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Pharmacotherapy 3 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Criteria to diagnose depression

A

Symptoms cause significant distress/impairment, episode not attributable to substance or other medical condition

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2
Q

Which is not a lab test used to rule out reversible causes of depression.

  1. TSH
  2. BMO
  3. Cortisol
  4. CRP
A

CRP

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3
Q

Serotonin is responsible for

A

Memory, emotions, sleep/wake

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4
Q

Dopamine is responsible for

A

Motivation, movement, attention, cognition

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5
Q

NE responsible for

A

Wakefulness, arousal, fight or flight

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6
Q

Antidepressant mechansm

A

Antidepressants block the NT reuptake pump causing more NT to be in the synapse

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7
Q

Antidepressant time to clinical effect for depression

A

2-4 weeks: Energy
4-6 weeks: Mood

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8
Q

Antidepressant efficacy directly results from

A

Decrease in receptor sensitivity

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9
Q

Drug Class: Isocarboxazid

A

MAOI

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10
Q

Drug Class: Phenelzine

A

MAOI

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11
Q

Drug Class: Selegiline

A

MAOI

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12
Q

Drug Class: Tranylcypromine

A

MAOI

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13
Q

MOAIs pose significant risk for

A

Serotonin syndrome and hypertensive crisis

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14
Q

MAOIs require a washout period of

A

10-14 days

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15
Q

How long do you have to wait to start an MAOI after discontinuing fluoxetine

A

5 weeks

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16
Q

Which antidepressant has dietary restriction

A

MAOIs, foods with tyramine

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17
Q

Drug Class: Amitriptyline

A

TCA

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18
Q

Drug Class: Desipramine

A

TCA

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19
Q

Drug Class: Doxepin

A

TCA

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20
Q

Drug Class: Imipramine

A

TCA

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21
Q

Drug Class: Nortiptyline

A

TCA

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22
Q

Secondary Amines of TCAs

A

Desipramine, Nortriptyline

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23
Q

Tertiary amines of TCAs

A

Amitriptyline, Doxepin, Imipramine (IDA)

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24
Q

Amitriptyline can also be used for

A

Migraine prophylaxis

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25
Q

Desipramine other indication

A

Urinary incontinence

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26
Q

Doxepin other indication

A

Insomnia at low doses

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27
Q

TCAs use in elderly

A

Avoid due to high risk of sedation

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28
Q

Rank antidepressants classes in order of tolerance from least to greatest

A

MAOI, TCA, SNRI, SSRI

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29
Q

Drug Class: Duloxetine

A

SNRI

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30
Q

Drug Class: Venlafaxine

A

SNRI

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31
Q

Drug Class: Desvenlafaxine

A

SNRI

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32
Q

Duloxetine indications

A

Depression, diabetic neuropathy, fibromyalgia, skeletal muscle pain

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33
Q

Duloxetine inhibits

A

CYP2D6

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34
Q

Which SNRI has a renal cutoff

A

Duloxetine, avoid if CrCl<30

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35
Q

Duloxetine has risk of

A

Hepatotoxicity, monitor LFTs

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36
Q

Which SNRI has very difficult discontinuation

A

Venlafaxine

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37
Q

Venlafaxine MOA in regards to dosing

A

Low doses (<150), inhibit 5HT reuptake,

NE at high doses

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38
Q

Drug Class: Citalopram

A

SSRI

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39
Q

Drug Class: Escitalopram

A

SSRI

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40
Q

Drug Class: Fluoxetine

A

SSRI

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41
Q

Drug Class: Fluvoxamine

A

SSRI

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42
Q

Drug Class: Paroxetine

A

SSRI

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43
Q

Drug Class: Sertraline

A

SSRI

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44
Q

Citalopram dose cutoff

A

Doses >40g not recommended due to risk of QTc prolongation

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45
Q

Citalopram dosing patients >60YO

A

20 mg

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46
Q

Which SSRI can be used in children

A

Escitalopram, fluoxetine

47
Q

SSRI with longest half life. And what does it mean

A

Fluoxetine has the longest half life so it self-tapers

48
Q

Which SSRI is a strong CYP2D6 inhibitor

A

Fluoxetine, paroxetine

49
Q

Which SSRI has most significant activating effects

A

Fluoxetine

50
Q

Which SSRI can be combined for treatment-resistant depression

A

Fluoxetine + olanzapine

51
Q

Fluvoxamine indication

52
Q

Which SSRI has significant DDIs

A

fluvoxamine

53
Q

Which SSRI should be avoided in pregnancy

A

Paroxetine

54
Q

Least well tolerated SSRI. Why?

A

Paroxetine, lots of anticholinergic, antihistaminergic, and significant discontinuation syndrome

55
Q

SSRI with shortest half-life

A

Paroxetine

56
Q

Best SSRI for pregnant and lactating patients

A

Sertraline

57
Q

TCA overdose potential

A

Due to cardiotoxicity

58
Q

Mirtazapine is also used for

A

Appetite stimulation and insomnia

59
Q

Trazodone is primarily used for

60
Q

Why can TCAs cause orthostatic hypertension

A

Alpha 1 antagonism

61
Q

Dopaminergic side effects

A

Agitation, sedation, movement disorder, psychosis

62
Q

What antidepressant class experiences dopaminergic side effects

63
Q

Adrenergic side effects

A

Tremor, tachycardia, diaphoresis, jitteriness, hypertension

64
Q

What antidepressant class experiences adrenergic side effects

A

TCA, SNRI, MAOI

65
Q

Serotonergic side effects

A

Anxiety, GI upset, sexual dysfunction, sedation, insomnia

66
Q

Which antidepressant classes has serotonergic side effects

67
Q

Mirtazapine sedation vs. activation

A

Sedating at low doses (<15)

Activating at high doses (>30)

68
Q

Mirtazapine side effects

A

Somnolence and weight gain

69
Q

Which antidepressant can be used in old people who can’t sleep

A

Mirtazapine (<15 mg)

70
Q

Trazodone PRN or scheduled?

71
Q

Trazodone side effect in men

A

Boner that doesn’t go away, trazobone

72
Q

Trazodone hangover effect

A

Dissipate with more frequent use

73
Q

Trazodone addictiveness

A

Less addictive compared to other sleep aids

74
Q

Bupropion effects

A

No serotonergic effect

75
Q

Which antidepressant has NO serotonergic effects

76
Q

Bupropion side effects

A

Very activating, can cause agitation

77
Q

Bupropion risk

A

High seizure risk

78
Q

Bupropion is contraindicated in what patient populations

A

Eating disorders and head trauma due to seizure risk

79
Q

Viibryd has _____ titration

A

Rapid titration

80
Q

Viibryd is helpful for

A

Depression and anxiety

81
Q

Trintellix effects

A

Pro-cognitive (helps focus and memory)

82
Q

Fetzema indication

A

Fibromyalgia

83
Q

Esketamine mechanism

A

Non-selective, non-competitive NMDA receptor antagonist

84
Q

Esketamine place in therapy

A

Adjunctive therapy for treatment-resistant depression

85
Q

Esketamine control class

86
Q

Esketamine therapeutic effect

A

Decreases severity of depression/suicidality in 2-4 hours

87
Q

Esketamine BBW

A

Risk of sedation and difficulty with attention, judgment, (has dissociation), high risk of abuse, and suicidal thoughts

88
Q

Esketamine dosing

A

56 mg on day 1, then 56 or 84 mg twice a week

Maintenance: once a week for weeks 5-8, then once every 2 weeks

89
Q

Esketamine administration

A

Intranasally in clinics only

90
Q

Brexanolone Mechanism

A

GABA-A Modulator

91
Q

Brexanolone indication

A

Post-partum depression

92
Q

Brexanolone control class

93
Q

Brexanolone BBW

A

Risk of excessive sedation or sudden loss of consciousness

94
Q

Brexanolone monitoring

A

Monitor for hypoxia

95
Q

Antidepressant augmentation: Additional antidepressant

A

Low-dose TCA< bupropion, mirtazapine

96
Q

Risk of adding mirtazapine as secondary depressive agent

A

Serotonin syndrome

97
Q

Most common kind of depression augmentation

A

Second generation antipsychotic (abilify, rexulti, seroquel)

98
Q

Augmentation options 4

A
  1. Additional antidepressant
  2. SGA
  3. Mood stabilizer lithium, lamotrigine
  4. Other; Modafinil, methylphenidate, triiodothyronine
99
Q

STAR*D trial results 3

A

1/3 of patients reached remission on 1st medication.
Nonresponse to one agent does not rule out the entire class, and
dose/duration are key to determine effectiveness

100
Q

What is considered a full response in depression

A

50% reduction in symptoms

101
Q

What is considered a partial response in depression

A

25-50% reduction in symptoms

102
Q

What to do if partial response after first antidepressant

A

Maximize dose. If that doesn’t work, consider augmentation

103
Q

What is considered a nonresponse in depression

A

<25% reduction in symptoms

104
Q

TRUE OR FALSE: When a patient has a partial response to an SSRI, augmentation can be considered no matter what treatment stage

105
Q

TRUE OR FALSE: When a patient fails initial treatment (non-response) with an SSRI, the next step should be augmentation

A

False, no point in continuing

106
Q

Serotonin syndrome symptoms

A

Neuromuscular abnormalities
Autonomic instability (fever, sweaty)
Mental status changes (confusion, instability)

107
Q

Serotonin syndrome treatment

A

Discontinue serotonergic agent and provide supportive care.

If extreme agitation or neuromuscular issues, can sedate with benzodiazepines and administer serotonin antagonist

108
Q

Serotonin antagonist drug of choice

A

Cyproheptadine

109
Q

Which side effect results from a drug-drug interaction?
Serotonin syndrome
Tyramine reaction
Discontinuation syndrome

A

Serotonin syndrome

110
Q

Antidepressant BBW

A

Risk of increased suicidality highest when <24 and lowest when >65

111
Q

Antidepressant use in pregnancy

A

The risk to the fetus is acceptable when compared to the risk of undertreated maternal depression

112
Q

Antidepressant risk to fetus

A

Potential malformations, autism, and ADHD.

Unclear if due to medications or disease state

113
Q

Major DDIs for antidepressants

A

NSAIDs/Aspirin/anticoagulants: Bleed risk
Triptans: Serotonin syndrome
Linezolid: Serotonin syndrome

Pharmacotherapy 3 (1 decks)

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