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NAPLEX - OUR cards > Depression > Flashcards

Depression Flashcards

1
Q

Why should benzos not be used alone in depression?

A

leaves depression itself untreated
can cause and/or mask depression
puts patient at risk for physiological dependence and withdrawal symptoms if it wears off

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2
Q

Natural products for depression

A 
St John's Wort (CYP inducer)
or SAMe (s-adenosyl-l-methionine)
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3
Q

List the MAO-I’s

A

phenelzine, tranylcypromine, isocarboxazid, selegeline (patch)

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4
Q

Why do we limit use of MAO-I’s

A

High risk of serotonin syndrome

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5
Q

Which antidepressant self-tapers due to its long half life?

A

Fluoxetine

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6
Q

Antidepressants with high risk of withdrawal and require a taper

A

Paroxetine, venlafaxine

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7
Q

Drugs that can cause or worsen depression

A

ADHD meds
Analgesics (indomethacin, methadone)
Antiretrovirals (efavirenz, rilpivirine)
CV drugs (BB’s esp propranolol, clonidine, methyldopa, procainamide, reserpine)
Hormones (contraceptives, steroids)
Systemic steroids, cyclosporine, ethandol, irotretinoin, interferons, varinicline (Chantix)

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8
Q

Adequate trial for antidepressant

A

6-8 weeks for full effect

May take 1-2 weeks to feel any benefit

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9
Q

Initial choice in pregnancy

A

Usually SSRI’s EXCEPT paroxetine (contraindicated in Brisdelle, new formulation for menopause)
Followed by TCA’s

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10
Q

Fluoxetine class, brand, dose, combo drug

A

SSRI
Prozac
10-60 mg/day, or 90 mg weekly
Combined with olanzapine (Symbyax) for resistant depression

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11
Q

Paroxetine class, brand, dose

A

SSRI
Paxil
10-60 mg/day or comes as CR 12.5-62.5 mg/day
10 mg IR = 12.5 mg CR

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12
Q

Sertraline class, brand, dose

A

SSRI
Zoloft
50-200 mg/day

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13
Q

Citalopram class, brand, dose

A 
SSRI
Celexa
20-40 mg/day
MAX 40 mg/day bc of QT prolong
MAX 20 mg/day in elderly bc of QT prolong
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14
Q

Escitalopram class, brand, dose

A

SSRI
Lexapro
10 mg/day max 20 mg/day

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15
Q

SSRI’s used in PMDD

A

Fluoxetine, sertraline

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16
Q

Vilazodone class, brand, dose

A

Viibryd
Combot SSRI and 5-HT1a partial agonist
10 mg x 7 days then 20 mg daily TAKE W FOOD

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17
Q

Vortioxetine class, brand, dose

A

Trintellix

10 mg/day, can increase 20 mg/day or down to 5 mg/day

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18
Q

SSRI’s boxed warnings, contraindications, regular warnings, side effects

A

Boxed: inc risk of suicidal thoughts or behavior
Contraindicaed with MAO-I’s or linezolid
May cause QT prolongation (esp citalopram)
May cause sexual side effects (dec libido, ED), somnolence, insomnia, nausea, dry mouth, diaphoresis (dose-related), weakness, tremor, dizziness, headache (but may help w migraines if taken continuously) (ALL of this shit was underlined)
Fluoxetine can cause activation - take in AM
Can cause SIADH, hyponatremia

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19
Q

Why don’t we use fluvoxamine a lot?

A

SSRI w a lot of drug interactions

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20
Q

SSRI w weekly dosing, how to switch

A

Fluxetine
90 mg/weekly (usually 10-60 mg/daily)
Start 7 days after last daily dose

21
Q

Benefit of vilazodone over other SSRI’s

A

Less sexual side effects

22
Q

Washout period for MAO-I’s

A

14 days except fluoxetine its 5 weeks

23
Q

Fluoxetine drug interactions

A

2D6 and 2C19 inhibitor

24
Q

Paroxetine drug interactions

A

2D6 inhibitor

25
Q

Tamoxifen drug interaction w SSRI’s

A

Decreased effectiveness with fluoxetine, paroxetine, and sertraline
(also with duloxetine and bupropion)

