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NAPLEX Review > Depression > Flashcards

Depression Flashcards

1
Q

What neurotransmitters are believed to be involved in depression?

A 
Serotonin (5-HT)
Glutamate
Acetylcholine
Dopamine
Norepinephrine
Epinephrine
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2
Q

What is the most widely used depression assessment scale?

A

Ham-D (HDRS)

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3
Q

What are the DSM-5 criteria for being diagnosed with depression

A 
At least 5 of the following during the same 2 week period (M SIG E CAPS)
Mood - depressed
Sleep - increased/decreased
Interest - diminished
Guilt or feeling of worthlessness
Energy - decreased
Concentration - decreased
Appetite - increased/decreased
Psychomotor agitation or retardation 
Suicidal ideation
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4
Q

Why should benzos not be used alone to manage depression and anxiety?

A

They can mask depression

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5
Q

What drugs can cause or worsen depression

A 
Atomoxetine
Indomethacin
Efavirenz
Rilpivirine
Beta blockers (esp propranolol)
Hormonal contraceptives
Anabolic steroids
Benzos
Systemic steroids
Interferons
Varenicline
Ethanol
Antidepressants in first few weeks
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6
Q

Natural products used for treating depression

A

St. John’s wort

SAM (S-adenosyl-L-methionine)

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7
Q

What should initial choice of antidepressant medication be based on? What is usually first line?

A

Side effect profile, safety concerns, and patient specific-symptoms
SSRI/SNRI

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8
Q

What medications are MAOi?

A

Phenelzine
Tranylcypromine
Isocarboxazid
Selegiline (MAO-B)

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9
Q

S/sx serotonin syndrome

A

Nausea, dizziness, HA, diarrhea, agitation, tachycardia, or hallucinations

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10
Q

Antidepressant withdrawal s/sx

A

Anxiety, agitation, insomnia, dizziness, flu-like symptoms

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11
Q

What antidepressant doesn’t need to be tapered? Why?

A

Fluoxetine

Long half-life

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12
Q

How long do guidelines recommend treating a patient before determining their antidepressant is not working

A

4-8 weeks at therapeutic dose

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13
Q

What to do if a patient is not improving on current dose of antidepressant

A

Change therapies
Increase dose
Use combo with different MOA
Augment with buspirone or low dose atypical

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14
Q

What medications can be used to augment if a patient is not improving on current dose of antidepressant

A 
Buspirone
Aripiprazole (Abilify)
Olanzapine + fluoxetine
Quetiapine ER
Lithium
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15
Q

Initial drug treatment for depression in pregnancy

A

SSRI (not paroxetine d/t cardiac effects) – preferred but warning d/t risk of persistent pulmonary HTN in newborn

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16
Q

Treatment for post-partum depression

A

Breastfeeding is beneficial

SSRI or TCA preferred (except doxepin)

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17
Q

What IV medication is approved for post-partum depression

A

Brexanolone (Zulresso)

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18
Q

BBW for all antidepressants

A

Increase in suicidal thoughts or actions in children, teens, or young adults in first few months

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19
Q

How long does it take for physical/psychological symptoms to improve when taking antidepressants?

A

Physical: 1-2 weeks
Psychological: 4 weeks or longer

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20
Q

What medications are SSRIs

A 
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
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21
Q

Citalopram and escitalopram max daily dose

A 
Citalopram 40mg (>60 years max is 20)
Escitalopram 20mg (>60 years max is 10)
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22
Q

SSRI MOA

A

Increase 5-HT by inhibiting its reuptake in neuronal synapse

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23
Q

SSRI CI, warnings, SE

A

CI: do not use with MAOi, linezolid
Warnings: QT prolongation, SIADH/hyponatremia, fall risk, bleeding risk
SE: Sexual side effects (decreased libido)

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24
Q

What is sarafem indicated for?

A

Premenstrual dysphoric disorder (PMDD)

25
Q

Which SSRI is preferred in patients with cardiac risk?

A

Sertraline

26
Q

How long of a break should you have after stopping an SSRI before starting an MAOi? Why?

A

Two weeks

5 weeks with fluoxetine d/t long half life

27
Q

What 2 SSRIs have highest risk for QT prolongation?

A

Citalopram and escitalopram

28
Q

Which SSRIs are CYP2D6 inhibitors

A

Fluoxetine
Paroxetine
Fluvoxamine

29
Q

Viibryd generic, MOA, administration notes

A

Generic: vilazodone
MOA: SSRI and 5-HT1A partial agonist
Take with food

30
Q

Trintellix generic, MOA

A

Generic: Vortioxetine
MOA: SSRI, 5-HT5 RA and 5-HT1A agonist

31
Q

What medications are SNRIs?

A

Venlafaxine (Effexor)
Duloxetine (Cymbalta0
Desvenlafaxine (Pristiq)

32
Q

SNRI CI, warnings, SE

A

CI: SNRIs and MAOi can be lethal drug interaction and can cause HTN crisis
Warnings: SIADH/hyponatremia, fall risk, bleeding
SE: similar to SSRI PLUS increased HR, dilated pupils, dry mouth, excessive sweating and constipation

33
Q

What medications are secondary and tertiary TCAs?

A

Secondary: Nortriptyline (Pamelor), amoxapine, desipramine, maprotiline, protriptyline
Tertiary: Amitriptyline, Doxepin, clomipramine, imipramine, trimipramine

34
Q

TCA MOA

A

Inhibit NE and 5-HT reuptake and block ACh and histamine receptors

35
Q

Difference between secondary and tertiary amine TCA

A

Secondary: relatively selective for NE
Tertiary: slightly more effective, but have a worse side effects

36
Q

TCA CI, SE, and notes

A

CI: Do not use with MAOi, linezolid, or methylene blue
SE: QT prolongation with overdose, orthostasis, dry mouth, blurred vision, urinary retention, constipation, weight gain
Notes: tertiary amines have greater anticholinergic properties and are more likely to cause sedation and weight gain

37
Q

What antidepressants are dopamine and norepinephrine reuptake inhibitors?

A

Bupropion (Welbutrin)

38
Q

Bupropion CI and SE

A

CI: seizure disorder, history of anorexia/bulimia, do not use with MAOi, linezolid, IV methylene blue or other forms of bupropion
SE: Dry mouth, CNS stimulation, tremors/seizures, weight loss

39
Q

MAOi warnings

A

Not commonly used but watch for drug-drug and drug-food interactions – if missed could be fatal; HTN crisis or serotonin syndrome when taken with TCAs, SSRIs, SNRIs, many other drugs and tyramine-rick foods

40
Q

What is the washout period when switching from fluoxetine to MAOi?

A

5 weeks d/t long half-life

41
Q

What drugs can MAOi NOT be used with d/t serotonin syndrome?

A

Linezolid, lithium, tramadol, methadone, St. John’s wort

42
Q

What foods should be avoided in someone on an MAOi?

A

Tyramine-rick foods (aged cheese, pickled herring, yeast extract, air-dried meats, sauerkraut, soy sauce)

43
Q

What medication is a tetracycline antidepressant? MOA, SE

A

Mirtazapine (Remeron)
MOA: central presynaptic alpha-2 adrenergic antagonist effects increasing release of NE and 5-HT
SE: Sedation, increased appetite, weight gain

44
Q

Trazodone MOA, indication, CI, SE

A

MOA: inhibits 5-HT reuptake, blocks H1 and alpha-1 adrenergic receptors
Indication: rarely used as antidepressant – used primarily for sleep
CI: do not use with MAOi, linezolid, or IV methylene blue
SE: Sedation, priapism

45
Q

Nefazodone BBW

A

Hepatotoxicity – rarely used d/t this

46
Q

Which antidepressant preferred in cardiac/QT risk?

A

Sertraline

47
Q

What antidepressant is preferred in smokers

A

Bupropion

48
Q

What antidepressant is preferred in patients with peripheral neuropathy or pain?

A

Duloxetine

49
Q

What antidepressant is preferred in patients who have seizure disorder

A

NOT bupropion

50
Q

What antidepressant is preferred in patients who are pregnant?

A

NOT paroxetine
Psychotherapy in mild/moderate depression
Citalopram, escitalopram, fluoxetine, sertraline preferred

51
Q

What antidepressant is preferred in patients who have daytime sedation?

A

Fluoxetine, bupropion

52
Q

What antidepressant is preferred in patients with insomnia

A

Paroxetine, mirtazapine, trazodone

Take at night

53
Q

What antidepressant is preferred in patients with sexual dysfunction

A

Bupropion or mirtazapine

54
Q

Depression that does not fully respond to ___ full treatment trials is considered treatment resistant

A

2

55
Q

What antipsychotics are used to augment depression therapy in treatment resistant depression?

A

Aripiprazole (Abilify)
Olanzapine/fluoxetine (Symbyax)
Quetiapine (Seroquel)
Brexpiprazole (Rexulti)

56
Q

Antipsychotics BBW, CI

A

BBW: elderly patients with dementia-related psychosis are at increased risk of death
CI: Olanzapine/fluoxetine (Symbyax) – do not use with pimozide, thioridazine and caution with other QT prolongation drugs

57
Q

Abilify SE

A

Anxiety, insomnia, akathisia

58
Q

Olanzapine SE

A

Sedation, weight gain, increased lipids and glucose

59
Q

Quetiapine SE

A

Sedation, orthostasis, weight gain, increased lipids and glucose

NAPLEX Review (79 decks)

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