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NAPLEX > Chapter 58: Depression > Flashcards

Chapter 58: Depression Flashcards

1
Q

Brand and drug class of aripiprazole?

A

Abilify®

TCA approved as augmentation therapy with antidepressants in treatment-resistant depression

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2
Q

Brand and drug class of olanzapine + fluoxetine?

A

Symbyax®

Atypical (2nd gen) antipsychotic + SSRI approved as augmentation therapy with antidepressants in treatment-resistant depression

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3
Q

Brand and drug class of fluoxetine?

A

Prozac®, Sarafem®, PROzac Weekly

SSRI

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4
Q

Brand and drug class of paroxetine?

A

Paxil®, Brisdelle® (indicated for the treatment of hot flashes in menopausal women)

SSRI

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5
Q

Brand and drug class of fluvoxamine?

A

Luvox®

SSRI

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6
Q

Brand and drug class of sertraline?

A

Zoloft®

SSRI

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7
Q

Brand and drug class of citalopram?

A

Celexa®

SSRI

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8
Q

Brand and drug class of escitalopram?

A

Lexapro®

SSRI
This is the S-enantiomer of citalopram

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9
Q

How long is considered an adequate treatment trial for an antidepressant assuming a therapeutic dose?

A

6-8 weeks

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10
Q

What two natural products, classified by the Natural Medicines Database as “likely effective,” may be helpful in treating depression?

A
  1. St. John’s Wort

2. SAMe

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11
Q

What boxed warning do all antidepressants have?

A

may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 y/o) with MDD

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12
Q

What is the generic for Sarafem®. What use is it approved for?

A

Fluoxetine (Sarafem®) this medication is approved for treating premenstrual dysphoric disorder (PMDD).

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13
Q

All SSRIs are approved for depression and a variety of anxiety disorders except fluvoxamine which is only approved for what anxiety disorder?

A

OCD

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14
Q

Which SSRI is the DOC in cardiac patients due to its lower risk of QT prolongation?

A

Sertraline (Zoloft®)

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15
Q

What dose of Celexa® should not be exceeded due to risk of QT prolongation?

A

Daily dose of citalopram (Celexa®) should not exceed 40mg.

However, the dose should not exceed 20mg if the patient is older than 60 y/o, has liver disease, is a CYP2C19 poor metabolizer, or on CYP2C19 inhibitors (omeprazole, esomeprazole, azole antifungals, cimetidine, Prozac®)

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16
Q

What dose of Lexapro® should not be exceeded due to risk of QT prolongation?

A

Daily dose of escitalopram (Lexapro®) should not exceed 20mg.

However, do not exceed 10mg if elderly

17
Q

All of the following are symptoms of withdrawal from antidepressant drug therapy, EXCEPT:

A. Anxiety
B. Flu-like symptoms
C. Agitation
D. Sedation
E. Dizziness
A

D. Sedation would NOT be a symptom of withdrawal from an antidepressant medication

18
Q

Which of the following are side effects of SSRIs? (Select all that apply)

A. Increased libido
B. SIADH
C. Xerostomia
D. Diaphoresis
E. Somnolence
A

B, C, D, and E are all correct

A. Increased libido is incorrect. SSRIs cause sexual side effects including DECREASED libido, ejaculation difficulties, and anorgasmia

19
Q

Which of the following statements is correct? (Select all that apply)

A. Sertraline has two different formulations that are pregnancy category D and X
B. SSRIs are contraindicated with MAOIs such as isocarboxazid
C. Varenicline, cyclosporine, and corticosteroids can all cause or worsen depression
D. SSRIs can increase bleeding risk with concurrent use of NSAIDs
E. Generic products in Symbyax are fluvoxamine + olanzapine

A

B, C, and D are correct

A and E are incorrect. Sertraline (Zoloft®) is pregnancy category C. Paroxetine (Paxil®, Brisdelle®) are pregnancy category D and X, respectively. Symbyax® is the combination product of fluoxetine + olanzapine. Olanzapine (Zyprexa®) is a 2nd generation atypical antipsychotic.

20
Q

Brand name and drug class/MOA of vilazodone?

A

Viibryd®

SSRI and 5-HT1a partial agonist

21
Q

Brand name and drug class/MOA of vortioxetine?

A

Brintellix®

SSRI and 5-HT1a agonist and 5-HT receptor antagonist

22
Q

Vilazodone (Viibryd®) is an antidepressant agent with a mixed MOA, SSRI and 5-HT1a partial agonist. Which of the following statements about Viibryd® are correct? (Select all that apply)

A. Has less sexual SE than other SSRIs and SNRIs
B. Contraindicated with IV methylene blue and linezolid
C. Take in the AM on an empty stomach
D. Patients beginning Viibryd® use a starter kit with dose titration over the following 2 weeks
E. Most common SE is constipation

A

A, B, and D are correct

Incorrect
C. Vilazodone (Viibryd®) should be taken WITH food, not on an empty stomach. Taking vilazodone on an empty stomach can decrease AUC by up to 50% according to the package insert.

E. Constipation is NOT a SE of vilazodone. Common SE include N/V/D, insomnia, and decreased libido (although causes less sexual SE than other SSRIs and SNRIs)

23
Q

When switching from an MAO inhibitor to an SSRI, how long should the patient wait before beginning the SSRI?

A

A 2 week washout period is required when going from an MAOi to an SSRI.

A 2 week washout period is also required when going from an SSRI to an MAO inhibitor, EXCEPT when switching to fluoxetine which requires a 5 week wash-out period (due to the long half-life of fluoxetine of at least 7 days)

24
Q

Which of the following statements is correct? (Select all that apply)

A. Sertraline is available as a concentrated oral solution and must be diluted prior to administration
B. Fluoxetine, but not vilazodone, can increase bleeding risk in patients also taking anti-platelets
C. Brand name of desvenlafaxine is Brintellix®
D. Brand name of levomilnacipran is Fetzima®
E. All SNRIs have a risk of increased BP with the greatest risk from venlafaxine at doses greater than 150mg daily

A

A, D, and E are Correct
A. Sertraline (Zoloft®) oral solution concentrate must be diluted immediately prior to administration. Mix with 4 ounces of water, ginger ale, lemon/lime soda, lemonade, or OJ only.

D. Levomilnacipran (Fetzima®) is an SNRI

E. All SNRIs have risk of increased BP, especially at higher doses. The max dose of venlafaxine IR is 375mg daily and max dose of venlafaxine ER is 225mg daily

Incorrect
B. All SSRIs and SNRIs (fluoxetine is an SSRI and vilazodone or Viibryd® is an SSRI + 5-HT1a partial agonist) can increase bleeding risk in patients taking concomitant anticoagulants, anti-platelets, NSAIDs, ginkgo, and thrombolytics.

C. Brand name of desvenlafaxine is Pristiq®. This antidepressant is an SNRI. Brintellix® is the brand name of vortioxetine, an SSRI + 5-HT receptor antagonist + 5-HT1a agonist.

25
Q

All SSRIs and SNRIs are contraindicated with concurrent use of MAO inhibitors. Which of the following are MAO inhibitors used in the treatment of depression? (Select all that apply)

A. Isocarboxazid
B. Eldepreyl®
C. Parnate®
D. Doxepin
E. Phenelzine
A

A, C, and E are Correct
Isocarboxazid (Marplan®), tranylcypromine (Parnate®), and phenelzine (Nardil®) are all MAO inhibitors used in the treatment of depression

Incorrect
B. Eldepreyl® is the brand name of selegiline, a selective MAO-B inhibitor used in the treatment of parkinson’s disease, not depression. Selegiline transdermal patch (Emsam®) is the MAO-B inhibitor used in the treatment of depression.

D. Doxepin (Silenor®) is a TCA used in the treatment of insomnia and depression and/or anxiety

26
Q

Which of the following drugs/conditions are contraindicated with Elavil®? (Select all that apply)

A. IV methylene blue
B. Phenelzine
C. Glaucoma
D. MI
E. Zyvox®
A

A, B, D, and E are correct

Elavil® or amitriptyline is a TCA used in the treatment of depression and, at lower doses, neuropathic pain and migraine prophylaxis. Elavil® is contraindicated in patients taking concurrent MAOi’s (phenelzine), patients with a hx of MI, linezolid (Zyvox®), and IV methylene blue.

The interaction between TCA’s, SSRIs, and SNRIs and IV methylene blue (and theoretically large oral doses) is due to TCA’s enhancing the serotonergic effects of methylene blue increasing the risk of serotonin syndrome. FDA recommends discontinuing TCAs 2 weeks prior to administration of methylene blue.

Methylene blue is FDA indicated for treatment of drug-induced methemoglobinemia. It is used off-label for several other conditions such as: chromoendoscopy (diagnostic aid), ifosfamide-induced encephalopathy, sentinel lymph node mapping in breast cancer surgery, toenail onychomycosis, vasoplegia syndrome associated with cardiac surgery, refractory septic shock.

C. Glaucoma is incorrect. Doxepin is the only TCA that is contraindicated in patients with hx of glaucoma (and urinary retention)

27
Q

Which of the following is NOT a common AE of TCA’s? (Select all that apply)

A. Orthostasis
B. Sedation
C. QT prolongation
D. Weight gain
E. Diarrhea
A

E. Diarrhea. TCA’s mostly cause constipation due to their anticholinergic effects.

NAPLEX (17 decks)

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