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NAPLEX > Depression > Flashcards

Depression Flashcards

0
Q

T/F? Pt needs instructions on how to respond to worsened mood, critical for adolescents and young adults?

A

True

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1
Q

Depression diagnosis criteria?

A

DSM-5 criteria - at least 5 of the ff sx during the same 2 wk period

Depressed mood

Marked diminished interest/pleasure

Significant weight loss or gain

Insomnia or hypersomnia

Psychomotor agitation or retardation

Fatigue of loss of energy

Feelings of worthlessness

Diminished ability to concentrate

Recurrent Suicidial ideation

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2
Q

What condition need to be rule-out prior to starting antidepressant therapy?

A

Bipolar disorder

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3
Q

List medications that cause or worsen depression

A

Beta-blockers, particularly propranolol

Clonidine, Corticosteroids, Cyclosporine

Ethanol

Isotretinion, Indomethacin, Interferons

Methadone, Methyldopa, Methylphenidate/ADHD meds/Atomoxetine

OCPs, anabolic steroids (Pt and medication specific)

Procainamide

Reserpine

Statins (pt specific)

Varenicline

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4
Q

List medical conditions that can cause or worsen depression

A

Stroke

Parkinson dx

Dementia

Thyroid disorders (esp, hypothyroidism)

Low Vit D levels

Metabolic conditions (hypercalcemia), Multiple sclerosis, Malignancy

OAB

Infectious dx

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5
Q

What’s the lag effect ass with antidepressant?

A

Physical sx (such as low energy) improve within a few weeks

Psychological sx (such as low mood) may take a month or longer

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6
Q

What Grp of antidepressant is pregnancy cat C? Exception?

A

SSRIs

Paroxetine (Cat. D)

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7
Q

Paroxetine is usually pregnancy cat D, which formulation of paroxetine is preg cat. X?

A

Brisdelle

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8
Q

What’s the new warning ass with SSRIs?

A

Bcuz of potential risk of persistent pulmonary hypertension of the newborn (PPHN)

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9
Q

What grp is the second recommended for pregnancy and depression?

A

Tricyclics

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10
Q

Which natural pdts may be helpful for depression?

A

St. John’s wort or SAMe (S-adenosyl-L-methionine)

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11
Q

What’s the issue with using St. John’s wort?

A

Can’t use with other serotonergic agents

Broad-spectrum CYP450 enzyme inducer and has many significant drug interactions

It’s photosensitizer and serotonergic

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12
Q

What’s a medical food pdt used for depression?

A

L-methylfolate (Deplin)

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13
Q

List SSRIs (Selective Serotonin Reuptake Inhibitors) agents

A

Fluoxetine (Prozac)

Paroxetine (Paxil)

Fluvoxamine (Luvox)

Sertraline (Zoloft)

Citalopram (Celexa)

Escitalopram (Lexapro - S-enantiomer of citalopram)

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14
Q

What’s the brand name of Fluoxetine (SSRIs)?

A

Prozac

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15
Q

What’s the brand name of Paroxetine (SSRIs)?

A

Paxil

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16
Q

What’s the brand name of Sertraline (SSRIs)?

A

Zoloft

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17
Q

What’s the brand name of Citalopram (SSRIs)?

A

Celexa

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18
Q

What’s the brand name of Escitalopram (SSRIs)?

A

Lexapro (S-enantiomer of citalopram)

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19
Q

CI to SSRIs use?

A

Potentially lethal DI with MAOIs

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20
Q

General SE of SSRIs?

A

Sexual SE: reduced libido, ejaculation difficulties, anorgasmia

Somnolence

Insomnia

Nausea

Xerostomia

Diaphoresis (dose-related)

Weakness

Tremor

Dizziness

Headache (may help for migraines if taken continuously)

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21
Q

SE specific to Fluoxetine?

A

Fluoxetine may be activating. Take dose in AM to prevent this

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22
Q

Which SSRIs SE is of more concern in elderly?

