Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

neurology/psychiatry > Depression > Flashcards

Depression Flashcards

1
Q

DSM-5 criteria for MDD

A

5 symptoms present during the same 2 week period
depressed mood or decreased interest + 4 symptoms from DSIGECAPS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DSIGECAPS

A

depressed mood
sleep
interest
guilt
energy
concentration
appetite
psychomotor
suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

onset of MDD

A

most commonly late 20s but can develop at any age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

duration of MDD

A

median time to recovery is 20 weeks with adequate treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

__% of patients with a single episode with recover without recurrence

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what defines a RESPONSE to treatment

A

> 50% reduction in symptom severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what defines REMISSION

A

absence of depressive symptoms (or only 1-2 mild symptoms) for >2 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

goal of acute phase

A

remission
select initial agent based on patient factors, optimize regiment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

goal of continuation phase

A

prevent RELAPSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

goal of maintenance phae

A

prevent RECURRENCE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

monoamine hypothesis

A

depressive symptoms related to deficiencies in 5HT, NE, DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

dysregulation hypothesis

A

depression results from dysregulation of neurotransmitters that leads to alterations in pre & post receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

neuroendocrine hypothesis

A

dysregulation of thyroid & HPA axis results in depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SSRI mechanism

A

inhibit reuptake of 5HT in the presynaptic neuron of CNS–> leading to increased serotonin in synaptic cleft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SSRI place in therapy

A

first line for MDD: well tolerated, low toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

SSRI (general) dosing

A

daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

SSRI drugs

A

citalopram
escitalopram
sertraline
paroxetine
fluoxetine
fluvoxamine
vortioxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

COMMON ssri side effects

A

n/v
headache
sleep changes
increased anxiety/agitation or sedation
sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SERIOUS ssri side effects

A

hyponatremia
increased bleeding/bruising
serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

most ACTIVATING ssri

A

fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

most SEDATING ssri

A

paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the “dirty ssri” and why

A

paroxetine: it is anticholinergic and antihistaminic, more sexual dysfunction, most weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which ssri causes the most diarrhea and why

A

sertraline: it can affect serotonin in the gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

which ssris have most QT prolongation risk

A

citalopram
escitalopram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

SNRI mechanism

A

inhibits the reuptake of serotonin and norepinephrine presynaptically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

SNRI place in therapy

A

first/second line for MDD: low toxicity, addition mechanism with NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the SNRIs

A

venlafaxine
duloxetine
desvenlafaxine
levomilnacipran

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are common side effects of SNRIs

A

same as SSRIs PLUS dose-dependent BP elevation, constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are serious side effects of SNRIs

A

hyponatremia, increased bleeding/bruising, serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

SARIs

A

trazodone, nefazodone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

SARI mechanism

A

5HT2A and 5HT2C receptor antagonist (post-synaptic)
inhibits serotonin reuptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

SARI place in therapy

A

not usually first or second line because too sedating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

SARI adverse effects

A

sedation, dizziness, orthostatic hypotension, priapism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

trazodone is used for

A

most commonly for insomnia rather than MDD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

nefazodone boxed warning

A

liver failure
not first line due to this toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

NDRI mechanism

A

inhibits reuptake of norepi and dopamine, no serotonin activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

NDRI place in therapy

A

first or second line treatment of MDD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

NDRI drug

A

bupropion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

NDRI side effects

A

activation (insomnia, agitation, tremor), weight loss, headache, n/v, constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

benefits of NDRI

A

fatigue, poor concentration, smoking cessation

41
Q

NDRI contraindications

A

bulimia, anorexia, seizure disorders
appetite suppression & lowers seizure threshold

42
Q

what does it mean that NDRI is activating

A

may exacerbate anxiety, caution in patients with psychotic features

43
Q

NDRI can be used for?

A

ssri-induced sexual dysfunction, smoking cessation

44
Q

NaSSa

A

mirtazapine

45
Q

NaSSa mechanism

A

primary: alpha2 antag
secondary: 5HT2, 5HT2C, 5HT3 antagonist, antihistamine

46
Q

mirtazapine place in therapy

A

considered second line

47
Q

mirtazapine side effects

A

weight gain and sedation worse at lower doses
less sexual dysfunction

48
Q

serotonin modulator

A

vilazodone

49
Q

vilazodone mechanism

A

serotonin reuptake inhibitor, 5HT1A partial agonist

50
Q

dosing vilazodone

A

daily at bedtime with food to inc bioavail

51
Q

which drug has the lowest incidence of sexual dysfunction

A

vilazodone

52
Q

TCA mechanism

A

presynaptic inhibition of NE and 5HT reuptake: increase them in synaptic cleft
varying affinity for H1, alpha, muscarinic

53
Q

TCA place in therapy

A

effective but third/fourth line due to toxicity in overdose & overall tolerability

