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Psych/Sub abuse/Alcohol Therapeutics > Depression > Flashcards

Depression Flashcards

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1
Q

DSM-5 Criteria for major depressive disorder

A

-5 or more symptoms present during same 2 week period
-At least 1 is depressed moof or loss of pleasure in activities
-Others: wt loss, insomnia or hypersomnia, psychomotor agitation, fatigue, worthlessness, can’t think, suicidal thoughts

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2
Q

BBW

A

Inc risk of suicidality in young adults 18-24 years old especially at early stages of treatment

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3
Q

First line depression meds

A

SSRIs, SNRIs, bupropion, mirtazapine, vortioxetine

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4
Q

Depression treatment

A

-Response: 50% symptom reduction after 4 weeks, AD should be continued at optimal dose and reevaluated at 6, 8 and 12 weeks
-Persist: switch to alternative AD or augmentation w/ AD with an alternative MOA, a SGA or psychotherapy

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5
Q

Selective Serotonin Reuptake Inhibitors (SSRIs)

A

-discontinuation syndrome (except Prozac)
-abnormal bleeding due to 5-HT reuptake on platelets, hyponatremia, serotonin syndrome, cognitive & motor impairment
-QTc effects from some SSRIs
-More energy boosting than sedating

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6
Q

Serotonergic drugs w/ SSRIs

A

Triptan migraine agents, pain meds (fentanyl/tramadol), nausea products (zofran, reglan), buspirone, linezoid, ritonavir

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7
Q

SSRI interactions

A

-QTc prolongation with contaminant meds
-inc risk of bleeding with NSAIDs, anti-platelets, anticoagulants

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8
Q

SSRI pearls

A

-d/c syndrome (except prozac) - common in Paxil
-abnormal bleeding due to serotonin reuptake on platelets
-hyponatremia
-serotonin syndrome
-cognitive and motor impairment
-QTc effects from some SSRIs
-More energy boosting than sedating

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9
Q

SSRIs AE

A

Anxiety initially (low dose than titrate), insomnia, HA (initially), hyponatremia & SIADH (rare but serious), monitor for inc lethargy mental status changes & serum Na+ less than 135, may cause sexual dysfunction

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10
Q

Discontinuation syndrome SE

A

FINISH (flu like symptoms, insomnia, nausea, sensory disturbances, hyper arousal)

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11
Q

Serotonin syndrome (agents that can inc risk)

A

Triptan migraine agents, pain meds (fentanyl/tramadol), nausea products (zofran, reglan), buspirone, linezolid, ritonavir

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12
Q

Citalopram

A

-SSRI
-High doses not recommended in elderly
-QTc warning
-ODT available
-Lower doses in hepatic impairment

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13
Q

Escitalopram

A

-SSRI
-MDD, GAD
-Lower dose in hepatic impairment
-Can use in PEDs 12-17

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14
Q

Paroxetine

A

-SSRI
-Short half life (discontinuation syndrome)
-Sedating and anticholinergic, so be careful in elderly patients
-Avoid in pregnancy
-Akathisia
-bone fractures have occurred in some patients

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15
Q

Sertraline

A

-SSRI
-Concentrate can only be mixed with water, ginger ale, lemon/lime soda, lemonade, OJ
-QTc but less than lexapro and celexa

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16
Q

Fluvoxamine

A

-SSRI
-Caution in elderly - most sedating and anticholinergic
-Many DDI (1A2)
-OCD

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17
Q

Fluoxetine

A

-SSRI
-Only SSRI approved for once weekly administration
-Inhibits TCAs and CBZ
-Anorexia, anxiety, insomnia
-Combo olanzapine + fluoxetine

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18
Q

SNRI AE

A

-abnormal bleeding due to serotonin reuptake on platelets
-potential for inc risk of activation of mania
-elevated BP
-hypenatremia
-serotonin syndrome and d/c syndrome
-more energy boosting than other AD

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19
Q

Desvenlafaxine

A

-SNRI
-3A4 interactions, don’t crush or chew
-hyperlipidemia has been reported
-Eosinophilic pneumonia (d/c)

20
Q

Venlafaxine

A

-SNRI
-give with food
-2D6 interactions
-BP changes at higher doses & eosinophilic pneumonia reported
-dose reductions up to 50% for mild-mod hepatic or renal impairment