A

SIADH

Hyponatremia

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23
Q

What may cause an increase in bleeding while using SSRIs?

A

Concurrent use of:

Anticoagulants

Antiplatelet

NSAIDs

Ginkgo

Thrombolytics

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24
Q

Which SSRI has FDA warning of QT prolongation? In what grp? At what dose?

A

Citalopram

At > 40mg/day

60+ years - > 20mg/day

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25
Q

How do u switch from fluoxetine daily to fluoxetine weekly?

A

Start 7 days after last daily dose

Weekly fluoxetine is dosed at 90mg/week

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26
Q

What agent is the SSRI and 5-HT1A partial agonist?

A

Vilazodone (Viibryd)

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27
Q

Is food a consideration when using Vilazodone (Viibryd), a SSRI and 5-HT1A Partial Agonist?

A

Yes.

Use with food

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28
Q

SEs of Vilazodone (Viibryd), a SSRI and 5-HT1A Partial Agonist?

A

Reduced libido (but less sexual SEs compared to SSRI and SNRIs)

Diarrhea

Nausea/vomiting

Insomnia

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29
Q

Bleeding risk and Vilazodone (Viibryd)?

A

Same as SSRIs (increased bleeding risk with concurrent use of anticoagulants, antiplatelets, NSAIDs, gingko, thrombolytics

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30
Q

List agent that’s SSRI, 5-HT3-1D, 5-HT7 receptor antagonist; 5-HT1A Agonist; and Partial 5-HT1B agonist

A

Vortioxetine (Brintellex)

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31
Q

SEs of Vortioxetine (Brintellex)?

A

Same as SSRIs and Vilazodone (increased bleeding risk with concurrent use of anticoagulants, antiplatelets, NSAIDs, gingko, thrombolytics

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32
Q

All SSRI req a 2-wk washout period when going to an MAOI or from an MAOI to an SSRI, except?

A

Fluoxetine.

Req a 5-week washout period (due to long half-life of at least 7days)

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33
Q

Whats the top choice for antidepressant in cardiac pts?

A

Sertraline

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34
Q

How should sertraline oral concentrate be used?

A

Must be diluted before use

Don’t use with disulfiram

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35
Q

List Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs ) agents

A

Venlafaxine (Effexor, Effexor XR)

Duloxetine (Cymbalta)

Desvenlafaxine (Pristiq)

Levomilnacipran (Fetzima)

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36
Q

What’s the brand name of Venlafaxine (SNRIs)?

A

Effexor

Effexor XR

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37
Q

What’s the brand name of Duloxetine (SNRIs)?

A

Cymbalta

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38
Q

What’s the brand name of Desvenlafaxine (SNRIs)?

A

Pristiq

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39
Q

CI to SNRIs use?

A

Potentially lethal DI: SNRIs and MAOIs (2 wks washout req)

40
Q

In addition to SEs similar to SNRIs, what other SE is a concern for SNRIs?

A

Increase in BP

41
Q

In what SNRIs is the increase in BP risk greatest?

A

Venlafaxine when dosed > 150mg/day

42
Q

SNRIs and bleeding risk?

A

Same as SSRIs, Vortioxetine (Brinand Vilazodone (increased bleeding risk with concurrent use of anticoagulants, antiplatelets, NSAIDs, gingko, thrombolytics

43
Q

SNRIs, SSRIs, Tricyclics and MAOI?

A

Same as SSRIs…..2 wk wash out if going to or from MAOI

Fluoxetine req 5 wk wash

44
Q

Linezolid or methylene blue IV and SSRI, SNRIs, Vilazodone (Viibryd), Vortioxetine (Brintellex)?

A

Avoid staring SSRIs, etc if pt is on Linezolid and methylene blue IV

45
Q

What med decreases the effectiveness of Duloxetine?

A

Tamoxifen

46
Q

T/F? Duloxetine is a 2D6 inhibitor?

A

True

47
Q

What counseling pt is unique to Desvenlafaxine and bowel movements?

