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53 Finals > IC12 Depression > Flashcards

IC12 Depression Flashcards

1
Q

RF for suicide

A

poor, elderly, lonely, man, comorbidities, previous attempts, triggering events, access to meds/firearms

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2
Q

Monoamine hypothesis

A

decrease NT in the brain — norepinephrine (NE/NA), serotonin (5HT), dopamine (DA)

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3
Q

medical conditions causing depression

A
  • Endocrine disorders: hypothyroidism, T2DM (depression and T2DM affects each other)
  • Deficiency states: anemia
  • Infections
  • Metabolic disorders: electrolyte imbalance, hepatic encephalopathy
  • CV: CAD, HF, MI (MI pt more likely to have depression)
  • Neurological: Alzheimer, Epilepsy, Pain, Parkinson, post-stroke
  • Malignancy
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4
Q

drug induced depression

A
  • Psychotropics: CNS depressants (benzodiazepines, opioids, barbiturates)
  • Withdrawal from alcohol and stimulants
  • Systemic corticosteroids
  • Isotretinoin (very potent vit A)
  • Interferon-ß-1a
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5
Q

Clinical Presentation of depression

A

In.SAD.CAGES
- Interest decr
- Sleep decr
- Appetite decr
- Depressed mood
- Concentration decr
- Activity decr
- Guilt
- Energy low
- Suicide

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6
Q

Dx of depression

A

A. ≥5 out of 9 sx for at least 2 weeks (of which one of them must be depressed mood or lost of interest)
B. significant distress/ functional impairment
C. not caused my other medical condition/ substance use

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7
Q

Adjustment disorder

A

sx occurs within 3mths of onset of stressor. sx do not persist if stressor is removed (eg booking in)

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8
Q

Acute stress disorder

A

sx occurs within 1mth of a traumatic event

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9
Q

what medical condition should be excluded before starting on antidepressants

A

mania

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10
Q

Depression vs deliruim/dementia

A
  • cyclical onset (good and bad days)
  • consciousness not impaired
  • no memory loss
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11
Q

Goals to tx

A

remission, suicide prevention
- assessment tool = PHQ-2/9

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12
Q

Non-pharm

A

sleep hygiene, psychotherapy, neurostimulation (for severe depression)

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13
Q

When is antidepressants indicated

A

moderate to severe depression
- mild depression no need antidepressants

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14
Q

first line antidepressant

A

mirtazapine, SSRI, SNRI, bupropion

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15
Q

acute phase tx: what is an adequate duration?

A

4-8 weeks

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16
Q

physical sx of depression (sleep and appetite) improves in…

A

1-2 weeks

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17
Q

mood sx of depression improves in…

A

4-8 weeks

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18
Q

total duration of antidepressant tx

A

6-12mths

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19
Q

why does mood sx takes longer to improve?

A

takes time for presynaptic autoreceptor to down-regulate to have unopposed secretion of NT (intended effect)

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20
Q

eg of TCA

A

Amitriptyline, Clomipramine, Nortriptyline

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21
Q

eg of SSRI

A

Fluoxetine, Paroxetine, Sertraline, Fluvoxamine, Citalopram, Escitalopram

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22
Q

eg of SNRI

A

Venlafaxine, Duloxetine

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23
Q

MOA of mirtazapine

A

NaSSA: increase 5HT and NE

24
Q

eg of MAOI used for depression

A

MAO-AI: moclobemide

25
Q

MOA of bupropion

A

Block reuptake of NE and DA (no effect of 5HT)

26
Q

bupropion should be avoided in which pt

A

psychosis (increase dopamine worsens psychosis), seizure, 2D6 substrates (bupropion is a 2D6 inhibitor)

27
Q

which antidepressants have short half life

A

paroxetine, venlafaxine

28
Q

which antidepressants have long half life

A

bupropion, fluoxetine

29
Q

which antidepressant should be taken with food to increase absorption

A

sertraline

30
Q

SE of TCA

A
  • GI, sexual dysfunction
  • M1: anticholinergic
  • H1: sedation, weight gain
  • a1: orthostatic hypotension
  • arrhythmia, seizure
31
Q

SE of SSRI

A

GI, sexual dysfunction

32
Q

which SSRI has most anticholinergic SE

A

most anticholinergic, sedating, weight gain, short T1/2

33
Q

which SSRI has QTc prolongation

A

citalopram, escitalopram

34
Q

SE of SNRI

A

GI, sexual dysfunction
- venlafaxine: increase BP

35
Q

SE of mirtazapine

A

increase appetite sedation, weight gain, reverse GI and sexual SE of SSRI/SNRI

36
Q

does bupropion has GI/sexual SE?

A

no (no activity with 5HT)

37
Q

adjunct for MDD

A
  • SGA: Aripiprazole, Brexpiprazole, Quetiapine XR (for tx resistant/ bipolar depression: olanzapine + fluoxetine)
  • Esketamine
  • PRN hypnotics
38
Q

Can St John Wort be used for depression

A

avoid due to DDI with antidepressants (St John Wort is a 3A4 inducer)

39
Q

when should antidepressant be swithced?

A

Adequate trial for 2 weeks & no improvement → switch medications (no need to wait for 4-8 weeks)

40
Q

Mx of partial/no response

A
  • Switching antidepressants (washout period for MAOI necessary)
  • Augmentation with antidepressant with different MOA (mirtazapine, bupropion) or SGA
41
Q

Define tx resistant depression

A

no response ≥2 adequate trials of antidepressants

42
Q

special populations mx

A

see specialist
- elderly (avoid TCA)
- hyponatremia usually occur with elderly (highest risk with SSRI)

43
Q

pt <24yo should be counselled for

A

suicide

44
Q

drug of choice: underweight + depression

A

mirtazapine

45
Q

drug of choice: neuropathic pain + depression

A

duloxetin

46
Q

serotonin syndrome

A

agitation, myoclonus, diaphoresis, confusion, coma

47
Q

which antidepressants has highest risk of bleeding?

A

SSRI

48
Q

avoid taking antidepressants with..

A

other CNS depressants, alcohol (space apart by 4-6hrs), anticholinergic drugs

49
Q

1A4 inhibitors

A

fluvoxamine

50
Q

2C19 inhibitors

A

fluvoxamine

51
Q

2D6 inhibitors

A

fluoxetine, paroxetine, bupropion

52
Q

3A4 inhibitors

A

grapefruit juice

53
Q

3A4 inducer

A

rifampicin, carbamazepine, phenytoin, St John Wort

54
Q

Antidepressants with the fewest DDI

A

mirtazapine, escitalopram, venlafaxine, desvenlafaxine, vortioxetine

55
Q

Antidepressant discontinuation syndrome (this is NOT withdrawal) sx

A

FINISH
- Flu like sx (lethargy, fatigue, headache, sweating)
- Insomnia
- Nausea
- Imbalance (dizziness)
- Sensation tingling
- Hyperarousal (anxiety)

56
Q

how to avoid Antidepressant discontinuation syndrome

A

gradually tapering of short acting drugs (paroxetine, venlafaxine)
- long acting drugs no need gradual taper (bupropion, floxetine)

53 Finals (10 decks)

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