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701 > Depression > Flashcards

Depression Flashcards

1
Q

What are some drugs that can contribute to depression?

A
  • Beta blocker
  • CCBs
  • Oral contraceptives
  • Steroids
  • ALL ANTIEPILEPTIC DRUGS
  • Opioids
  • Stimulants
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2
Q

What is the major BBW on antidepressants?

A

Increased risk of suicide in children and young adults up to 24 years old

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3
Q

What is AUVELITY?

A

The only oral NMDA receptor antagonist approved for treatment of MDD in adults (dextromethorphan + bupropion)

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4
Q

What are CI to AUVELITY?

A
  • Seizure disorder (has bupropion)
  • Eating disorder
  • Within 14 days of MAOIs
  • Elevated blood pressure + HTN
  • Serotonin syndrome
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5
Q

What should you do if a patient has a 50% reduction in symptoms after 4 weeks of antidepressant therapy?

A

Continue the patient and reevaluate at weeks 6, 8, and 12

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6
Q

What should you do if a patient has persistent symptoms after 4-8 on an adequate dose of an antidepressant?

A

Switch to an alternative AD, augment with an alternative MOA AD, SGA, psychotherapy

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7
Q

What should you do if a patient has a partial or no response 1-4 weeks after starting an antidepression?

A

Assess adherence
Increase dose if possible
Consider ECT

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8
Q

What can a patient expect on their first week of an antidepressant?

A

Things get WORSE
- Increased anxiety
- Improved sleep/appetite
- N/V, diarrhea

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9
Q

What can a patient expect on weeks 1-3 of an antidepressant?

A
  • Increased activity, sex drive, self care, memory
  • Thinking and movement more normal
  • Sleeping and eating more normal
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10
Q

What can a patient expect on weeks 2-4 of an antidepressant?

A
  • Relief of depressed mood
  • Thoughts of suicide begin to subside
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11
Q

SSRI pearls

A
  • Insomnia or sedation (take in the morning/switch for insomnia)
  • Sexual dysfunction (switch or bupropion or other)
  • Serotonin syndrome (mental changes, neuromuscular issues, GI)
  • QTc, torsades
  • Bleeding risk
  • Discontinuation syndrome (except fluoxetine)
  • More likely energy boosting than sedating
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12
Q

Citalopram

A

SSRI
- QTc warning from FDA -> avoid in older adults
- ODT available

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13
Q

Escitalopram

A

SSRI
- Isomer of citalopram
- Does NOT have QTc or dose warning

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14
Q

Fluvoxamine

A

SSRI
- Not very used
- Caution in elderly
- Many 1A2 interactions
- One of the most sedating
- Can be anticholinergic (less tolerable)

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15
Q

Fluoxetine

A

SSRI
- Long half life
- Once weekly admin available
- Liquid available
- Diminish appetite, weight loss possible

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16
Q

Paroxetine

A

SSRI
- Bone fracture
- Don’t use in older adults, very sedating
- Don’t use in pregnancy
- Very anticholinergic
- Short half life -> you feel it if you miss a dose

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17
Q

Sertraline

A

SSRI
- Well tolerated, efficacious
- Has concentrate that can ONLY mixed with water

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18
Q

What is fluvoxamine’s only FDA approved use?

A

OCD

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19
Q

What is citalopram’s only FDA approved use?

A

MDD

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20
Q

What is escitalopram FDA approved for?

A

MDD, GAD

21
Q

What is fluoxetine NOT FDA approved for?

A

GAD, PTSD, SAD

22
Q

What is paroxetine NOT FDA approved for?

A

Bulimia nervosa, BPI depressive episodes

23
Q

What is sertraline NOT FDA approved for?

A

GAD, Bulimia nervosa, BPI depressive episodes

24
Q

SNRIs

A

Tend to be more energy boosting, cause more mania, and cause more HTN than SSRIs

25
Q

Venlafaxine

A

SNRI
- Give with food, swallow whole
- BP changes*

26
Q

Duloxetine

A

SNRI
- Cannot use with any kind of hepatic disease or impairment

27
Q

What is desvenlafaxine’s only FDA approved indication?

A

MDD

28
Q

What is levomilnacipran’s only FDA approved indication?

A

MDD

29
Q

What is duloxetine NOT FDA approved for?

A

Panic disorder, social phobia

30
Q

What is venlafaxine NOT FDA approved for?

A

fibromylagia, musculoskeletal pain, neuropathic pain

31
Q

TCAs

A
  • Highly anticholinergic
  • Highly lethal in overdose (cardiac block) - avoid in suicidal risk
  • Do not use in cardiac complications
  • Doxepin now for insomnia low dose
32
Q

MAOis

A
  • DDIs or drug-food interactions (tyramine) -> fatal hypertensive crisis
  • 2 week, 4-5 half life washout for most ADs (5 weeks for fluoxetine, 3 weeks for vortioxetine)
  • Serotonin syndrome risk (DXM, amphetamines, decongestants)
  • Last resort
33
Q

Selegiline

A

MAOi
- Available as a patch (must implement dietary restrictions at higher dose)

34
Q

Nefazodone

A

Serotonin modulator
- BBW of severe hepatic failure (life threatening)
- Only for specific needs

35
Q

Trazodone

A

Serotonin modulator
- Sedating, often misused in sleep to offset stimulating effect of another drug
- Increases risk of serotonin syndrome
- Priapism possible

36
Q

Vilazodone

A

Serotonin modulator

37
Q

Bupropion

A

Miscellaneous MDD
- Big risk of seizures, especially in eating disorders (electrolyte imbalance)
- HTN, insomnia, activation, and anxiety ADEs

38
Q

Mirtazapine

A

Miscellaneous MDD
- Significant weight gain
- Sedating (good for insomnia)
- Cholesterol/LFT elevation

39
Q

Spravato (Esketamine) nasal spray

A

Treatment resistant depression (failed 2 others)
- Only in combo with oral antidepression
- NMDA antagonist
- Causes increased blood pressure -> CI with vascular disease, intracerebral hemorrhage
- Can cause inability to operate machinery
- BBW for sedation, dissociation, abuse/misuse, suicide
- REMS program - taken in front of health care provider and monitored for 2 hours

40
Q

Brexanolone

A

For post-partum depression
- Only as IV infusion
- Takes 60 hours
- Hypoxia, excessive sedation
- Not CI in pregnancy but not recommended

41
Q

What antidepressant should be avoided in seizure disorders?

A

Bupropion

42
Q

What antidepressant should be avoided in substance abuse?

A

Benzos

43
Q

What antidepressant should be avoided in cardiac complications?

A

TCAs

44
Q

What antidepressant should be avoided in GI bleeding and anticoagulation?

A

SSRIs/SNRIs

45
Q

What antidepressants are preferred in elderly patients?

A

SSRI

AVOID TCA and paroxetine!! - anticholinergic

46
Q

What antidepressants should be avoided in pregnancy?

A

Paroxetine - anticholinergic

47
Q

Lithium

A

Augmentation first line after failed monotherapy
Evidence primarily with TCAs

48
Q

SGA augmentation

A
  • Aripiprazole, Brexpiprazole, Quetiapine
  • Olanzapine (WITH FLUOXETINE)
    Monitor metabolic effects
49
Q

Which foods have tyramine

A

Pickled, smoked, aged, yeast extracts

701 (11 decks)

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