A

Pt may see what looks like a tab in their stool. This is the empty shell from the tablet after the medicine was absorbed by your body

48
Q

Effect of alcohol and Levomilnacipran?

A

Alcohol may cause the med to be released quickly

49
Q

How long does it take to feel a benefit from SSRI and SNRIs? To feel the full effect on mood?

A

1-2 wks

6-8 wks

50
Q

MOA of Tricyclics?

A

Tertiary Amines

  • Amitriptyline
  • Doxepin
  • Clomipramine
  • Imipramine
  • Trimipramine

Secondary Amines

  • Amoxapine
  • Desipramine (Norpramine)
  • Maprotiline
  • Nortriptyline (Pamelor)
  • Protriptyline (Vivactil)
51
Q

What’s the difference btw tertiary and secondary amines (Tricyclics)?

A

Secondary amine - relatively selective for NE

Tertiary amine - may be slightly more effective, but have worse SE profile

52
Q

What’s the dosing of Amitriptyline (Tricyclics)?

A

Depression - 100-150mg bid

Neuropathic pain/migraine prophylaxis: 10-50mg QHS

53
Q

What’s the dosing of Nortriptyline (Tricyclics)?

A

Depression: 25mg TID-QID

54
Q

What’s the dosing of Doxepin (Tricyclics)?

A

Depression: 100-300mg daily

55
Q

Main SEs of tricyclics?

A

Cardiotoxicity (esp Orthostasis)

Anticholinergic (dry mouth, blurred vision, urinary retention, constipation)

56
Q

What’s the cardiotoxic SE of Tricyclics?

A

QT prolongation with overdose

Orthostasis

Tachycardia

57
Q

What’s the anticholinergic SE of Tricyclics?

A

Dry mouth

Blurred vision

Urinary retention

Constipation (may use a stool softener or laxative)

58
Q

What SEs usually go away with time from Tricyclics use?

A

Anxiety or Insomnia or Vivid dreams

59
Q

Which antidepressant is a good choice if a pt has both pain and depression?

A

Duloxetine

60
Q

Which antidepressant is a good choice if a pt has neuropathic pain/ migraine prophylaxis?

A

Amitriptyline 10-50mg QHS

61
Q

MOA of MAOIs?

A

Inhibit enzyme monoamine oxidase, which breaks down catecholamines, including 5-HT, NE, EPU, DA. If these NTs increase dramatically, hypertensive crisis and death can result

62
Q

List of MAOI agents used in depression

A

Isocarboxazid (Marplan)

Phenelzine (Nardil)

Tranycypromine (Parnate)

63
Q

CI to monoamine oxidase inhibitors (MAOI) use?

A

Not commonly used, but watch out for drug-drug and drug-food interactions

64
Q

What’s the brand name of Isocarboxazid (MAOIs) used in depression?

A

Marplan

65
Q

What’s the brand name of Phenelzine (MAOIs) used in depression?

A

Nardil

66
Q

What’s the brand name of Tranylcypromine (MAOIs) used in depression?

A

Parnate

67
Q

SEs of MAOIs?

A

Anticholinergic effect (dry eyes, dry mouth, constipation, urinary retention)

Orthostasis

Sedation (except Tranylcypromine (Parnate), which causes stimulation)

Sexual dysfunction

Weight gain

Headache

Insomnia

68
Q

Name the MAOI that comes in a patch?

A

Selegiline (Emsam)

69
Q

What types of food should be avoided when using MAOIs?

A

Tyramine-rich foods anything aged, fermented, pickled or smoked

70
Q

Emsam (Selegiline) patch application?

A

Change once daily

Pick a time of the day u can remember.

Apply to either outer surface of the upper arm.

Rotate site and don’t use same site 2 days in a row

Wash hands with soap after applying

Don’t expose to heat

Washout period includes patch

71
Q

List Dopamine (DA) and Norepinephrine (NE) Reuptake inhibitors agents

A

Bupropion

Mirtazapine (Remeron)

Trazodone

Nefazodone

72
Q

What’s the brand name of Bupropion used in depression?