26
Q

Venlafaxine class, brand, dose

A

SNRI
Effexor
37.5-375 mg/day

27
Q

Duloxetine class, brand, dose

A

SNRI
Cymbalta
40-60 mg/day up to 120 mg/day (but doses > 60 mg/day may not be more effective)

28
Q

Desvenlafaxine class, brand, dose

A

SNRI
Pristiq, Khedezla
50 mg/day, no benefit higher than this but up to 100 mg/day

29
Q

SNRI warnings

A

Increased BP, greatest w venlafaxine > 150 mg/day (but all SNRI’s have risk)
Same risk of suicidal ideation and whatnot especially in young adults/children
Venlafaxine QT prolongation

30
Q

SNRI to MAO-I switch

A

Washout period of 5-14 days (duloxetine) or 7 days (venlafaxine, desvenlafaxine, levomilnacipan)

31
Q

Amitriptyline class, brand, dose

A

TCA
Elavil
100-300 mg qHS for depression, lower doses for neuropathic pain/migraine ppx (10-50 mg HS)

32
Q

Doxepin class, dose

A

TCA

100-300 mg/day

33
Q

Nortriptyline class, brand, dose

A

TCA
Pamelor
25 mg TID to QID

34
Q

Warnings w TCAs

A

Anticholinergic (dry mouth, blurred vision, urinary retention, constipation)
Also can cause orthostasis, QT prolongation w overdose

35
Q

Isocarboxazid class, brand, dose

A

MAO-I
Marplan
20 mg/day in divided doses

36
Q

Phenelzine class, brand, dose

A

MAO-I
Nardil
15 mg TID, max 60-90 mg/day

37
Q

Tranylcypromine class, brand, dose

A

MAO-I
Parnate
30 mg/day divided doses

38
Q

Selegiline class, brand, dose

A

MAO-I (B selective)
Emsam = transdermal
6 mg patch/day up to 9-12 mg/day

39
Q

Warnings w selegiline

A

Avoidhigh tyramine foods, discontinue 10 days before elective surgery requiring general anesthesia

No dietary concerns w 6 mg patch, just 9 or 12 mg!

40
Q

Warnings w MAO-I’s

A

Fatal drug interactions can occur, although these drugs aren’t commonly used

41
Q

Emsam patch counseling

A 
Silegiline
Change once daily
Apply to upper chest, back (below neck, above the waist), upper thigh, or outer surface of the upper arm
Do not use the same site 2 days in a row
Wash hands with soap after patch
42
Q

Buproprion class, brand, dose, warnings, counseling

A

Dopamine and norepinephrine reuptake inhibitor
300-450 mg daily
Wellbutrin SR = 200 mg BID
Wellbutrin XL = once daily (seasonal affective disorder)

Warnings = inc seizure risk
Side effects = dry mouth, insomnia, tremors/seizures (dose-related)
Note no 5-HT activity so sexual dysfuction is rare

43
Q

Mirtazepine class, brand, dose, side effects

A 
Remeron
TCA sorta
Very sedating so take at night 
15-45 mg qHS
Increased appetite and weight gain as well
44
Q

Trazodone class, brand, dose, side effects

A

Inhibits 5-HT reuptake, blocks H1 and alpha1 adrenergic receptors

Dose 150-300 mg/day divided doses
(Sleep dose is 50-100 mg HS)

Sedating, can cause sexual dysfunction and priapism

45
Q

Drugs associated with weight gain, weight loss

A 
Mirtazepine = weight gain
Bupropion = weight loss
46
Q

Drugs to avoid in cardiac issues

Which is preferred?

A 
Avoid = citalopram, escitalopram
Pref'd = sertraline
47
Q

Avoid in patients w seizure risk

A

Bupropion, do not exceed 450 mg/day

48
Q

Drug that causes priapism

A

Trazodone

49
Q

Define treatment resistant depression, what are adjunctive therapy options

A

Depression that does not fully respond to two full treatment trials

Can add aripiprazole (Abilify) or quetiapine (Seroquel)

Symbyax is also a combo olanzapine/fluoxetine and is an option

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