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PHM701 > Exam 3 - Depression > Flashcards

Exam 3 - Depression Flashcards

1
Q

What are the SSRIs? (6)

A

citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft)

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2
Q

What are the SNRIs? (5)

A

desvenlafaxine (Pristiq), duloxetine (Cymbalta, Irenka), levomilnacipran (Fetzima), milnacipran (Savella), venlafaxine (Effexor)

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3
Q

What are the serotonin modulators? (4)

A

nefazodone (Serzone), trazodone (Desyrel), vilazodone (Viibryd), vortioxetine (Trintellix)

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4
Q

What are the TCAs? (10)

A

amitriptyline, amoxapine, clomipramine (Anafil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), maprotiline, nortriptyline, protriptlyine, trimipramine

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5
Q

What are the MAO-Is? (4)

A

phenelzine, tranylcypromine, selegiline, rasagiline

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6
Q

What are the miscellaneous antidepressants? (4)

A

brexanolone, bupropion, esketamine, mirtazapine

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7
Q

What is Auvelity a combination of?

A

dextromethorphan and bupropion

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8
Q

What are contraindications for Auvelity? (3)

A

seizure, bulimia or anorexia nervosa, MAO-Is within 14 days (excluding fluoxetine)

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9
Q

What are first line medications for depression? (5)

A

SSRIs, SNRIs, bupropion, mirtazapine, vortioxetine

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10
Q

What is considered a response to depression treatment?

A

reduction of symptoms by 50%

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11
Q

What should be done if symptoms persist after an adequate trial of 4-8 weeks?

A

switch to alternate antidepressant or augment with an alternative MOA, SGA, or psychotherapy

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12
Q

What are two depression rating scales?

A

Hamilton Depression Rating scale (HAM-D) and Montgomery-Asberg Depression rating scale (MADRS)

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13
Q

What are non-pharmacologic approaches to treating depression? (6)

A

psychotherapy, vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) electroconvulsive therapy (ECT), bright light therapy, lifestyle interventions (improved diet (protein), exercise, adequate sleep)

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14
Q

What are AEs of SSRIs? (5)

A

insomnia/sedation, sexual dysfunction, serotonin syndrome, QTc prolongation, increased bleed risk

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15
Q

What are special considerations for citalopram (Celexa)? (2)

A

> 40mg not recommended, QTc prolongation

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16
Q

What are special considerations for fluvoxamine (Luvox)? (2)

A

caution in elderly, CYP1A2 interactions

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17
Q

What are special considerations for escitalopram (Lexapro)? (1)

A

like citalopram but potentially better

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18
Q

What are special considerations for fluoxetine? (2)

A

only SSRI requiring once weekly administration, also available as a liquid

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19
Q

What are special considerations for paroxetine (Paxil)? (4)

A

caution in elderly, avoid in pregnancy, akathisia, bone fractures (?)

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20
Q

What is the only indication for fluvoxamine (Luvox)?

A

OCD

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21
Q

What are the indications for escitalopram (Lexapro)? (2)

A

MDD and GAD

22
Q

What is the only indication for citalopram (Celexa)?

A

MDD

23
Q

What is the only indication sertraline (Zoloft) is NOT approved for?

A

GAD

24
Q

Which SSRI is approved for nearly all depressive-related disorders?

A

paroxetine (Paxil)

25
Q

What are special considerations for desvenlafaxine (Pristiq)? (3)

A

hyperlipidemia, eosinophilic pneumonia and interstitial lung disease

26
Q

What is the only indication for desvenlafaxine (Pristiq)?

A

MDD

27
Q

What are special considerations for venlafaxine (Effexor)? (3)

A

pediatric alerts, eosinophilic pneumonia, dose adjustments (hepatic and renal)

28
Q

What are the indications for venlafaxine? (4)

A

MDD, GAD, PD and SAD

29
Q

What are special considerations for duloxetine (Cymbalta)? (3)

A

avoid in renal or hepatic dysfunction, urinary retention, hypotension

30
Q

What are the indications for duloxetine (Cymbalta)? (4)

A

MDD, GAD, diabetic neuropathy, fibromyalgia and musculo-skeletal pains

31
Q

What are special considerations for levomilnacipran (Fetzima)? (2)

A

urinary retention and increased HR

32
Q

What is the only indication for levomilnacipran (Fetzima)?

A

MDD

33
Q

What are the indications for TCAs? (3)

A

MDD, insomnia, nocturnal enuresis

34
Q

What are AEs of TCAs? (3)

A

anticholinergic and CV effects, cognitive impairment, urinary retention

35
Q

How long must one wait after using a MAO-I before trying a new drug with a potential interaction?

A

4-5 half-lives of drug or active metabolite

36
Q

What are examples of tyramine-containing foods? (4)

A

aged, smoked, pickled products and yeast extracts

37
Q

What are AEs of MAO-Is? (4)

A

postural hypotension (or other hypertensive crises), anticholinergic effects, sexual dysfunction, serotonin syndrome

38
Q

Which serotonin modulator has a boxed warning for hepatic failure?

A

nefazodone (Serzone)

39
Q

What are special considerations for trazodone (Desyrel)? (3)

A

sedation, priapism, more anticholinergic and bleed risks than nefazodone

40
Q

What are special considerations for bupropion? (2)

A

seizure risk in patients with eating or substance abuse disorders, hypertension

41
Q

What are the requirements for starting esketamine (Spravato)? (2)

A

failure of at least two other drugs and used in combination with an antidepressant

42
Q

What are AEs for esketamine (Spravato)? (3)

A

hypertension, cognitive impairment (machinery risk), avoid in pregnancy

43
Q

What is a boxed warning for esketamine (Spravato)?

A

sedation, abuse, suicidal ideation (REMS)

44
Q

What is the MOA of brexanolone (Zulresso)?

A

positive allosteric modulation of GABA-a receptors

45
Q

How is brexanolone (Zulresso) administered?

A

IV infusion over 60 hours

46
Q

What is the best and worst treatment choice for depression in an elderly patient, respectively?

A

best = SSRI, worst = TCA (delirium)

47
Q

What are augmentation agents for depression? (5)

A

lithium, triiodothyronine, SGAs, buspirone, stimulants

48
Q

Which augmentation agent is first line for depressive episodes that fail?

A

lithium

49
Q

What characteristics are most likely to signify NMS? (6)

A

dopamine antagonists, onset 1-3 days, lead pipe rigidity, hyporeflexia, normal pupils, normal or decreased bowel sounds

50
Q

What characteristics are most likely to signify serotonin syndrome? (5)

A

serotonin agents, onset < 12 hrs, hyperreflexia, dilated pupils, hyperactive bowel sounds

PHM701 (14 decks)

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