Brainscape's Knowledge GenomeTM

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


See full index

NAPLEX 2023 > Chapter 63: Depression > Flashcards

Chapter 63: Depression Flashcards

1
Q

Which neurotransmitters are believed to be involved in depression

most important?

A

serotonin (5HT), NE, glutamine, Ach, DA, and Epi

serotonin may be the most important

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

What is the most widely used depression assessment scale?

A

Hamilton Depression Rating Scale (Ham-D/HDRS)

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

How is depression diagnosed per DSM-5 criteria

A

at least 5 of the following symptoms during the same 2 week period (must include depressed mood or diminished interest/pleasure)

  • Mood – depressed
  • Sleep – increased/decreased
  • Interest/pleasure – diminished
  • Guilt or feeling or worthlessness
  • Energy – decreased
  • Concentration – decreased
  • Appetite – increased/decreased
  • Psychomotor agitation or retardation
  • Suicidal ideation

remember: M SIG E CAPS

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

Key drugs that can worsen depression

A 
Atomoxetine (Strattera)
Indomethacin
Efavirenz (in Atripla)
Rilpivirine (in Complera, Odefsy)
BB (especially propranolol)
Hormonal contraceptives
Anabolic steroids
antidepressants
Benzodiazepines
Systemic steroids
Interferons
Varenicline 
Ethanol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What disorder should be ruled out prior to starting any anti-depressant and why?

A

bipolar
prevent inducing mania or rapid-cycling

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

Why should benzodiazepines not be used alone in depression

A

They can worsen and/or mask depression and can be problematic in patients with concurrent substance abuse disorders

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

What natural products may be helpful for treating depression

A

St. John’s wort, SAMe, valerian, 5-HTP

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

Of the natural products that can be used for depression, which can increase the risk of serotonin syndrome

A

Both St. John’s wort, SAMe, 5-HTP

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

wich natural product for depression can cause sedation?

A

Valerian

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

If a drug does not work after a suitable trial of at least ____, treatment should be reassessed

A

4-8 weeks

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

For most patients, which class/classes of antidepressants should be used?

A

SSRI or SNRI

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

SSRIs are often used first line in pregnancy besides which SSRI and why?

A

paroxetine
potential cardiac effects

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

What is the possible risk of SSRI use in pregnancy?

A

persistent pulmonary HTN of the newborn (PPHN)

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

preferred agents for depression during breastfeeding

A

SSRIs or TCAs (except doxepin)

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

MAO inhibitors such as phenelzine, tranylcypromine and isocarboxazid is restricted to which types of patients

A

Patients unresponsive to other treatments

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

When is the risk for serotonin syndrome the most severe

A

when an MAOi is administered with another serotonergic medication

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

Symptoms of serotonin syndrome include

A

severe nausea, dizziness, HA, diarrhea, agitation, tachycardia, hallucinations, muscle rigidity

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

When d/c an antidepressant, it must be tapered over several weeks to avoid withdrawal EXCEPT which druge?

A

fluoxetine, which self-tapers because of its long half-life

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

Which two antidepressants carry a higher risk of withdrawal symptoms and must be tapered upon d/c

A

Paroxetine and venlafaxine

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

What is treatment resistant depression

A

depression that does not fully respond to two full treatment trials

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

The ____ guidelines state that patients should receive a 4-8 week trial of medication at a therapeutic dose before concluding that a drug is not working

A

American Psychiatric Association (APA)

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

If the patient is not improving or has an incomplete response to an antidepressant:

A
  • Change to a new antidepressant
  • Increase the antidepressant dose
  • Use a combination of antidepressants with different MOA
  • Augment with buspirone or a low dose of an atypical antipsychotic.
  • Augmentation with lithium, thyroid hormone (i.e., T3), or in some cases, electroconvulsive therapy (ECT)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Agents approved as augmentation therapy with antidepressants are:

A

aripiprazole (Abilify), olanzapine + fluoxetine (Symbyax), quetiapine ER (Seroquel XR) and brexpiprazole (Rexulti)

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

Which medications are generally preferred for postpartum depression

A

SSRIs or TCAs (with the exception of doxepin, per ACOG recommendations); Brexanalone (Zulresso) is FDA-approved for PPD

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

All antidepressants carry a boxed warning of ______

A

a possible increase in suicidal thoughts or actions in some children, teenagers, or young adults within the few months of treatment or when the dose is changed

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

What needs to be dispensed with all antidepressants

A

MedGuides

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

Physical symptoms such as low energy improve within __ weeks but psychosocial symptoms, such as low mood, may take _____

A

1-2 weeks

a month or longer

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

MOA of SSRIs

A

increase 5-HT by inhibiting its reuptake in the neuronal synapse

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

Citalopram brand name

A

Celexa

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

Citalopram max dose

Max dose in elderly (> 60 years)

A

40 mg/day

20 mg/day

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

Escitalopram brand name

A

Lexapro

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

Escitalopram max dose

Max dose in elderly (> 60 years)

A

20 mg/day

10 mg/day

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

Fluoxetine brand name

A

Prozac

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

Fluoxetine has another brand name (Sarafem) which is used for ____

A

premenstrual dysphoric disorder (PMDD)

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

Fluoxetine should be taken in the morning due to being activating. What is the fluoxetine formulation that should be taken at bedtime and why?

A

fluoxetine/olanzapine (Symbyax)
sedating

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

Paroxetine brand name

A

Paxil

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

Paroxetine has another brand name (Brisdelle) which is used for

A

moderate-severe vasomotor symptoms associated with menopause

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

paroxetine is (sedating/activating)

A

sedating
take qhs

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

Sertraline brand name

A

Zoloft

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

What are CI to SSRIs

A

Do not use with MAOi, linezolid, IV methylene blue or pimozide

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

Brisdelle (paroxetine) has a CI with

A

pregnancy

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

SSRI warnings include

A

QT prolongation (dose limit for citalopram and escitalopram), SIADH/hyponatremia, fall risk, bleeding

43
Q

SSRI side effects

A
  • Sexual SE
  • Somnolence, insomnia, nausea, dry mouth, diaphoresis (dose-related), weakness, tremor, dizziness, HA
44
Q

Most activating SSRI

A

fluoxetine; take dose in AM

45
Q

Most sedating SSRIs

A

paroxetine, fluvoxamine; take dose in PM

46
Q

which SSRI is preferred in patients with cardiac risk

A

sertraline

47
Q

How long should you wait when switching between MAOi and SSRIs?
With which exception?

A

2 week washout period
fluoxetine needs 5 week washout due to long t1/2

48
Q

QT prolongation occurs mostly with which SSRIs

A

Citalopram and escitalopram

Max dose of citalopram = 40, max escital = 20 mg

49
Q

Which medications and natural products can increase bleeding risk when taken with SSRIs & SNRIs

A

anticoagulants, antiplatelets, NSAIDs, select natural products (e.g., gingko, garlic, ginseng, glucosamine, fish oils), thrombolytics

50
Q

Which SSRIs are 2D6 inhibitors

which has drug interaction with what drug?

A

Fluoxetine, paroxetine and fluvoxamine

tamoxifen DDI - decr. effectiveness

51
Q

Tamoxifen requires conversion to its active form by ____. Decreased tamoxifen effectiveness occurs with fluoxetine and paroxetine. Which medication is preferred in combination with tamoxifen

A

CYP2D6
Venlafaxine (an SNRI)

52
Q

Which medications have less sexual side effects compared to SSRIs

A

Vilazodone (Viibryd) and Vortioxetine (Trintellix)

53
Q

how should vilazodone (Viibryd) be taken?

A

take with food

I v(w)ill take my vilazodone after im (vilazo)done with food

54
Q

SNRI MOA

A

increase 5-HT by inhibiting its reuptake in the neuronal synapse also inhibit reuptake of NE

55
Q

Venlafaxine brand name

A

Effexor XR

56
Q

Venlafaxine uses

A

Depression, GAD, panic disorder, SocialAD

57
Q

Max dose of Venlafaxine

A

375 mg/day (IR)

58
Q

Duloxetine brand name

A

Cymbalta

59
Q

Duloxetine uses

A

Depression, peripheral neuropathy, fibromyalgia, GAD, chronic musculoskeletal pain

60
Q

Desvenlafaxine brand name

A

Pristiq

61
Q

SNRI contraindications

A

MAOi can potentially cause a lethal drug interaction: hypertensive crisis; linezolid, IV methylene blue

62
Q

SNRI warnings

A

SIADH/hyponatremia, fall risk, bleeding

63
Q

SNRI have similar side effects as SSRIs d/t the decrease in 5-HT reuptake. What are the added on SEs?

