Exam 5 - Lec 69 Depression Ott Flashcards
risk of recurrence of depression:
1 episode: ___-___%
2 episodes: ___%
3 episodes: ___%
50-60%
70%
90%
T or F: risk of recurrence becomes higher over time as duration of remission increases
F (lower over time)
T or F: persistent mild sx during remission is a predictor of recurrence
T
Which is FALSE about recurrence?
a. risk becomes lower over time as duration of remission decreases
b. persistent mild sx during remission is a predictor of recurrence
c. function deteriorates during the episode and goes back to baseline upon remission
a. risk becomes lower over time as duration of remission decreases (not decreases; should be increases)
DSM-5 diagnostic criteria for depression: at least one of the symptoms must be depressed mood or ?
a. insomnia
b. loss of interest/pleasure in doing things
c. fatigue
d. weight or appetite change
b. loss of interest/pleasure in doing things
DSM-5 diagnostic criteria mnemonic
SIGE CAPS
Sleep
Interest decreased
Guilt/worthlessness
Energy loss/fatigue
Concentration difficulties
Appetite change
Psychomotor agitation/retardation
Suicidal ideation
what are the two self-administered rating scales for depression
PHQ-9 and MDQ
which rating scale can be used to rule out bipolar disorder?
a. PHQ-9
b. MDQ
b. MDQ
which rating scale was developed for the primary care setting?
a. PHQ-9
b. MDQ
a. PHQ-9
look at slide 11 for the 4 goals of tx
ok
goal of the acute phase of depression tx
a. induce remission
b. prevent relapse
c. prevent recurrence
a. induce remission
goal of the continuation phase of depression tx
a. induce remission
b. prevent relapse
c. prevent recurrence
b. prevent relapse
goal of the maintenance phase of depression tx
a. induce remission
b. prevent relapse
c. prevent recurrence
c. prevent recurrence
boxed warning for all antidepressant meds
suicidality in pts 24 or younger
which of the following SSRIs can cause QTc prolongation?
a. citalopram
b. escitalopram
c. fluoxetine
d. sertraline
a. citalopram
which SSRI is a substrate of 2C19 and 3A4?
a. citalopram
b. fluoxetine
c. fluvoxamine
d. paroxetine
a. citalopram
which SSRI has the longest half-life and has activating potential?
a. citalopram
b. fluoxetine
c. paroxetine
d. sertraline
b. fluoxetine (96-144 hours)
what is the active metabolite of fluoxetine and which CYP does it inhibit?
norfluoxetine; 3A4 inhibitor
which SSRI is a 1A2, 2C19 inhibitor?
a. sertraline
b. fluvoxamine
c. fluoxetine
d. paroxetine
b. fluvoxamine
which SSRI must be tapered due to anticholinergic effects?
a. paroxetine
b. sertraline
c. citalopram
d. fluvoxamine
a. paroxetine
which SSRI is a 2D6, 2B6 inhibitor?
a. citalopram
b. sertraline
c. paroxetine
d. fluoxetine
c. paroxetine
which SSRI causes weight gain, sedation, and has a septal wall defect risk to the fetus?
a. sertraline
b. fluvoxamine
c. citalopram
d. paroxetine
d. paroxetine
which drug causes more nausea/GI upset than other antidepressants?
a. citalopram
b. fluoxetine
c. paroxetine
d. sertraline
d. sertraline
fluoxetine is an inhibitor of which CYP?
