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NAPLEX Prep > Depression > Flashcards

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
Q

Antidepressant preferred for cardiac risk?

A

Sertraline

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26
Q

ADRs associated with SSRIs?

A

Sexual ADR: decreased libido, ED, ejaculation difficulties, anorgasmia

Somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, DZ, HA

Bleeding risk

SIADH/hyponatremia, fall risk

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27
Q

What is the washout period between MAOIs and SSRIs?

A

2 weeks

Fluoxetine is 5 weeks due to long half-life

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28
Q

Drugs that can ↑ bleeding risk of SSRIs and SNRIs?

A

Anticoagulants, antiplatelets, NSAIDs, ginko, ginger, garlic, glucosamine, ginseng, fish oil

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29
Q

Which of the SSRIs are CYP2D6 inhibitors? DDI?

A

Fluoxetine, paroxetine, and fluvoxamine

Decreases tamoxifen effectiveness, venlafaxine is preferred with combinations

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30
Q

What makes Vilazodone and Vortioxetine different from the other SSRIs?

A

Vilazodone (Viibryd): SSRI and 5-HT1A Partial Agonist

Vortioxetine (Trintellix): SSRI and 5-HT3 receptor antagonist and 5-HT1A agonist

Less sexual side effects

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31
Q

What are the SNRIs?

A

Venlafaxine
Duloxetine
Desvenlafaxine

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32
Q

Venlafaxine

A

Effexor XR

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33
Q

Duloxetine

A

Cymbalta

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34
Q

Desvenlafaxine

A

Pristiq

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35
Q

How does the side effects of SNRI correlate with MOA?

A

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

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36
Q

What antidepressant leaves a ghost tablet

A

Pristiq

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37
Q

What SNRI causes the most QTc prolongation?

A

Venlafaxine

38
Q

What is the washout period when switching to SSRI or MAOI from SNRI?

39
Q

What SNRI could be cautioned with tamoxifen? Why?

A

Duloxetine is a CYP2D6 inhibitor that can ↓ tamoxifen effectiveness

40
Q

Indications for duloxetine

A
  1. Depression
  2. Peripheral neuropathy
  3. Fibromyalgia
  4. GAD
  5. Chronic musculoskeletal pain
41
Q

Indications for venlafaxine?

A
  1. Depression
  2. GAD
  3. Panic disorder
  4. Social anxiety
42
Q

How does TCAs differ from serotonin antidepressants?

A

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
Q

What are the tertiary amines?

A

Amitriptyline
Doxepin
Clomipramine
Imipramine
Trimipramine

44
Q

Indication for Silenor

45
Q

Amitriptyline

46
Q

What are the secondary amine TCAs?

A

Nortripyline
Amoxapine
Desipramine
Maprotiline
Protriptyline

47
Q

Nortriptyline

48
Q

CI for TCAs?

A

MOAIs, linezolid, IV methylene blue, MI, glaucoma and urinary retention (doxepin)

49
Q

TCA washout period from MAOI

50
Q

ADRs of TCAs?

A

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
Q

How is Bupropion MOA different from other antidepressants?

A

Dopamine and NE reuptake inhibitor

52
Q

Bupropion Indications

A

Wellbutrin XL and SR: depression and SAD

Bupropion SR (Zyban): smoking cessation
+ Naltrexone (Contrave): weight management

53
Q

How do you reduce seizure risk for bupropion?

A

Do not exceed 450 mg/day

54
Q

CI of bupropion?

A
  1. SX disorder
  2. Hx of anorexia/bulemia
  3. Avoid MOAI, linezolid, IV methylene blue, and other bupropion products
55
Q

ADRs of bupropion

A

Dry mouth, CNS stimulation (insomnia, restlessness), tremors/seizures, weight loss

Sexual disfunction is rare due to lack of serotonin activity

56
Q

Why is there a washout period between bupropion and MOAI

A

Increased risk of hypertensive crisis

57
Q

MOAI MOA

A

Inhibit the enzyme monoamine oxidase that breaks down catecholamines (5-HT, NE, Epi, and DA)

58
Q

MOA inhibitors

A

Isocarboxazid
Phenelzine
Tranylcyorimine
Selegiline

59
Q

Isocarboxazid

60
Q

Phenelzine

61
Q

Tranylcypromine

62
Q

How is selegiline different?

A

Selective MOA-B inhibitor transdermal patch

63
Q

ADRs of MOAIs?

A

Anticholinergic effects (taper)
Orthostasis
Sedation
Sexual dysfunction, weight gain, HA, insomnia

64
Q

Interactions with MOAIs?

A

HTN crisis and serotonin syndrome can occur when taken with TCAss, SSRIs, SNRIs, and tyramine rich foods

65
Q

CI of MOAIs?

A

Pheochromocytoma

66
Q

Examples of tyramine-rich foods?

A

Aged cheese, pickled herring, yeast extract, air-dried meats, sauerkraut, soy sauce

Fermented, aged, smoked, or pickled foods

67
Q

Mirtazapine

A

Remeron, Remeron SolTab

68
Q

Trazodone

69
Q

Indications for Remeron? MOA

A

Sleep and increased appetite

MOA: TCA that has central presynaptic alpha-2 adrenergic antagonist effects that ↑ NE and 5-HT

70
Q

ADR of mirtazapine?

A

Sedation, appetite, weight gain

QTc prolongation

71
Q

MOA of trazodone

A

5-HT reuptake inhibitor and blocks H1 and a1 adrenergic receptor

72
Q

ADR of trazadone

A

Sedation, orthostasis, sexual dysfunction, priapism

QTc prolongation

73
Q

MOA of nefazodone

A

5-HT and NE reuptake inhibitors blocks 5-HT2 and a1 adrenergic receptors

74
Q

Why is nefazodone rare used>

A

Hepatotoxicity

75
Q

How long should a drug be used before stating its not working??

76
Q

What are some strategies if a patient is unresponsive to treatment?

A
  1. Change AD
  2. ↑ dose
  3. Combo
  4. Augment with buspirone or low dose atypical antipsychotics
  5. Augment with lithium, T3, or ECT
77
Q

tx for resistant depression?

A

Aripiprazole
Olanzapine/fluoxetine
Quetiapine
Brexipiprazole
Cariprazine
Esketamine
Buspirone

78
Q

Aripiprazole

79
Q

Olanzapine/fluoxetine

80
Q

Quetiapine

81
Q

Brexipiprazole

82
Q

Cariprazine

83
Q

BBW with antipsychotics

A

Elderly patients with dementia-related psychosis there is increased mortality

84
Q

Ariprazole ADR

A

Anxiety, insomnia, akathisia

85
Q

Olanzapine ADR

A

Sedation, weight gain, lipids and BG, EPS, lower risk QTc prolonagtion

86
Q

Quetiapine ADR

A

Sedation, orthostasis, weight gain, lipids, BG, EPS (lower risk)

87
Q

BRexiprazole ADR

A

Weight gain, dyspepsia, diarrhea, agitation

88
Q

Cariprazine

A

EPS, dystonia, HA, insomnia

89
Q

What schedule is Esketamine

90
Q

How should Esketamine be administered?

A

Nasal spray administered under the supervision of HCP and monitor for ADR for at least 2 hrs

REMS

91
Q

BBW for esketamine

A

Sedation, dissociative or perceptual changes, potential for abuse and misuse

NAPLEX Prep (2 decks)

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