A

↑ HR, dilated pupils, dry mouth, excessive sweating and constipation, increased BP (greatest risk with venlafaxine >150mg)

due to NE component

64
Q

Which SNRI has additive QT prolongation risk

A

Venlafaxine

65
Q

Which SNRI is a moderate 2D6 inhibitor and will cause decreased tamoxifen effectiveness when used together

A

Duloxetine

66
Q

TCAs primarily inhibit NE and 5-HT reuptake. They also block ______

A

Ach and histamine receptors

67
Q

Which category of TCAs are selective for NE

A

Secondary amines

increase anticholinergic properties

68
Q

Which category of TCAs have a worse SE profile

A 
Tertiary amines
(amitriptyline, imipramine, clomipramine, trimipramine, and doxepin)
69
Q

Nortriptyline brand name

A

Pamelor

70
Q

TCA contraindications

A

Do not use with MAOi, linezolid or IV methylene blue

71
Q

TCA side effects

A
  • QT prolongation with overdose (monitor for suicidal ideation, as overdose can quickly cause fatal arrhythmias)
  • Orthostasis
  • Dry mouth, blurred vision, urinary retention, constipation, weight gain, risk of falls in elderly (BEERS criteria)
72
Q

Which TCAs are tertiary amines

A
  • Amitriptyline (Elavil)
  • Doxepin
  • Clomipramine (Anafranil)
  • Imipramine (Tofranil)
  • Trimipramine
73
Q

Which TCAs are secondary amines

A
  • Nortriptyline (Pamelor)
  • Amoxapine
  • Desipramine (Norpramin)
  • Mapotiline
  • Protriptyline
74
Q

Bupropion brand name

A

Wellbutrin SR, Wellbutrin XL

75
Q

Zyban indication

A

(bupropion)
smoking cessation

76
Q

contrave indication

A

bupropion/naltrexone
for weight loss

77
Q

Bupropion should not exceed ____ mg/day due to seizure risk

A

450

78
Q

Bupropion CI

A

Seizure disorder; history of anorexia/bulimia; do not use with MAOi, linezolid, IV methylene blue or other forms of bupropion

79
Q

bupropion side effects

A
  • Dry mouth, CNS stimulation (insomnia, restlessness), tremors/seizures (dose-related), weight loss
  • Sexual dysfunction is rare
80
Q

Washout period between MAOi and bupropion, SSRIs, SNRIs, TCAs

A

14 days

81
Q

Isocarboxazid brand name

A

Marplan

82
Q

Phenelzine brand name

A

Nardil

83
Q

Tranylcypromine

A

Parnate

84
Q

Selegiline transdermal patch brand name

A

Emsam

85
Q

Selegiline transdermal patch is a ____ selective inhibitor

A

MAO-B

86
Q

CI drugs that increase serotonin & should not be taken with MAOi d/t risk of serotonin syndrome and hypertensive crisis

A

linezolid, lithium, tramadol, methadone, St. John’s Wort, meperidine, SSRIs, SNRIs, TCAs, mirtazapine, buspirone, carbamazepine, cyclobenzaprine, dextromethorphan

87
Q

Which foods are rich in tyramine and should be avoided with MAOi

A

aged cheese, pickled herring, yeast extract, air-dried meats, sauerkraut, soy sauce, fava beans and some red wines and beers.

high in tyramine if they have been aged, fermented, picked or smoked

88
Q

Mirtazapine brand name

A

Remeron, Remeron SolTab

89
Q

Mirtazapine is used commonly in oncology and skilled nursing to help with ____ & to ↑ _____

A

sleep (dosed QHS); appetite

90
Q

Mirtazapine SE

A

Sedation, ↑ appetite, weight gain

91
Q

What is another indication for trazodone besides depression

A

Sleep

92
Q

Trazodone CI

A

Do not use with MAOi, linezolid or IV methylene blue

93
Q

SE of trazodone

A

Sedation, risk of priapism

94
Q

Nefazodone is rarely used d/t a boxed warning of ______

A

hepatotoxicity

95
Q

Mirtazapine & trazodone have an additive risk of

A

QT prolongation, serotonergic

96
Q

Which drugs have a lower risk of sexual dysfunction

A

bupropion and mirtazapine

high risk with SSRIs/SNRIs

97
Q

Aripiprazole brand names

A

Abilify, Ability Maintena

98
Q

Quetiapine brand name

A

Seroquel

99
Q

Antipsychotics used for treatment-resistant depression have a boxed warning for

A

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at ↑ risk of death

100
Q

Olanzapine/fluoxetine (Symbyax) CI

A

do not use with pimozide, tioridazine, & caution with other drugs/conditions that cause QT prolongation

101
Q

Aripiprazole SE

A

anxiety, insomnia, akathisia

102
Q

Olanzapine SE

A

sedation, weight gain, ↑ lipids, ↑ glucose

103
Q

Quetiapine SE

A

sedation, orthostasis, weight gain, ↑ lipids, ↑ glucose

104
Q

Esketamine MOA, administration, DEA class

A

NMDA receptor antagonist
Nasal spray
C-III

requires REMS program

NAPLEX 2023 (88 decks)

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