54
Q

which TCAs are tertiary amines

A

amitriptyline
clomipramine
doxep8in
imipramine

55
Q

which TCAs are secondary amines

A

amoxapine
desipramine
nortriptyline

56
Q

what does tertiary amine mean

A

more anticholinergic, alphalytic, antihistaminergic

57
Q

what does secondary amine mean

A

more NE reuptake inhibition

58
Q

common TCA side effects

A

anticholinergic
antihistaminergic
orthostasis
photosensitivity

59
Q

serious TCA side effects

A

cardiotoxicity: QT prolongation, risk of MI
decrease seizure threshold

60
Q

what is the most anticholinergic and alphalytic TCA

A

amitriptyline

61
Q

what is amitriptyline used for

A

chronic pain, migraine

62
Q

what is the most serotonergic TCA

A

clomipramine

63
Q

what is clomipramine used for

A

OCD

64
Q

what is the most noradrenergic/lowest anticholinergic TCA

A

desipramine

65
Q

what is the most antihistaminic TCA

A

doxepin

66
Q

what is imipramine used for

A

GAD, panic disorder with agoraphobia

67
Q

what is the best tolerated TCA

A

nortriptyline

68
Q

MAOI mechanism

A

inhibition of monoamine oxidase enzymes (MAO-A & MAO-B) resulting in increased concentrations of NE, 5HT, DA in synapse

69
Q

common MAOI side effects

A

hypotension, dizzy, urinary retention, constipation, xerostomia

70
Q

serious MAOI side effects

A

hypertensive crisis (drug-food interaction)
serotonin syndrome (drug-drug interaction)

71
Q

definition of hypertensive crisis

A

diastolic BP> 120 mmHg

72
Q

symptoms of hypertensive crisis

A

occipital headache, palpitations, neck stiffness, n/v, dilated pupils/photophobia, tachy/bradycardia, chest pain

73
Q

MAOIs require dietary modifications to prevent food-drug interaction with _____

A

tyramine

74
Q

foods to avoid with MAOIs

A

dried, aged, smoked, fermented, spoiled meat/fish
broad bean pods
aged cheese
tap & non-pasteurized beer
marmite, sauerkraut
soy products/tofu

75
Q

foods allowed with MAOIs

A

fresh/processed meat
veggies
processed & cottage cheese, ricotta, yogurt
canned/bottled beers
brewer’s and baker’s yeast

76
Q

treatment of hypertensive crisis with MAOIs from tyramine

A

phentolamine
nifedipine, chlorpromazine

77
Q

drug-drug interactions with MAOIs

A

decongestants (eg sudafed)
stimulants (amphetamine, coke)
antidepressants w/ NRI (TCA, NRI, SNRI, NDRI)
appetite suppressants (phentermine)

78
Q

selegiline pearls

A

selective for MAO-B
no need for dietary restriction w/ patch
but drug-drug interactions still a concern

79
Q

phenelzine pearls

A

weight gain, hepatotoxicity

80
Q

tranylcypromine pearls

A

similar to amphetamine structurally (stimulating)
insomnia
transient hypertension

81
Q

serotonin syndrome

A

agitation, tachycardia, diarrhea, diaphoresis, clonus, tremor, hyperreflexia

82
Q

DDIs causing serotonin syndrome

A

antidepressants
other TCA-like drugs
antibiotics (linezolid)
appetite suppressants (sibutramine)
opioids

83
Q

prevention of serotonin syndrome with MAOIs

A

allow for a 2 week washout period
(5 week after fluoxetine)

84
Q

boxed warning on all antidepressants

A

suicidality in children/antidepressants up to 24 years old

85
Q

discontinuation syndrome

A

flu-like, paresthesia

86
Q

drug with most severe discontinuation syndrome

A

venlafaxine

87
Q

onset of discontinuation syndrome

A

1-2 days after d/c

88
Q

MDD treatment in pregnancy?

A

avoid paroxetine

89
Q

postpartum depression treatment?

A

SSRIs are first line

90
Q

MDD treatment in peds?

A

SSRIs: fluoxetine, escitalopram, citalopram, sertraline

91
Q

MDD treatment in elderly?

A

start low and go slow
may manifest as cognition changes

92
Q

first line in MDD treatment algorithm

A

psychotherapy, SSRI, SNRI, mirtazapine, bupropion

93
Q

improvements seen in week 1

A

decrease anxiety
increase sleep, appetite, energy

94
Q

improvements seen in week 2

A

increase activity, self care, memory, concentration

95
Q

improvements seen in week 3

A

decreased depression, hopelessness

96
Q

when is full response seen

A

4-6 weeks

97
Q

what is an adequate trial

A

6 weeks

98
Q

define treatment resistant depression

A

failure of at least 2 treatment attempts of adequate dose and duration

99
Q

options for treatment resistant depression

A

SGA
lithium
buspirone
stimulants
esketamine

neurology/psychiatry (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions