Depression/Anxiety Flashcards
If you have a patient that struggles with depression and anorexia, what drug should be considered?
Mirtazapine (increased appetite)
Which SSRI has strict dosing?
Citalopram (should no exceed 40mg/d for anyone, should not exceed 20mg/d for most pts >60yo or those on CYP2C19 inhibitors)
Higher doses = increased risk of QT
CI of Bupropion
Pts with seizure history
T/F: orthostasis is common with tertiary and secondary amine TCAs
True
What is FINISH syndrome? What drug is it worse with?
Flu-like symptoms Insomnia Imbalance Sensory disturbances Hyperarousal
Paroxetine
Which SNRI should you not use for pts with liver disease due to hepatotoxicity risk?
Duloxetine
If a pt presents with atypical MDD with hyperphagia or hypersomnia, what class of meds should be considered?
Monoamine Oxidase A Inhibitors
Which SNRI is most associated with dose dependent HR/BP increase?
Venlafaxine
Which TCA should be considered for migraine prophylaxis?
Amitriptyline
Which SSRI has a long half life?
Fluoxetine
Which BZD is good for seizure disorders?
Clonazepam
Priapism = what AD?
Trazadone
What meds are short term/intermittent use for anxiety?
Benzo’s
What are the SNRIs? (4)
Venlafaxine
Desvenlafaxine
Duloxetine
Milnacipran/Levomilnacipran
Which 3 benzo’s come in IV formulation?
Lorazepam
Diazepam
Midazolam
What medication is usually the drug of choice for anxiety?
SSRI/SNRI (venlafaxine)
If your patient is trying to quit smoking and has depression, what should you use?
Bupropion
What is the monoamine oxidase B inhibitor? Pts with what neurologic condition may benefit due to the patch formulation?
Selegiline
Parkinson’s pts who cannot swallow
What are the 2 secondary amine TCAs?
Desipramine
Nortriptyline
Which SSRI has a very short half life and concerns for withdrawal?
Paroxetine
Which SNRI is best for pain from diabetic peripheral neuropathy/fibromyalgia/chronic MSK pain?
Duloxetine
When should a TCA be considered?
Intolerant or refractory to SSRI/SNRI, or for pain syndromes
Which SSRI is best for kids?
Fluoxetine
Which amines have more sedation, wt gain, and anticholinergic effects?
Tertiary > secondary
What AD is safe for pregnancy?
Sertraline
What BZD is used for status epilepticus?
Lorazepam
What are the 5 BZD’s?
Alprazolam Clonazepam Lorazepam Diazepam Midazolam
What are the 4 tertiary amine TCAs?
Imipramine, Clomipramine, Doxepin, and Amitriptyline
What are the 3 Monoamine Oxidase A Inhibitors?
Isocarboxazid
Tranylcypromine
Phenelzine
Which two drugs are SSRIs and partial 5-HT receptor agonists?
Vilazodone
Vortioxetine
T/F: Benzo’s are safe during pregnancy
False
What screening must be completed when putting pts on TCAs?
Screen for cardiac conduction abnormalities, monitor regularly
What are the SSRIs? (5)
Fluoxetine Paroxetine Sertraline Citalopram Escitalopram
If you have a patient that struggles with depression and insomnia, what drug should be considered?
Trazadone
What class of meds is consistently linked to dementia?
BZDs
Classic signs for TCA overdose
The Three C’s:
Convulsions
Cardiac arrhythmias/cardiac arrest
Coma
If your patient is having sexual function concerns with their current AD, what should you consider next?
Bupropion
Which AD should you avoid if anxiety is present?
Bupropion
Which SNRI is most associated with discontinuation/FINISH syndrome?
Venlafaxine
Red flags for dependency on BZDs
Long term use (>1 month)
Rebound anxiety and insomnia on withdrawal
Strong desire to use them
Driving under influence of BZDs
Use of BZDs despite falls
Use of them in addition to other hypnotics (ETOH, opioids)
Continuing to use despite recommendation to stop
Other than minimal sexual dysfunction, what are two other benefits of bupriopion?
Minimal sedation
Minimal weight gain
Which 2 BZDs are used for conscious sedation?
Diazepam
Midazolam