A

Aplenzin

Budeprion SR, Budeprion XL,

Wellbutrin SR and XL, Wellbutrin,

Forfivo XL

73
Q

CIs to Bupropion use?

A

Seizure disorder

Don’t exceed 450mg/d due to seizure risk

Bipolar disorder

Anorexic

74
Q

SEs of Bupropion?

A

Dry mouth

Insomnia

Tremors/seizures (dose-related)

75
Q

Bupropion has no effect on serotonin (5-HT), effect of this?

A

No sexual dysfunction

76
Q

What’s the brand name of Mirtazapine (DA and NE Reuptake inhibitor)?

A

Remeron

77
Q

SEs of Mirtazapine (Remeron)?

A

Sedation

Increase appetite, weight gain

78
Q

Whys Trazodone rarely used?

A

Sedation

79
Q

What’s a se of Trazodone, that’s a medical emergency?

A

Risk of Priapism

80
Q

SE of Nefazodone?

A

Hepatoxicity (t4, rarely used)

81
Q

CI to bupropion use

A

Any pt on Buproban or Zyban for smoking cessation; same drug

Any to with seizure hx; Bupropion lowers seizure threshold

82
Q

What’s the max single dose and daily dose of Bupropion?

A

Max single dose: 150mg

Max daily dose: 450mg

83
Q

When should Mirtazapine (Remeron) be used?

A

At night, it’s sedating and increases appetites

84
Q

What must be done to classify depression as tx resistance depression?

A

Rule-out bipolar disorder

Check if antidepressant is at optimal dose, sometimes use combo standard antidepressants

Augment with various options

85
Q

List agents that are used in Tx Resistance Depression Only

A

Aripiprazole (Abilify, Abilify Discmelt)

Olanzapine/Fluoxetine (Symbyax)

Quetiapine extended release (Seroquel, Seroquel XR)

86
Q

What’s the brand name of Aripiprazole for Tx Resistance Depression?

A

Abilify

Abilify Discmelt

87
Q

What’s the brand name of Olanzpine/Fluoxetine for Tx Resistance Depression?

A

Symbyax

88
Q

What’s the brand name of Quetiapine extended release for Tx Resistance Depression?

A

Seroquel

Seroquel XR

89
Q

What’s the warnings associated with agents used in tx resistance depression (Aripiprazole - Abilify, Abilify Discmelt; Olanzapine/Fluoxetine - Symbyax; Quetiapine ext release - Seroquel, Seroquel XR)

A

Risk of Neuroleptic Malignant Syndrome

Risk of Tardauve Dyskinesia

Risk of Leukopenia, Neutropenia, Agranulocytosis

90
Q

CI to Olanzapine/Fluoxetine (Symbyax) use?

A

Don’t use Symbyax with:

Pimozide

Thioridazine

Other QT prolongating drugs/conditions

91
Q

SEs of agents used in tx resistance depression (Aripiprazole - Abilify, Abilify Discmelt; Olanzapine/Fluoxetine - Symbyax; Quetiapine ext release - Seroquel, Seroquel XR)?

A

Metabolic issues e.g. Dyslipidemia, wt gain, diabetes

Orthostatic/dizziness

92
Q

Which metabolic issue is less with Aripiprazole (Abilify, Abilify Discmelt)?

A

Diabetes

93
Q

SE particular to Abilify (Aripiprazole)?

A

Anxiety

Insomnia

Constipation

94
Q

SE particular to Olanzapine?

A

Sedation

Weight gain

Increased lipids, glucose

EPS

QT prolongation (lower risk)

95
Q

SE particular to Quetiapine (Seroquel, Seroquel XR)?

A

Sedation

Orthostasis

Weight gain, increased lipids and glucose

All these are similar to Olanzapine

Little risk of EPS (unlike Olanzapine)

96
Q

Which SSRI is used in PMDD?

A

Fluoxetine (Sarafem)

97
Q

Brand name of Fluoxetine + Olanzapine?

A

Symbyax

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