Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics > Exam 5 lecture 2 > Flashcards

Exam 5 lecture 2 Flashcards

1
Q

Risk of recurrence of depression based on number of episodes

A

1 episode- 50-60%
2 episodes- 70%
3 episodes- 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are factors that increase or decreases chances of remission

A

Risk becomes lower over time as duration of remission increases

Persistent mild symptoms during remission is a predictor of recurrence

Function deteriorates during episode and oes back to normal upon remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DSM 5 Diagnostic criteria for depression

A

SIGE CAPS

S- sleep (insomnia/hypersomnia)
I- Interest decreased (anhedonia)
G- Guilt/worthlessness
E-ENergy loss/fatigue
C-concentration difficulties
A- Appetite change (increase or decrease)
p-Psychomotor agitation/retardation
s- suicidal ideation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Self administered rating scales for depression

A

PHQ-9
MDQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

goals of tx of depression

A

reduce or eliminate signs and symptoms of depression

restore occupational and psychosocial functioning to baseline

Reduce the risk of elapse and recurrence

reduce the risk of harmful consequences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Phases of treatment of depression

A

Acute- 6-12 weeks or remission (induce remission)

continuation- 4-9 months (prevent relapse)

Maintenance- indefinite treatment if > 3 major depressive disorders (prevent recurrence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a boxed warning in ALL antidepressants

A

Boxed warning for suicidality in all antidepressants aged <24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

pharmacologic classes of antidepressants

A

SSRIs
SNRIs
TCAs
MAOIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the SSRIs

A

Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are things we must remember about citalopram (side effects and metabolizers)

A

QTC prolongation
Substrate of 2C19and 3A4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Things to remember about fluoxetine ( half life, metabolizer)

A

Long half life (96-144 hrs)
2D6 inhibitor, 3A4 inhibitor

you dont have to taper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

fluvoxamine metabolizer

A

1A2 and 2C19 inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Things to know about paroxetine

A

Must taper due to anticholinergic side effects
weight gain, sedation
Septal wall defect risk to the fetus
inhibitor of 2D6 and 2B6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sertraline clinical pearls

A

More GI upset than other antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SNRIs adverse effects and key points

A

Useful in pain syndrome, muscoskeletal pain, fibromyalgia, neuropathic pain

Side effects- BP elevation and nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Monitoring for duloxetine

A

Obtain LFTs at baseline and when symptomatic or every 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

notable side effects of paroxetine? Fluoxetine? and SSRIs in general

A

weight gain (paroxetine)
Weight loss (Fluoxetine)
Generally- increased bleeding risk, hyponatremia, sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What to know about desvenlafaxine? CYP metabolism?

A

Active metabolite of venlafaxine. Dose limiting side effect- Nausea

No major CYP interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What to know about duloxetine? CYP metabolism?

A

causes nausea

FDA warning for hepatotoxicity

inhibitor of 2D6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What to know about levomilnacipran (Metabolism)

A

Must adjust in renal impairement or strong 3A4 inhibitor

3A4 substrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Things to know about venlafaxine ( metabolism)

A

Must be >150 mg/day to have NE effects

2D6 inhibitor at higher doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

TCAs MOA

A

Primarily affect serotonin and norepinephrine, but also affects dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What TCA is important for exam? What is it used for?

A

Amitriptyline- pain and headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

