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P&T > Depression > Flashcards

Depression Flashcards

0
Q

3 important roles of NE

A
  1. sleep and arousal
  2. attention
  3. learning and memory
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1
Q

NMDA antagonist that has recent interest in use in depression

A

Ketamine

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2
Q

2 ways in which catecholamines are metabolized

A
  1. Monoamine oxidases (MAO)

2. catechol-O-methyltransferase (COMT)

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3
Q

Types of NE receptors

A

alpha and beta adrenergic metabolotropic receptors

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4
Q

NE pre-synaptic autoreceptor that is important in feedback inhibition

A

alpha2 receptor

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5
Q

Where the majority of neurons that synthesize serotonin are located

A

raphe nuclei

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6
Q

Serotonin receptor that is a ligand-gated ion channel

A

5HT3

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7
Q

Serotonin receptor that is a pre-synaptic auto-receptor that is important in feedback inhibition

A

5HT1D

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8
Q

Enzyme that metabolizes serotonin within the neuron

A

MAO

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9
Q

Main precursor of serotonin

A

tryptophan

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10
Q

Enzyme involved in the synthesis of both serotonin and NE

A

aromatic L-AA decarboxylase

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11
Q

3 MAO-Is that are exhibit non-selective MAO-A and B irreversible inhibition and increase synaptic 5HT, NE and DA

A
  1. Pheneizine
  2. Transylcypromine
  3. Isocarbazid
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12
Q

MAOI that exhibits selective MAO-A irreversible inhibition and increases synaptic DA

A

Selegiline TS

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13
Q

Cut off below which selegilline does not have dietary restrictions

A

6 mg

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14
Q

Toxicity that can occur if MAOIs are taken with tyramine-containing foods

A

hypertensive crisis

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15
Q

Drug that is used in the case of hypertensive crisis associated with MAOIs

A

Phentolamine

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16
Q

Drug is a non-selective serotonin antagonist that can be used to help reverse serotonin syndrome

A

cyproheptadine

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17
Q

5 tertiary amine TCAs that have NE > 5HT reuptake

A
  1. amitryptyline
  2. imipramine
  3. trimipramine
  4. clomipramine
  5. doxepin
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18
Q

Only TCA that has sig. 5HT reuptake inhibition

A

Clomiptamine

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19
Q

SSRI that has been shown to be safely used post-MI

A

Sertraline

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21
Q

3 secondary amine TCAs that have selective NE reuptake inhibition, less antimuscarinic action, less sedation, and less postural hypotension

A
  1. Desipramine
  2. Nortriptyline
  3. Protriptyline
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22
Q

5 patient populations to use caution with TCAs

A
  1. underlying CV disease
  2. seizure disorder
  3. angle-closure glaucoma
  4. urinary retention
  5. elderly
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23
Q

3 main adverse effects of TCAs

A
  1. atropine-like effects (dry mouth, blurred vision, constipation, urinary retention)
  2. orthostatic hypotension
  3. sedation
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25
Q

5 SSRIs

A
  1. Fluoxitine
  2. Paroxetine
  3. Sertraline
  4. Citalopram
  5. Escitalopram
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26
Q

Initial adult dose of citalopram

A

20 mg QD

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27
Q

Max adult dose/day of citalopram

A

40 mg

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28
Q

Initial adult dose of escitalopram

A

10 mg QD

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29
Q

Highest rate of sexual dysfunction and weight gain of the SSRIs

A

Paroxitine

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30
Q

SSRI that is pregnancy category D

A

Paroxitine

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33
Q

SSRI that has the highest rate of diarrhea

A

Sertraline

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34
Q

Initial adult dose of fluoxitine

A

10 mg QD

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37
Q

Max adult dose/day of escitalopram

A

20 mg

38
Q

Initial adult dose of paroxitine CR

A

25 mg QD

39
Q

Max adult dose/day of fluoxitine

A

80 mg

40
Q

Max adult dose/day of paroxitine CR

A

62.5 mg

41
Q

SSRI that has the longest half-life

A

Fluoxitine

42
Q

5 SNRIs

A
  1. Duloxetine
  2. Venlafaxine
  3. Desvenlafaxine
  4. Milnacipran
  5. Levomilnacipran
43
Q

SNRI that is only FDA approved for fibromyalgina, not depression

A

Milnacipran

44
Q

Initial adult dose of duloxetine

A

20-30 mg BID

45
Q

Max adult dose/day of duloxetine

A

60 mg

46
Q

Initial adult dose of venlafaxine

A

25 mg TID or 37.5 mg BID

47
Q

Max adult dose/day for venlafaxine

A

375 mg

48
Q

Initial adult dose of venlafaxine ER

A

75 mg QD

49
Q

Max adult dose/day of venlafaxine ER

A

225 mg

50
Q

2 drugs that are selective serotonin reuptake inhibitors and are partial 5HT1A receptor agonist

A
  1. Vilazodone

2. Vortioxtine

51
Q

2 drugs that are weak serotonin reuptake inhibitors and 5HT2A and 5HT2C receptor antagonist

A
  1. Trazodone

2. Nefazodone

52
Q

Black box warning for nefazodone

A

Rare hepatic failure

53
Q

Drug that inhibits dopamine and NE uptake

A

Buproprion

54
Q

Initial adult dose of buproprion IR

A

100 mg BID

55
Q

Max adult dose/day of buproprion IR

A

450 mg

56
Q

Initial adult dose of buproprion SR

A

150 mg QD

57
Q

Max adult dose/day of buproprion SR

A

400 mg

58
Q

Initial adult dose of buproprion XL

A

150 mg QD

59
Q

Max adult dose/day of buproprion XL

A

450 mg

60
Q

Drug that is an alpha-2, 5HT2, 5HT3 and H1 antagonist

A

Mirtazapine

61
Q

Initial adult dose of mirtazapine

A

15 mg QHS

62
Q

Max adult dose of mirtazapine

A

45 mg

63
Q

SEs of mirtazapine

A

sedation and weight gain

64
Q

Neuronal growth factor that antidepressants may cause the upregulation of

A

BDNF (brain derived neurpotropic factor)

65
Q

Transcription factor that regulates BDNF

A

CREB (cyclic AMP responsive element binding protein)

66
Q

Typical duration of an untreated MDE

A

at least 6 months

67
Q

Typical duration of a treated MDE

A

4-5 months

68
Q

QIDS score that indicates no depression

A

0-5

69
Q

QIDS score that indicates mild depression

A

6-10

70
Q

QIDS score that indicates moderate depression

A

11-15

71
Q

QIDS score that indicates severe depression

A

16-20

72
Q

QIDS score that indicates very severe depression

A

> 20

73
Q

QIDS score that indicates a response (regardless of starting score)

A

6-8

74
Q

QIDS score that indicates remission

A

<6

75
Q

The return of symptoms meeting full criteria within 6-12 months following remission of the index episode

A

Relapse

76
Q

Occurrence of a new episode following 6-12 months of full and sustained remission from the index episode

A

Recurrence

77
Q

5 most common residual symptoms

A
  1. Insomnia
  2. Fatigue
  3. Pain
  4. Difficulty concentrating
  5. Lack of interest
78
Q

Max adult dose/day of sertraline

A

200 mg

79
Q

Max adult dose/day of paroxitine

A

50 mg

81
Q

Initial adult dose of sertraline

A

50 mg QD

86
Q

Initial adult dose of paroxitine

A

20 mg QD

97
Q

Main precursor of NE

A

Tyrosine

99
Q

Where neurons that synthesize NE primarily originate from

A

locus ceruleus

P&T (18 decks)

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