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Depression Flashcards

1
Q

What are the neurotransmitters are believed to be involved in depression?

A

5-HT, NE, Epi, DA, Glutamate, and Ach

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2
Q

How do we diagnose depression?

A

DSM5, HAM-D (HDRS)

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3
Q

What is the DSM criteria for depression?

A

Sleep (increased/decreased)
Interest/pleasure (diminished)
Guilt or feelings of worthlessness

Mood (depressed)
Energy (decreased)

Concentration (decreased)
Appetite (increased/decreased)
Psychomotor agitation or retardation
Suicidal ideation

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4
Q

Natural products used for depression?

A

St John’s, SAMe, 5-HTP

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5
Q

What is first line for depression during pregnancy?

A

Psychotherapy

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6
Q

What are the first line medications for depression during pregnancy? Which agents do you avoid?

A

Sertraline and escitalopram

Paroxetine should be avoided for cardiac effects

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7
Q

What are the potential risks focusing SSRIs during pregnancy?

A

Persistent pulmonary HTN of the newborn

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8
Q

What is first line for postpartum depression?

A

SSRIs
IV brexanolone and PO zuranolone but can’t cause excessive sedation

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9
Q

Antidepressants that have higher risk of withdrawal symptoms? Which is an exception?

A

Paroxetine and venlafaxine

Fluoxetine

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10
Q

What is the BBW of all antidepressants?

A

Increase in suicidal thoughts or actions in teenagers or young adults

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11
Q

When do you see a resolution in depressive symptoms?

A

Physical symptoms (low energy): 1-2 weeks
Psychological symptoms (low mood): a month or longer

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12
Q

What are the SSRIs?

A

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fuvoxamine

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13
Q

Citalopram

A

Celexa

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14
Q

Escitalopram

A

Lexapro

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15
Q

Fluoxetine

A

Provac

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16
Q

Sertraline

A

Zoloft

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17
Q

Paroxetine

A

Paxil

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18
Q

What is the indication for fluvoxamine?

A

OCD

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19
Q

CI for SSRIs?

A

Serotonin medications: MOAI, linezolid, IV methylene blue

Induce serotonin syndrome

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20
Q

What is used for moderate-severe vasomotor sx with menopause?

A

Paroxetine (Brisdelle)

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21
Q

SSRIs associated with QTc prolongation. How should they be adjusted?

A

Citalopram max dose for >60 YO: 20 mg/d

Escitalopram max dose for >60YO: 10 mg/d

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22
Q

What is the most activating SSRI?

A

Fluoxetine should be taken in AM

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23
Q

What is the most sedating SSRI?

A

Paroxetine and fluvoxamine should be taken in PM

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24
Q

SSRIs needed for premenstrual dysphoric disorder?