TCA adverse effect

A

CNS sedation, reduced seizure threshold, confusion

anticholinergic, blurred vision, urinary retention, constipation

Cardiovascular, orthostatic hypotension, tachycardia

Weight gain sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Key point to know about TCA
Narrow therapeutic index- fatal in OD as low as 1000 mg (4-10 tabs) due to cardiac arrhythmias or seizures
26
What is an important thing to know before switching antidepressant to MAO inhibitors
Must have 2 week washout period before switching antidepressants (5 week washout period if switching from fluoxetine)
27
What is required to do when on MAO I drug? cautions?
all require tyramine diet except for selegiline caution due to hypotensive crisis and serotonin syndrome
28
tyramine diet is not required with what MAOI
Selegiline patch
29
Bupropion MOA? side effects?
Dopamine and norepinephrine reuptake inhibitor Stimulated insomnia and appetite suppression
30
Metabolism of Bupropion
2D6 inhibitor
31
Contraindication of bupropion
Contraindiacted in active seizure and eating disorders
32
Can bupropion be used with SSRIs
Yes
33
Mirtazapine dosing?
Sedation and increased appetite occurs with doses <15 mg/day (yess less than)
34
Warning of mirtazapine? Can they be combined with SSRIs?
Warning- agranulocytosis, increased cholesterol can be used in combination with SSRI/SNRI
35
MOA of trazodone? Doses?
selectively inhibits neuronal reuptake of serotonin and acts as antagonist dosing- higher doses needed for depression
36
side effects of trazodone
Orthostatic hypotension Risk of priapism- medical emergency
37
Vilazodone MOA
Primarily SSRI, may have some 5HT1a agonism which may provide anxiolytic effects
38
can we combine vilazodone with SSRIs?
no
39
Metabolism of vilazodone? How to take it?
3A4 bioavailability increases with food (significat nausea)
40
Vortioxetine MOA? Can we use with SSRIs
SSRI + 5HT1A agonist + 5HT3 antagonist do not combine with SSRIs/SNRIs
41
Adverse effects and metabolism of vortioxetine
Substrate 2D6, Nausea and less sexual function
42
Which SSRIs have withdrawal syndrome? Which ones should always be tapered
Common with ALL antidepressants EXCEPT fluoxamine Antidepressants with anticholinergic activity should be tapered no matter what, NOT life threatening but extremely uncomfortable
43
What are the most common augmentation agents for depression
Antipsychotics Lithium Lamotrigine (anticonvulsants)
44
What are some FDA approved augmentation agents
Aripiprazole Brexipiprazole Cariprazine Quetiapine
45
What are antidepressants used for specific factors?
Post-partum depression- Brexanolone, zuranolone Treatment resistant depression- Esketamine nasal spray
46
Overall counseling points for antidepressants
Abrupt discontinuation can lead to antidepressant withdrawal syndrome possible increase in suicidal thinking during the first few weeks of therapy
47
What is the mood pole experienced most by people with bipolar
Depression
48
common comorbidities with bipolar disorder
Alcohol and substance use is common (50-60%) anxiety disorders are common comorbidities and can significantly impact remission of mood episodes if left untreated or inadequately treated
49
difference between bipolar 1 and bipolar 2
Bipolar 1 is > or =1 manic episodes Bipolar 2- hypomanic episodes both have depression but seems more common in 2
50
1st line therapy of bipolar disorder
Lithium or valproic acid Atypical antipsychotics can also be used in combination with Lithium and valproic acid
51
How effective is lithium for bipolar treatment? what is associated with it? How to convert lithium therapy?
Effective and safe associated with decrease in suicidality use 1:1 conversion
52
Serum levels considered to be toxic?
above 1.2 is toxic toxicity mild to severe- >1,5 and >3.0
53
Toxicity associated with Li
GI, ataxia, coarse hand tremor, altered mental status, seizure, lethargy, confusion, agitation
54
side effects of Li
Fine hand tremor, hypothyroidism, polyuria, polydipsia, acne, dry mouth, weight gain
55
When to use and avoid Li in pregnancy
Avoid in 1st trimester. Use in caution in 2nd and 3rd trimester
56
Labs to monitor on Li
SCr, BUM, urine specific gravity, Na, K, Ca, ECG, thyroid function, CBC, weight, pregnancy test
57
Drug interaction of Li on decreased renal clearence
ACEi, ARBs, THiazides, NSAIDs
58
Drug interaction with increased Li renal clearence
Caffeine, osmotic diuretic, loop diuretic
59
What is the use of valproate? What are the available dosage forms and what is the difference between them? conversion? Which one is high risk for GI ulceration
common 1st line for bipolar Extended release (ER) dosage form- 10-15% less bioavailable that delayed release (DR) 1:1 cpnversion- expect lower serum concentration with ER Valproic acid syrup and capsule sprinkle form- higher risk for GI ulcerations
60
What serum levels of valproate associated with most efficacy? When to obtain this level after first dose?
Serum levels- 80-125 mcg/ml associated with the most efficacy in mania. Obtain level atleast 96 hours after 1st dose or dose increase
61
Valproate in pregnancy
NEVER, PCOS occurs in up to 50% of women
62
Side effects of valproic acid
GI- anorexia, N/V/D, dyspepsia, ulceration increased appetite- weight gain Thrombocytopenia, platelet dysfunction Teratogenic- Neural tube defects enduring negative effects on IQ of offspring hyperammonemia
63
Valproate monitoring
Baseline- pregnancy test, LFT, CBC serum concentration serum ammonia- if suspect hyperammonemia, routine ammonia monitoring is not necessary
64
Drug interactions present with valproate
Significant concerns with combination use with lamotrigine-increased lamotrigine serum concentrations increase risk of stevens johnsosn syndrome
65
What are the two antipsychotics used in mood stabilizing
Carbamazepine and oxcarbamezapine
66
Carbamazepine side effects?
thrombocytopenia/hematologic effects
67
Oxcarbamazepine metabolism, side effects
CYP450 inducer associated with hyponatremia
68
anticonvulsant drugs
lamotrigine topiramate
69
when is lamotrigine 1st line treatment
depressive symptoms of bipolar disorder
70
Is lamotrigine useful for acute treatment for manic episodes?
NOT useful
71
Topiramate side effects
May cause weight loss heat intolerance/hypohidrosis metabolis acidosis and kidney stones possible teratogen
72
Can antipsychotics be used as monotherapy for bipolar disorder
Yes, they can also be used in conjunction with other mood stabilizers (usually valproate or lithium)
73
Monitoring parameters for antipsychotics in bipolar
Metabbolic syndorme and movement side effects
74
What are some treatment considerations of mood disorders
Mood stabilizer tx is long term and is cnsidered to be maintenance treatment to reduce time to subsequent mood episodes suicide attempt risk is high in both poles of bipolar disorder- monitor closely, use lithium cautiously
75
Can we use lithium + valproate?
yes we can use valproate +antipsychotic we can use all 3 + antidepressant Never use two atypical antipsychotics
76
What drugs are known or possible teratogens in bipolar tx
Li, Valproate, carbamazepine, topiramate
77
1st line tx for bipolar pregnant women
Atypicl antipsychotics
78
What type of drugs do we prefer to use when handling bipolar disorder
prefer to use mood stabilizers that target depressive pol (lamotrigine, lithium, lurasidone, quetiapine)
79

Therapeutics (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions