Clinical Questions Flashcards
What is the DSM-5 Criteria for Depression Diagnosis?
At least 5 of the the following symptoms present for the same 2 week period WITH depressed mood:
- increased/decreased Sleep
- decreased Interest
-Guilt
- decreased Energy
- decreased Concentration
- increased/decrease appetite
- Pyschomotor agitation or retardation
- Sucidal ideation
What natural products may have increased serotonin syndrome risk with SSRI/SNRI treatment?
St. John’s wart
SAMe
5-HTP (hydroxytryptophan)
Which SSRI is the most activating and should be taken in the AM?
Fluoxetine (Prozac)
Which SSRI is the most sedating and should be taken in the PM?
Paroxetine (Paxil)
A 62 year old patient with depression is on Celexa 40 mg daily from another provider. Patient is also on Lipitor 20 mg daily and Zestril 10 mg daily. Patient has complaints of somnolence and fatigue. What intervention should you make?
Citalopram (Celexa) dose should not exceed 20 mg/day. Decrease dose to 20 mg.
What concern do you have when a patient is on Phenelzine and Cymbalta at the same time?
SEROTONIN SYDROME
**MAO inhibitors (phelzine, tranylcypromine, and isocaboxazid) in combination with SSRI/SNRI
What concern do you have when a patient’s home medications are Topamax, Inderal, and Elavil, and they are started on linezolid for an infection?
SEROTONIN SYNDROME
***linezolid is contraindicated with amitriptyline (Elavil)
A 24 year old patient is on Aviane, Effexor ER, Inderal, and Vasotec, which medications have a potential risk to worsen depression?
Aviane - birth control = DOES
Effexor (Venlafaxine) = DOES
Inderal (Propanolol) = DOES
Vasotec (Enalapril) = nope
Which symptoms are from increase NE when taking SNRIs?
increased HR
dilated pupils
dry mouth
excessive sweating
constipation
increased BP
Which SNRI has the greatest risk for high blood pressure?
Venlafaxine (Effexor) when dosed > 150 mg per day
Which ART drug class has a risk of worsening depression?
NNRTIs (Efarirenz, Rilpivirine)
Which Tricyclic Antidepressants have increased anticholinergic properties with more sedation and weight gain?
Tertiary amines (Amitriptyline and Doxepin)
What antidepressantis contraindicated for people with history of anorexia/bullemia and seizure disorder?
Buproprion (Wellbutrin)
A 34 patient with atrial fibrillation and hypertension has just been diagnosed with depression. What is the best initial treatment for her?
(be specific)
Sertraline (Zoloft)
**preferred with cardiac or QT risk
A patient has depression and peripheral neuropathy from diabetes what is the best treatment?
Duloxetine (Cymbalta)
Which SSRI/SNRI should NOT be used in pregnancy?
Paroxetine (Paxil)
A patient has experience sexual dysfunction in the past with his depression treatment, which two medications could be the best option to avoid this symptom?
Mirtazapine (Remeron)
Buproprion (Wellbutrin)
A depressed patient struggles with insomnia, which treatment should she avoid, and which treatments are the best options?
AVOID: buproprion and fluoxetine
BEST: paroxetine, trazodone, and mirtazapine
A patient is taking Cymbalta and needs to be transitioned to Nardil. When may the patient start taking the Nardil?
Phenelzine (Nardil) needs to be started after at least 2 weeks AFTER discontinuing duloxetine (Cymbalta) due to Serotonin Syndrome