1. Duloxetine
2. Venlafaxine
3. Desvenlafaxine

Question 19

What is the MOA of SNRIs?

Answer 19

Inhibits neuronal uptake of serotonin, norepinephrine and dopamine

Question 20

Duloxetine can be used as first line especially in patients with ____ and ____

Answer 20

Fatigue / neuropathy pain, depression

Question 21

_____(SNRI) is good for depression and anxiety disorder

Answer 21

Venlafaxine

Question 22

What is the general side effect profile of SNRIs?

Answer 22

Similar to SSRIs plus hyponatremia

Question 23

What are the side effects of SNRIs specific to norepinephrine?

Answer 23

Hypertension
Sweating
Dizziness
Dry mouth
Constipation

Question 24

What are contraindications to SNRIs? (4)

Answer 24

1. MAOI use
2. Renal impairment
3. Hepatic impairment
4. Seizures

Question 25

Be careful with SNRIs in pts with ____

Answer 25

HTN

Question 26

SNRIs + (herbal) can cause serotonin syndrome

Answer 26

St. Johns Wort

Question 27

What is mirtazapine?

Answer 27

Tetracyclic antidepressent

Question 28

Mirtazapine MOA

Answer 28

Increases norepinephrine and serotonin release via central presynaptic alpha-2 adrenergic receptor antagonism and Postsynaptic 5-HT2 and 5-HT3 receptor antagonist, increases neurotransmission via 5-HT1 receptors

Question 29

Why is mirtazapine sedating?

Answer 29

High affinity for H1 receptors

Question 30

What is mirtazapine indicated for?

Answer 30

Depression and anxiety

Question 31

When is mirtazipine a good choice in depression?

Answer 31

-Insomnia -Significant weight loss (appetite stimulating)

Question 32

Mirtazapine has fewer ____ side effects than SSRIs

Answer 32

Sexual

Question 33

What are the top side effects of mirtazapine?

Answer 33

Sedation and weight gain

Question 34

What are other AEs of mirtazipine?

Answer 34

(Sedation and weight gain) -Dry mouth -Constipation -Tremor -Dizziness -Agranulocytosis

Question 35

What is the contraindication of mirtazipine?

Answer 35

MAOI inhibitors

Question 36

What are the tertiary tricyclic antidepressants? (4)

Answer 36

1. Amitriptyline 2. Clomipramine 3. Imipramine 4. Doxepin

Question 37

What are the secondary TCAS? (2)

Answer 37

1. Desipramine 2. Nortriptyline

Question 38

What are the indications for TCAs?

Answer 38

1. Depression 2. Insomnia 3. Neuropathies 4. Migraines 5. Urge incontinence

Question 39

Why are TCAs used less frequently than other options?

Answer 39

High AE profile, severe overdose potential

Question 40

What are the main AEs of TCAs?

Answer 40

1. Anticholinergic effects 2. Weight gain 3. Prolonged QT interval 4. Sedation 5. Lower seizure threshold 6. SIADH

Question 41

What are the anticholinergic effects of TCAs?

Answer 41

-Dry mouth -Constipation -Urinary retention -Tachycardia -Orthostatic hypotension -Confusion/hallucinations (elderly)

Question 42

What does TCA overdose look like?

Answer 42

The three C's: Cardiotoxicity Convulsions Coma

Question 43

What does the cardiotoxicity of TCA overdose look like?

Answer 43

Wide complex tachycardia due to Na+ channel blocking effect

Question 44

What do the convulsions of TCA entail?

Answer 44

Seizures or other neuro symptoms (like respiratory depression)

Question 45

How do you manage TCA overdose?

Answer 45

Sodium bicarb for cardiotoxicity

Question 46

When are TCAs contraindicated?

Answer 46

Use of MAOI Recent MI Seizure history

Question 47

Which TCAs are the most anticholinergic/antihistiminic and antiadrenergic?

Answer 47

Tertiary amines (higher toxicity with overdose)

Question 48

Which TCA is most useful in neuropathies, insomnia and chronic pain?

Answer 48

Amitriptyline (due to Na channel blocking properties)

Question 49

Which TCA is most useful in OCD?

Answer 49

Clomipramine (most serotonin specific)

Question 50

Doexpin is good for ____

Answer 50

chronic pain