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neuro psych & abuse exam 1 > Depression > Flashcards

Depression Flashcards

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1
Q

depression disorders

A

MDD
adjustment disorder and depressed mood
seasonal affective disorder
substance-ind mood disorder

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2
Q

depression causes medical

A

hypothyroidism
anemia
HIV/AIDS
autoimmune disease
CV disease
neurologic disorders (epilepsy, huntingtons, parkinsons, alzheimers, post-stroke)

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3
Q

depression causes med-induced

A

BBs, CCBs, OCs, steroids, topiramate, levetiracetam, opioids, stimulants

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4
Q

MDD DSM5 criteria for dx

A

5 or more of the following in same 2-eek period
1. depressed mood most of day, nearly every day
2. marked dec in pleasure and interest in all or almost all activities
3. significant weight loss (>5% in 1mo)
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation
6. feeling worthlessness or excessive or inappropriate guilt
7. dec ability to think or concentrate
8. recurrent thoughts of death

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5
Q

SSRIs includes …

A

citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline

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6
Q

SNRIs includes …

A

desvenlafaxine, duloxetine, levominacipran, venlafaxine, milnacipran

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7
Q

serotonin modulators includes …

A

trazodone, fefazodone, vilazodone, vortioxetine

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8
Q

TCAs includes …

A

amitriptyline, nortriptyline, protriptyline, doxepin, amoxipine, clomipramine, desipramine, trimipramine, maprotiline

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9
Q

MAO-i s includes …

A

phenelzine, tranylcypromine
rasagiline, selegiline

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10
Q

misc ADs

A

brexanolone, bupropion, esketamine, mirtazepine

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11
Q

ADs and BPD warning

A

unopposed use of AD in BPD may precipitate a manic/mixed episode

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12
Q

first line ADs

A

SSRIs, SNRIs, bupropion, mirtazepine, vorioxetine

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13
Q

an adequate trial is________. After this a pateint can _____

A

4-8weeks
switching or augmenting w different MOA

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14
Q

D/C SSRi can cause

A

electric shock sensations (except prozac d/t long half life)

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15
Q

SSRi rare but serious AE

A

hyponatremia and SIADH. monitor for inc lethargy, AMS, Na <135

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16
Q

SSRis and which serotonergic drugs should not be used due to serotonin syndrome

A

triptans
fentanyl, tramadol
zofran, reglan
buspar
linezolid
ritonavir

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17
Q

citalopram
MDD
dose adjustments
forms
FDA warngin

A

> 40mg not recommended
MDD 20mg for : elderly, hepatic impairment, 2C19
FDA - QTc warning
ODT, tab

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18
Q

escitalopram

A

no dose adjustments or QTc like citalopram does
MDD 10mg for hepatic impairment

19
Q

fluvoxamine
elderly?
DDI?
use

A

caution in elderly - most sedating and anticholinergic AE
many DDI via 1A2
only for OCD

20
Q

fluoxetine
pearls
AE
uses

A

only approved one for qweek admin
available as liquid
inhibits 2D6 (TCAs), 3A4 (CBZ)
AE: anorexia, anxiety and insomnia
uses: MDD, OCD, bulimia nervosa, panic disorder, PMDD, TRD, BPD-I

21
Q

paroxetine
pearls
AE
uses

A

avoid in pregnancy!!
akasthisia
sedating and anticholinergic –> careful in elderly
uses: MDD, OCD, PD, GAD, SAD, PTSD, PMDD, VSM
dose adjustments for severe hepatic and renal impairment

22
Q

sertraline
uses

A

MDD, OCD, PD, SAD, PTSD, PMDD

23
Q

only SSRIs that can be used for GAD

A

lexapro and paxil

24
Q

only SSRI indicated for bulimia nervosa and BPI depressive episode

also only med indicated for adolescent depression in down to 8yo

A

fluoxetine

25
Q

venlafaxine
use
pearl

A

MDD, GAD, PD, SAD
take w food
2D6 interactions
BP changes at higher doses

26
Q

SNRI indicated only for MDD

A

Levomilnacipran

27
Q

only SNRI that can be used for panic disorder and social phobia

A

venlafaxine (other indications include MDD GAD)

28
Q

TCAs indications

A

MDD, insomnia, nocturnal enuresis (imipramine)

29
Q

TCAs AE

A

“CA” = cardiac adverse effects
switch letters –> “AC” = anticholinergic AE
CV ventricular tachycardia and heart block
cognitive impairment, urinary retention

also…
weight gain
sexual dysfunction
2D6 interactions

30
Q

TCAs withdrawl s/sx

A

insomnia
weight gain
abd pain
diarrhea
myalgias
nausea

31
Q

only TCA indicated for depression AND insomnia

A

doxepin

32
Q

MAO-i
switching to MAO-i instructions

A

after d/c interacting agent, wait 4-5 t1/2 to initiate MAOi
f;uoxetine and vortioxetine have longest t1/2s at 5 and 3 weeks!!

no tyramine!!
monitor BP
AE: postural hypotension, diarrhea, anticholinergic drying effects, sexual dysfunction

33
Q

MAOis + _______ are a concern for hypertensive crisis
MAOis + _______ are a concern for serotonin syndrome

A

amphetamines, decongestants, methylphenidate

dextromethorphan

34
Q

selegiline is available in what dosage forms

A

po, ODT, TD patch

35
Q

escitalopram approved for what ages

A

12+

36
Q

SSRI options in OCD

A

fluoxetine, paroxetine, sertraline, fluvoxamine

37
Q

which TCAs can be used for MDD in peds and what age range

A

amitriptyline, nortriptyline and doxepin in 12-17 yo

38
Q

ADs safe to use in pregnanacy

A

typically SSRis EXCEPT PAROXETINE

39
Q

what qualifies a pt as refractory/tx resistant depression
and waht are options

A

non response to 2 separate trials of different ADs of adequate dose and duration
switch, combo, augment
combos include SSRI/SNRI + bupropion/mirtazepine
augmentation: lithiumtriiodothyronine, SGAs

40
Q

lithium is usually augmentation of

A

TCAs for major depressive episodes in MDD and BPD

41
Q

NMS (neuroleptic malignant syndrome)
s/sx causes

A

DA antagonists
onset 1-3d
HTN, tachyc, hyperthermia, hypersalivation, diaphoresis, pallor, lead pipe rigidity in all muscle groups, hyporeflexia, normal pupils, normal or dec bowel sounds, mental status variable

42
Q

serotonin syndrome s/sx causes

A

serotonin agents
onset <12hHTN, tachyc, hyperthermia, hypersalivation, diaphoresis, inc tone in lower extremities, hyperreflexia, dilated pupils, hyperactive bowel sounds, mental status variable

43
Q

NMS vs SS

A

NMS onset is much longer than SS (1-3d vs <12h
NMS has muscle rigidity in ALL muscle groups, SS is just lower extremities

SS has dilated pupils and hyperactive bowel sounds. NMS does not

NMS has hyporeflexia, SS has hyperreflexia

neuro psych & abuse exam 1 (5 decks)

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