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PHRM 845 > exam 5 ott depression and bipolar > Flashcards

exam 5 ott depression and bipolar Flashcards

1
Q

What is the risk of recurrence for depression?

A

1 episode = 50-60%
2 episodes = 70%
3 episodes = 90%
recurrence becomes lower overtime as duration of remission increases

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2
Q

What are the DSM 5 criteria for depression?

A

atleast one of the symptoms must be depressed mood or loss of interest or pleasure in doing things

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3
Q

what are symptoms of depression?

A

SIGE CAPS
sleep
interest
guilt
energy loss
concentration difficulties
appetite changes
psychomotor agitation
suicidal ideation

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4
Q

what are the self-administered rating scales?

A

PHQ-9
MDQ
QIDS-SR-16

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5
Q

what are the goals of treatment?

A

reduce signs/symptoms
restore ocupation and psychosocial functioning
reduce risk of relapse and recurrence
reduce risk of harmful consequences

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6
Q

what is a boxed warning for all antidepressant medications?

A

risk of suicidality

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7
Q

What is important about citalopram?

A

dose dependent QT prolongation
substrate for CYP 2C19 and 3A4

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8
Q

what is important about flouxetine?

A

long half life –> do not have to taper
activating potential due to being an inhbitor for 2D6 and 3A4(norfluoxetine)
weight loss

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9
Q

What is important about fluvoxamine?

A

inhibitor for 1A2 and 2C19

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10
Q

what is important about paroxetine?

A

must taper due to anticholinergics
weight gain, sedation
teratogenic –> septal wall defect in fetus
inhibitor of 2D6, 2B6

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11
Q

what is important for sertraline?

A

more GI upset than other antidepressants

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12
Q

what are the class effects for SSRIs?

A

hyponatremia
increase bleeding (platelet inhibition)
sexual dysfunction

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13
Q

what is important about desvenlafaxine?

A

active metabolite for venlafaxine
dose-limiting side effect: nausea
no major CYP interactions

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14
Q

what is important about duloxetine?

A

Ott’s go to drug
FDA warning for hepatotoxicity –> monitor LFTs
inhibitor of 2D6
nausea

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15
Q

what is important about levomilnacipran?

A

must adjust in renal impairment or strong 3A4
substrate for 3A4

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16
Q

what is important about venlafaxine?

A

must be >150mg for NE effects
2D6 inhbitor at higher doses

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17
Q

what are the ADRs for SNRIs?

A

SSRI ADRs and hypertension and nausea

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18
Q

what is TCA MOA?

A

DAT, NET, SERT inhibitor

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19
Q

what is important about TCA?

A

amitriptyline - tertiary amine
used for neuropathic pain syndromes
Sides:
CNS: sedation, reduced seizure threshold
anticholinergics:
CV: orthostatic hypotension, tachycardia
NTI –> fatal overdose as low was 1000mg

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20
Q

what is important about MAOi?

A

must have 2 weeks washout before switching to antidepressant
needs 5 weeks for fluoxetine
all require tyramine diet except for selegiline patch
caution due to HTN crisis and serotonin syndrome

21
Q

what is MOA for buproprion?

A

DAT and NET inihibitor

22
Q

what is important about buproprion?

A

stimulating - insomnia and appetite suppression
2D6 inhibitor
CI in seizure disorder and eating disorder
can be combined with SSRI/SNRI

23
Q

what is important about mirtazepine?

A

sedation and increased appetite with <15mg/day
agranulocytosis, increased cholesterol
can be used in combination with SSRIs/SNRIs

24
Q

what is important about trazodone?

A

MOA: 5HT1, 5HT2, H1, A1 antagonist inhibitor
higher doses for depression
sides:
orthostatic hypotension
risk for priapism

25
Q

what is important about vilazodone?

A

primarily SSRI with some 5HT1a agonism for anxiolytic effect
do not use with SSRI/SNRI
take with food: increase bioavailability and significant N
substrate 3A4

26
Q

what is important about vortioxetine?

A

SSRI, 5HT1a agonist, 5HT3 antagonist
do not use in combination with SSRI/SNRI
possibly less sexual dysfunction
substrate 2D6
nausea

27
Q

what is serotonin syndrome?

A

medical emergency with excessive amounts of serotonin in CNS

28
Q

what is antidepressant withdrawal syndrome?

A

common with all antidepressants except fluoxetine
antidepressants with anticholinergic activity should be tapered

29
Q

what is used for augmentation?

A

atypical antipsychotics:
aripiprazole, brexpiprazole, cariprazine, quetiapine

30
Q

what are overall counseling points of antidepressants?

A

abrupt discontinuation can lead to antidepressant withdrawal syndrome
possible increase in suicidal thinking during the first few weeks of therapy

31
Q

What are clinical factors of bipolar?

A

depression is a mood pole that is experienced most often in bipolar –> so can lead to misdiagnosis
alcohol and substance use is common
anxiety is common comorbiity that can impact remission of mood episodes

32
Q

what is bipolar 1 disorder?

A

1 or more manic episodes
manic episodes last for greater than 1 week

33
Q

what is bipolar 2 disorder?

A

major depressive and hypomanic epsiodes
usually last >4 days

34
Q

what is the treatment arm of bipolar?

A

mood stabilizers:
1st line: lithium or valproic acid
2nd line: carbamazepine, oxcarbazepine, lamotriginr, topiramate
antipsychotics

35
Q

what is important about lithium?

A

associated with decrease in suicidality
NTI drug –> 1.2-1.5 mEq has toxicity
dose: normally use 1:1 conversion

36
Q

what are the ADRs of lithium?

A

toxicity: ataxia, GI, coarse hand tremor, altered mental status, seizure
sides: fine hand tremor, hypothyroidism, polyuria, polydipsia, acne, weight gain, ECG changes
teratogenic: avoid in first trimester

37
Q

what should be monitored when using lithium?

A

Scr, BUN, electrolytes
CBC
thyroid functions

38
Q

what are drug interactions with lithium?

A

increase Li levels when taking ACE/ARB, thiazide, NSAIDS, dehydration

39
Q

what are adverse effects of valproic acid?

A

unsafe in any trimester – needs a pregnancy test
PCOS occurs in 50% of women
GI: anorexia, N/V/D, dyspepsia, ulceration
thrombocytopenia, platelet inhbition
teratogenic – neural tube defect
hypermmonemia
increased appetite

40
Q

what are monitoring parameters of valproate?

A

baseline: pregnancy test, LFTs, CBC
routine: serum concentrations
serum ammonia if suspected for hyperammonia

41
Q

what are drug interactions with valproate?

A

significant concern with lamotrigine
increased lamotrigine concentration and can lead to stevens johnson syndrome

42
Q

what is important about carbamazepine?

A

thrombocytopenia
hematological effects

43
Q

what is important about oxcarbazepine?

A

CYP450 3A4 inducer
hyponatremia

44
Q

what is important about lamotrigine?

A

1st line treatment for depressive symptoms in bipolar
not useful for acute treatment or for manic episodes

45
Q

what is important about topiramate?

A

may cause weight loss
heat intolerance/hypohidrosis
metabolic acidossi and kidney stones
possible teratogen

46
Q

how are antipsychotics used in bipolar?

A

can be used in bipolar as monotherapy or in combination with other mood stabilizers, but not two together

47
Q

what are treatment considerations for bipolar?

A

mood stabilizer treatment is long-term and considered to be maintenance treatment to reduce time to subsequent mood episodes
suicide attempt risk is high in both poles –> monitor lithium carefully

48
Q

what should be used in bipolar during pregnancy?

A

lithium is good in first trimester
lithium, valproic acid, carbamazepine, topiramate are all known possible teratogens

49
Q

what are the antidepressant uses in bipolar?

A

needs to have a mood stabilizer on board
serotonergic antidepressant used to treat anxiety
prefer mood stabilizers that target the depressive pole:
lithium, lamotrigine, lurasidone, quetiapine

PHRM 845 (9 decks)

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