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PHRM 845 > exam 5 ott depression and bipolar > Flashcards

exam 5 ott depression and bipolar Flashcards

(49 cards)

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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?

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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?

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A

DAT and NET inihibitor

22
Q

what is important about buproprion?

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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?

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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?

Study These Flashcards
A

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

25
what is important about vilazodone?
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
what is important about vortioxetine?
SSRI, 5HT1a agonist, 5HT3 antagonist do not use in combination with SSRI/SNRI possibly less sexual dysfunction substrate 2D6 nausea
27
what is serotonin syndrome?
medical emergency with excessive amounts of serotonin in CNS
28
what is antidepressant withdrawal syndrome?
common with all antidepressants except fluoxetine antidepressants with anticholinergic activity should be tapered
29
what is used for augmentation?
atypical antipsychotics: aripiprazole, brexpiprazole, cariprazine, quetiapine
30
what are overall counseling points of antidepressants?
abrupt discontinuation can lead to antidepressant withdrawal syndrome possible increase in suicidal thinking during the first few weeks of therapy
31
What are clinical factors of bipolar?
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
what is bipolar 1 disorder?
1 or more manic episodes manic episodes last for greater than 1 week
33
what is bipolar 2 disorder?
major depressive and hypomanic epsiodes usually last >4 days
34
what is the treatment arm of bipolar?
mood stabilizers: 1st line: lithium or valproic acid 2nd line: carbamazepine, oxcarbazepine, lamotriginr, topiramate antipsychotics
35
what is important about lithium?
associated with decrease in suicidality NTI drug --> 1.2-1.5 mEq has toxicity dose: normally use 1:1 conversion
36
what are the ADRs of lithium?
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
what should be monitored when using lithium?
Scr, BUN, electrolytes CBC thyroid functions
38
what are drug interactions with lithium?
increase Li levels when taking ACE/ARB, thiazide, NSAIDS, dehydration
39
what are adverse effects of valproic acid?
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
what are monitoring parameters of valproate?
baseline: pregnancy test, LFTs, CBC routine: serum concentrations serum ammonia if suspected for hyperammonia
41
what are drug interactions with valproate?
significant concern with lamotrigine increased lamotrigine concentration and can lead to stevens johnson syndrome
42
what is important about carbamazepine?
thrombocytopenia hematological effects
43
what is important about oxcarbazepine?
CYP450 3A4 inducer hyponatremia
44
what is important about lamotrigine?
1st line treatment for depressive symptoms in bipolar not useful for acute treatment or for manic episodes
45
what is important about topiramate?
may cause weight loss heat intolerance/hypohidrosis metabolic acidossi and kidney stones possible teratogen
46
how are antipsychotics used in bipolar?
can be used in bipolar as monotherapy or in combination with other mood stabilizers, but not two together
47
what are treatment considerations for bipolar?
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
what should be used in bipolar during pregnancy?
lithium is good in first trimester lithium, valproic acid, carbamazepine, topiramate are all known possible teratogens
49
what are the antidepressant uses in bipolar?
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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