Exam 3 - Depression Flashcards
What are the SSRIs? (6)
citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft)
What are the SNRIs? (5)
desvenlafaxine (Pristiq), duloxetine (Cymbalta, Irenka), levomilnacipran (Fetzima), milnacipran (Savella), venlafaxine (Effexor)
What are the serotonin modulators? (4)
nefazodone (Serzone), trazodone (Desyrel), vilazodone (Viibryd), vortioxetine (Trintellix)
What are the TCAs? (10)
amitriptyline, amoxapine, clomipramine (Anafil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), maprotiline, nortriptyline, protriptlyine, trimipramine
What are the MAO-Is? (4)
phenelzine, tranylcypromine, selegiline, rasagiline
What are the miscellaneous antidepressants? (4)
brexanolone, bupropion, esketamine, mirtazapine
What is Auvelity a combination of?
dextromethorphan and bupropion
What are contraindications for Auvelity? (3)
seizure, bulimia or anorexia nervosa, MAO-Is within 14 days (excluding fluoxetine)
What are first line medications for depression? (5)
SSRIs, SNRIs, bupropion, mirtazapine, vortioxetine
What is considered a response to depression treatment?
reduction of symptoms by 50%
What should be done if symptoms persist after an adequate trial of 4-8 weeks?
switch to alternate antidepressant or augment with an alternative MOA, SGA, or psychotherapy
What are two depression rating scales?
Hamilton Depression Rating scale (HAM-D) and Montgomery-Asberg Depression rating scale (MADRS)
What are non-pharmacologic approaches to treating depression? (6)
psychotherapy, vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) electroconvulsive therapy (ECT), bright light therapy, lifestyle interventions (improved diet (protein), exercise, adequate sleep)
What are AEs of SSRIs? (5)
insomnia/sedation, sexual dysfunction, serotonin syndrome, QTc prolongation, increased bleed risk
What are special considerations for citalopram (Celexa)? (2)
> 40mg not recommended, QTc prolongation
What are special considerations for fluvoxamine (Luvox)? (2)
caution in elderly, CYP1A2 interactions
What are special considerations for escitalopram (Lexapro)? (1)
like citalopram but potentially better
What are special considerations for fluoxetine? (2)
only SSRI requiring once weekly administration, also available as a liquid
What are special considerations for paroxetine (Paxil)? (4)
caution in elderly, avoid in pregnancy, akathisia, bone fractures (?)
What is the only indication for fluvoxamine (Luvox)?
OCD
What are the indications for escitalopram (Lexapro)? (2)
MDD and GAD
What is the only indication for citalopram (Celexa)?
MDD
What is the only indication sertraline (Zoloft) is NOT approved for?
GAD
Which SSRI is approved for nearly all depressive-related disorders?
paroxetine (Paxil)
What are special considerations for desvenlafaxine (Pristiq)? (3)
hyperlipidemia, eosinophilic pneumonia and interstitial lung disease
What is the only indication for desvenlafaxine (Pristiq)?
MDD
What are special considerations for venlafaxine (Effexor)? (3)
pediatric alerts, eosinophilic pneumonia, dose adjustments (hepatic and renal)
What are the indications for venlafaxine? (4)
MDD, GAD, PD and SAD
What are special considerations for duloxetine (Cymbalta)? (3)
avoid in renal or hepatic dysfunction, urinary retention, hypotension
What are the indications for duloxetine (Cymbalta)? (4)
MDD, GAD, diabetic neuropathy, fibromyalgia and musculo-skeletal pains
What are special considerations for levomilnacipran (Fetzima)? (2)
urinary retention and increased HR
What is the only indication for levomilnacipran (Fetzima)?
MDD
What are the indications for TCAs? (3)
MDD, insomnia, nocturnal enuresis
What are AEs of TCAs? (3)
anticholinergic and CV effects, cognitive impairment, urinary retention
How long must one wait after using a MAO-I before trying a new drug with a potential interaction?
4-5 half-lives of drug or active metabolite
What are examples of tyramine-containing foods? (4)
aged, smoked, pickled products and yeast extracts
What are AEs of MAO-Is? (4)
postural hypotension (or other hypertensive crises), anticholinergic effects, sexual dysfunction, serotonin syndrome
Which serotonin modulator has a boxed warning for hepatic failure?
nefazodone (Serzone)
What are special considerations for trazodone (Desyrel)? (3)
sedation, priapism, more anticholinergic and bleed risks than nefazodone
What are special considerations for bupropion? (2)
seizure risk in patients with eating or substance abuse disorders, hypertension
What are the requirements for starting esketamine (Spravato)? (2)
failure of at least two other drugs and used in combination with an antidepressant
What are AEs for esketamine (Spravato)? (3)
hypertension, cognitive impairment (machinery risk), avoid in pregnancy
What is a boxed warning for esketamine (Spravato)?
sedation, abuse, suicidal ideation (REMS)
What is the MOA of brexanolone (Zulresso)?
positive allosteric modulation of GABA-a receptors
How is brexanolone (Zulresso) administered?
IV infusion over 60 hours
What is the best and worst treatment choice for depression in an elderly patient, respectively?
best = SSRI, worst = TCA (delirium)
What are augmentation agents for depression? (5)
lithium, triiodothyronine, SGAs, buspirone, stimulants
Which augmentation agent is first line for depressive episodes that fail?
lithium
What characteristics are most likely to signify NMS? (6)
dopamine antagonists, onset 1-3 days, lead pipe rigidity, hyporeflexia, normal pupils, normal or decreased bowel sounds
What characteristics are most likely to signify serotonin syndrome? (5)
serotonin agents, onset < 12 hrs, hyperreflexia, dilated pupils, hyperactive bowel sounds