A

Fluoxetine, Paxil CR, Sertraline

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25
Antidepressant preferred for cardiac risk?
Sertraline
26
ADRs associated with SSRIs?
Sexual ADR: decreased libido, ED, ejaculation difficulties, anorgasmia Somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, DZ, HA Bleeding risk SIADH/hyponatremia, fall risk
27
What is the washout period between MAOIs and SSRIs?
2 weeks Fluoxetine is 5 weeks due to long half-life
28
Drugs that can ↑ bleeding risk of SSRIs and SNRIs?
Anticoagulants, antiplatelets, NSAIDs, ginko, ginger, garlic, glucosamine, ginseng, fish oil
29
Which of the SSRIs are CYP2D6 inhibitors? DDI?
Fluoxetine, paroxetine, and fluvoxamine Decreases tamoxifen effectiveness, venlafaxine is preferred with combinations
30
What makes Vilazodone and Vortioxetine different from the other SSRIs?
Vilazodone (Viibryd): SSRI and 5-HT1A Partial Agonist Vortioxetine (Trintellix): SSRI and 5-HT3 receptor antagonist and 5-HT1A agonist Less sexual side effects
31
What are the SNRIs?
Venlafaxine Duloxetine Desvenlafaxine
32
Venlafaxine
Effexor XR
33
Duloxetine
Cymbalta
34
Desvenlafaxine
Pristiq
35
How does the side effects of SNRI correlate with MOA?
5-HT: decreased libido, ED, ejaculation difficulties, anorgasmia NE: increased HR, dilated pupils, dry mouth, excessive sweating and constipation Increased BP: venlafaxine is >150 mg/d Bleeding risk, SIADH/hyponatremia, fall risk
36
What antidepressant leaves a ghost tablet
Pristiq
37
What SNRI causes the most QTc prolongation?
Venlafaxine
38
What is the washout period when switching to SSRI or MAOI from SNRI?
14 days
39
What SNRI could be cautioned with tamoxifen? Why?
Duloxetine is a CYP2D6 inhibitor that can ↓ tamoxifen effectiveness
40
Indications for duloxetine
1. Depression 2. Peripheral neuropathy 3. Fibromyalgia 4. GAD 5. Chronic musculoskeletal pain
41
Indications for venlafaxine?
1. Depression 2. GAD 3. Panic disorder 4. Social anxiety
42
How does TCAs differ from serotonin antidepressants?
Block AcH and histamine receptors Secondary amine: selective for NE Tertiary amine: More effective but worse ADRs, increased anticholinergic effects causing more sedation and weigh gain
43
What are the tertiary amines?
Amitriptyline Doxepin Clomipramine Imipramine Trimipramine
44
Indication for Silenor
Insomnia
45
Amitriptyline
Elavil
46
What are the secondary amine TCAs?
Nortripyline Amoxapine Desipramine Maprotiline Protriptyline
47
Nortriptyline
Pamelor
48
CI for TCAs?
MOAIs, linezolid, IV methylene blue, MI, glaucoma and urinary retention (doxepin)
49
TCA washout period from MAOI
2 weeks
50
ADRs of TCAs?
QTc prolongation and suicidal ideations with overdose leading to fatal arrhythmias Anticholinergic: dry mouth, urinary retention, blurred vision, constipation, vivid dreams, and weight gain Risk of falls High doses can ↑ seizures
51
How is Bupropion MOA different from other antidepressants?
Dopamine and NE reuptake inhibitor
52
Bupropion Indications
Wellbutrin XL and SR: depression and SAD Bupropion SR (Zyban): smoking cessation + Naltrexone (Contrave): weight management
53
How do you reduce seizure risk for bupropion?
Do not exceed 450 mg/day
54
CI of bupropion?
1. SX disorder 2. Hx of anorexia/bulemia 3. Avoid MOAI, linezolid, IV methylene blue, and other bupropion products
55
ADRs of bupropion
Dry mouth, CNS stimulation (insomnia, restlessness), tremors/seizures, weight loss Sexual disfunction is rare due to lack of serotonin activity
56
Why is there a washout period between bupropion and MOAI
Increased risk of hypertensive crisis
57
MOAI MOA
Inhibit the enzyme monoamine oxidase that breaks down catecholamines (5-HT, NE, Epi, and DA)
58
MOA inhibitors
Isocarboxazid Phenelzine Tranylcyorimine Selegiline
59
Isocarboxazid
Marplan
60
Phenelzine
Nardil
61
Tranylcypromine
Parnate
62
How is selegiline different?
Selective MOA-B inhibitor transdermal patch
63
ADRs of MOAIs?
Anticholinergic effects (taper) Orthostasis Sedation Sexual dysfunction, weight gain, HA, insomnia
64
Interactions with MOAIs?
HTN crisis and serotonin syndrome can occur when taken with TCAss, SSRIs, SNRIs, and tyramine rich foods
65
CI of MOAIs?
Pheochromocytoma
66
Examples of tyramine-rich foods?
Aged cheese, pickled herring, yeast extract, air-dried meats, sauerkraut, soy sauce Fermented, aged, smoked, or pickled foods
67
Mirtazapine
Remeron, Remeron SolTab
68
Trazodone
Desyrel
69
Indications for Remeron? MOA
Sleep and increased appetite MOA: TCA that has central presynaptic alpha-2 adrenergic antagonist effects that ↑ NE and 5-HT
70
ADR of mirtazapine?
Sedation, appetite, weight gain QTc prolongation
71
MOA of trazodone
5-HT reuptake inhibitor and blocks H1 and a1 adrenergic receptor
72
ADR of trazadone
Sedation, orthostasis, sexual dysfunction, priapism QTc prolongation
73
MOA of nefazodone
5-HT and NE reuptake inhibitors blocks 5-HT2 and a1 adrenergic receptors
74
Why is nefazodone rare used>
Hepatotoxicity
75
How long should a drug be used before stating its not working??
4-8 wks
76
What are some strategies if a patient is unresponsive to treatment?
1. Change AD 2. ↑ dose 3. Combo 4. Augment with buspirone or low dose atypical antipsychotics 5. Augment with lithium, T3, or ECT
77
tx for resistant depression?
Aripiprazole Olanzapine/fluoxetine Quetiapine Brexipiprazole Cariprazine Esketamine Buspirone
78
Aripiprazole
Abilify
79
Olanzapine/fluoxetine
Symbyax
80
Quetiapine
Seroquel
81
Brexipiprazole
Rexulti
82
Cariprazine
Vraylar
83
BBW with antipsychotics
Elderly patients with dementia-related psychosis there is increased mortality
84
Ariprazole ADR
Anxiety, insomnia, akathisia
85
Olanzapine ADR
Sedation, weight gain, lipids and BG, EPS, lower risk QTc prolonagtion
86
Quetiapine ADR
Sedation, orthostasis, weight gain, lipids, BG, EPS (lower risk)
87
BRexiprazole ADR
Weight gain, dyspepsia, diarrhea, agitation
88
Cariprazine
EPS, dystonia, HA, insomnia
89
What schedule is Esketamine
C3
90
How should Esketamine be administered?
Nasal spray administered under the supervision of HCP and monitor for ADR for at least 2 hrs REMS
91
BBW for esketamine
Sedation, dissociative or perceptual changes, potential for abuse and misuse

NAPLEX Prep (23 decks)

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