2D6
which SSRI causes weight loss?
a. paroxetine
b. fluoxetine
c. escitalopram
b. fluoxetine
3 bolded AEs of SSRIs to know (slide 17)
-inc bleeding risk (platelet inhibition)
-hyponatremia (especially in elderly)
-sexual dysfunction
active metabolite of venlafaxine
desvenlafaxine
which SNRI has a dose-limiting SE of nausea?
a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. venlafaxine
a. desvenlafaxine
(duloxetine also has nausea)
which SNRI has no major CYP interactions?
a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine
a. desvenlafaxine
which SNRI has a FDA warning for hepatotoxicity?
a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine
b. duloxetine
which SNRI is a 2D6 inhibitor? (2 of them; one is a 2D6 inhibitor at high dose)
a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine
b. duloxetine
e. venlafaxine (at high doses)
which SNRI must be adjusted in renal impairment or with strong 3A4 inhibitor?
a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine
c. levomilnacipran
which SNRI is a 3A4 substrate?
a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine
c. levomilnacipran
which SNRI must be > 150 mg/day to have NE effects?
a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine
e. venlafaxine
SNRIs AEs (2 of them in bold)
BP elevation, nausea
with which SNRI should we obtain LFTs at baseline and when symptomatic or every 6 months?
a. desvenlafaxine
b. duloxetine
c. levomilnacipran
d. milnacipran
e. venlafaxine
b. duloxetine
useful in pain syndrome, musculoskeletal pain, fibromyalgia, and neuropathic pain
a. SSRIs
b. SNRIs
c. TCAs
b. SNRIs
amitriptyline is a ______ amine
a. secondary
b. tertiary
c. tetracyclic
b. tertiary
TCAs are more often used for _____ _____ syndromes than depression
neuropathic pain
look at slide 21 for TCAs AEs
you got it
TCAs have a narrow therapeutic index and are fatal in overdose as low as _______ mg (4-10 tablets) due to cardiac arrhythmias or seizures
1000 mg
which MAOI does NOT require a low tyramine diet?
a. isocarboxazid
b. phenelzine
c. selegiline
d. tranylcypromaine
c. selegiline
how long should the washout period be before switching antidepressants?
2 seeks (5 weeks for fluoxetine)
T or F: MAOIs should be used with caution due to hypertensive crisis and serotonin syndrome
T
MOA of bupropion (2 things bolded)
-DNRI
-stimulating - insomnia and appetite suppression
bupropion is CI in active _____ and _____ disorders
seizure; eating
bupropion is a ____ inhibitor (CYP)
2D6
T or F: bupropion and mirtazapine should NOT be used in combo with SSRI/SNRIs
F (can be used in combo with SSRIs/SNRIs)
for mirtazapine, sedation and inc appetite occur with doses of ___ mg/day or less
15 mg/day
two warnings for mirtazapine
agranulocytosis; inc cholesterol
T or F: low doses of trazodone are used for depression
F (higher doses needed)
SE of trazodone (2 bolded)
-orthostatic hypotension
-risk of priapism (medical emergency)
vilazodone mechanism
primarily SSRI, may have some 5HT1A agonism which may provide anxiolytic effects
T or F: vilazodone or vortioxetine should NOT be used in combo with SSRI/SNRIs
T
vilazodone is a ___ substrate
3A4
why should vilazodone be taken with food? (2 things bolded)
-significant nausea
-bioavailability inc with food
which drug’s mechanism is a SSRI + 5HT1A agonist + 5HT3 antagonist?
a. vilazodone
b. bupropion
c. vortioxetine
c. vortioxetine
AE of vortioxetine (only one bolded)
nausea
vortioxetine is a ___ substrate
2D6
T or F: vortioxetine has more sexual dysfunction than other antidepressants
F (possibly less)
antidepressant withdrawal syndrome is common with ALL antidepressants EXCEPT
a. duloxetine
b. paroxetine
c. fluoxetine
d. sertraline
c. fluoxetine
T or F: antidepressant withdrawal syndrome is life threatening
F
antidepressants with __________ activity should be tapered no matter what
anticholinergic
4 atypical FDA-approved augmentation agents
-aripiprazole
-brexpiprazole
-cariprazine
-quetiapine
which of the following is FALSE about electroconvulsive therapy?
a. 2-3 times weekly as induction
b. usual course is 6-12 treatments
c. age is not a factor
d. can continue drug therapy
e. unsafe in pregnancy
f. can have temporary memory loss
g. CI in recent MI or hemorrhagic stroke
e. unsafe in pregnancy (it is safe)