21
Q

Duloxetine

A

-SNRI
-avoid in liver dysfunction or ESRD
-avoid ETOH
-1A2 and 2D6 interaction; do not chew or crush
-hepatotoxicity; severe skin rxns
-urinary retention
-hypotension
-less insomnia potential than other SNRIs

22
Q

Levomilnacipran

A

-SNRI
-urinary retention
-inc HR

23
Q

TCAs

A

-less commonly used for depression
-Cardiovascular events
-Anticholinergic effects
-CV ventricular tachycardia, heart block, lethal in OD
-Give at bed b/c of sedation
-Cognitive impairment, urinary retention possible
-Can cause: wt gain, sexual dysfunction, drug interaction 2D6, monitor serum conc. for adherence, toxicity, baseline EKG

24
Q

TCA withdrawal syndrome

A

-due to abrupt d/c
-symptoms: insomnia, sweating, abdominal pain, diarrhea, myalgias, nausea

25
Q

TCA drugs

A

Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Maprotiline

26
Q

MAOIs

A

-last line b/c of interactions
-after d/c interacting agent must wait 4-5 half lives before starting MAOI
-Wait 5 weeks before starting fluoxetine
-Wait 3 weeks before starting vortioxetine
-dietary restirctions of tyramine containing foods (aged foods, smoked, pickled, yeast extracts (risk of hypertensive crisis) - Amphetamines, decongestants, methylphenidate

27
Q

MAOI SE

A

postural hypotension, diarrhea, anticholinergic drying effects, sexual dysfunction

28
Q

MAOI serotonin syndrome

A

dextromethorphan

29
Q

MAOI drugs

A

Phenelzine, Selegiline (patch), Tranylcypromine

30
Q

Serotonin modulators

A

-Nefazodone, Trazodone, Vilazodone (Viibryd), Virtioxetine (trintellix)

31
Q

Nefazodone

A

-serotonin modulator
-hepatic BBW
-CYP3A4: avoid statins

32
Q

Trazodone

A

-serotonin modulators
-sedating, priapism

33
Q

Viibryd (vilazodone)

A

less sexual SE

34
Q

Trintellix (vortioxetine)

A

-serotonin modulator
-rapid onset
-taper
-improved tolerability
-reduce 50% for 2D6 poor metabolizers

35
Q

NDRI

A

-bupropion
-lower seizure threshold
-weight loss
-loss of appetite
-less sexual dysfunction
-caution w/ eating disorders

36
Q

Mirtazipine

A

-sedating
-cholesterol elevation
-significant weight gain
-elderly: inc med slowly b/c of decreased CL

37
Q

Esketamine

A

-CIII
-nasal spray
-used for treatment resistant depression (failure of 2 other AD)
-used in combo with oral AD
-can lead to inc BP, cognitive impairment, impaired ability to drive/operate machinery, embryo-fetal toxicity
-REMs (need to be monitored b/c of dissociation etc.
-BBW: sedation, dissociation, abuse and misuse, suicidal thoughts and behaviors (sit for 2 hours for REMS, monitor for dissociation and high BP)

38
Q

Esketamine CI

A

aneurysmal vascular disease
intracerebral hemorrhage

39
Q

Brexanolone

A

used for postpartum depression
assess hypoxia every 2 hours, if occurs d/c
iv infusion

40
Q

Elderly

A

-beers list
-SSRIs best choice
-don’t use bupropion if they have epilepsy
-don’t use TCA’s if they have delirium
-hx of falls and fractures don’t use TCA or SSRi unless no safer alternative

41
Q

Children

A

-fluoxetine: 8+
-escitalopram: 12+

42
Q

Pregnancy

A

-no paroxetine
-SSRIs best option

43
Q

Refractory

A

-combo: SSRI or SNRI + bupropion (or mirtazepine)
-SSRI + TCA

44
Q

NMS

A

-dopamine antagonists
-lead pipe rigidity
-hyporeflexia
-normal pupils
-normal or dec bowel sounds

45
Q

Serotonin syndrome

A

-serotonin agents
-hyperreflexia
-dilated pupils
-hyperactive bowel sounds

46
Q

SGA augmentation

A

-abilify, brexpiprazole, quetiapine, combo olanzapine/fluoxetine

Psych/Sub abuse/Alcohol Therapeutics (5 decks)

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