Depression Flashcards
What are the SSRI agents?
- Citalopram
- Escitalopram
- Fluoxetine
- Fluvoxame
- Paroxetine
- Sertraline
What are the SNRI agents?
- Duloxetine
- Desvenlafaxine
- Levomilnacipram
- Venlafaxine
- Milnacipram
What are the TCA agents?
- Amtriptylline
- Amoxapine
- Clomipramine
- Desipramine
- Doxepin
- Imipramine
- Maprotiline
- Trimipramine
- Nortryptylline
- Protriptyline
What are the MAOIs?
- Phenelzine
- Selegeline
- Rasagiline
- Tranylcypromine
What are the miscellaneous agents for depression?
- Bupropion
- Brexanolone
- Esketamine
- Mirtazapine
What SSRIs are FDA-recommended for MDD
- Citalopram
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
What are your first line medications for depression?
- SSRI
- SNRI
- Bupropion
- Mirtazapine
- Vortioxetine
What should you do if symptoms persist after 4 - 8 weeks?
Switch to alternate AD
Augment with alternative MOA, 2nd gen APS or Psychotherapy
What are the two main MDD Rating Scales?
HAM - D
MADRS
What should you do if you see a an extreme response less than 2 weeks?
Watch. D/C, taper due to manic switch
Counseling symptoms for Serotonin Syndrome
Mental Status Changes
Autonomic instability
Neuromuscular abnormality
GI symptoms
Issues/Adverse Effects of SSRIs
QTc prolongation w/ concomitant meds
Increased risk of bleeding (NSAIDs/plates/anticoags)
Hyponatremia
Sexual side effects
Withdrawal Syndrome
Hepatic Impairment
True or False. With SSRIs, dose modifications are common and are required for renal impairment
False. With SSRIs, there’s caution/dose modification with hepatic impairment
True or false. SSRIs are more sedating than energy boosting.
False. The other way around
Which SSRI is available as ODT?
Citalopram
What is the dosing of Citalopram in older adults?
20 mg
What is one of the most sedating SSRIs and also can be anticholinergic and is cautioned in the elderly?
Fluvoxamine
What is the only SSRI approved for once weekly admin?
Fluoxetine
What is the Drug Interaction for Fluvoxamine?
CYP1A2
What SSRI is available as a liquid?
Fluoxetine
For which population is Citalopram 20 mg required?
- 60 years old plus
- CYP2C19 Poor Metabolizers
- Hepatic impairment
What dose is required for Escitalopram in the hepatically impaired?
10 mg
What population should be cautious or avoid paroxetine?
Avoid in the elderly
Avoid in pregnancy
*Reports of bone fracture
What is the most common drug-drug interaction with SSRIs?
CYP2D6
Side effects of SNRIs
Abnormal bleeding (5HT reuptake on platelets)
Elevated blood pressure
Hyponatremia
5HT Syndrome
Discontinuation Syndrome
True or False. SNRIs are more energy boosting than other antidepressants.
True
What SNRIs are indicated for Depression (MDD)?
Duloxetine
Desvenalfaxine
Venlafaxine
Levomilnacipram
Should you give Venlafaxine with food?
Yes
What is the dual diagnosis with Duloxetine?
Depression
Pain
In what populations should you avoid use of Duloxetine?
Hepatic Dysfunction
ESRD
What TCAs are used in Depression?
All but Clomipramine
What is the dual diagnosis with Doxepin?
Depression
Insomnia
MAOIs Precaution with Washout
Must wait 4 - 5 half lives of drug/active metabolite (usually 2 weeks)
Washout period for Fluoxetine
5 weeks
Washout period fro Vortioxetine
3 weeks
Dietary restrictions with MAOIs
Tyramine containing foods and can lead to hypertensive crisis
What formulation does Selegline come in?
Patch
***9 -12 mg - implement diet restrictions
What are your antidepressant Serotonin Modulators?
Nefadozone
Trazodone
Vilazodone
VortioxetineAISIG
