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PHRM 845 > L69 - Ott depression > Flashcards

L69 - Ott depression Flashcards

1
Q

risk of recurrence in depression
1 episode: __%
2 episodes: ___%
3 episodes __ %

A

50-60
70
90

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2
Q

Acronym for DSM-5 diagnostic criteria

A

SIGE CAPS
Sleep
Interest decreased
Guilt/ worthlessness
Energy loss/ fatigue
Concentration difficulties
Appetite changes
Psychomotor
Suicidal ideation

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3
Q

Higher suicide risk
Longer duration of illness
Poor treatment response
A. w/ anxious distress
B. w/ melancholic features
C. w/ atypical features

A

A

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4
Q

Anhedonia
Psychomotor retardation/agitation -> worse in the morning, more likely in elderly
A. w/ anxious distress
B. w/ melancholic features
C. w/ atypical features

A

B

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5
Q

Reactive mood
Weight gain
Hypersomnia -> more likely in younger patient
A. w/ anxious distress
B. w/ melancholic features
C. w/ atypical features

A

C

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6
Q

3 self-administered rating scales

A

PHQ-9
QIDS-SR-16
MDQ

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7
Q

name the 3 phases of tx

A

acute
continuation
maintenance

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8
Q

the boxed warning for suicide in all antidepressants is for what age?

A

24 and below

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9
Q

what is the only ssri that does not require a taper

A

fluoxetine

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10
Q

what ssri has more GI upset than the others

A

sertraline

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11
Q

which ssri has dose dependent QTc prolongation

A

Citalopram

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12
Q

2C19 and 3A4 substrate ssri

A

citalopram

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13
Q

2D6 and 3A4 inhibitor ssri

A

fluoxetine

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14
Q

1A2 and 2C9 ssri

A

fluvoxamine

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15
Q

avoid in pregnancy

A

paroxetine

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16
Q

paroxetine CYPs

A

2D6 and 2B6

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17
Q

3 key adverse effects across all SSRIs

A

increased bleeding
hyponatremia
sexual dysfxn

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18
Q

specific paroxetine adverse effect (not related to pregnancy )

A

weight gain

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19
Q

specific adverse effect for fluoxetine

A

weight loss

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20
Q

Desvenlafaxine CYPS

A

none

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21
Q

SNRI with dose-limiting side effect of nausea

A

Desvenlafaxine

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22
Q

SNRI with FDA warning for hepatotoxicity

A

duloxetine

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23
Q

duloxetine CYP(s)

A

2D6

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24
Q

SNRI that you MUST adjust in renal impairment or strong 3A4 inhibitors

A

Levomilnacipran (fetzima)

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25
Q

SNRI that must be >150 mg/day to have NE effects

A

venlafaxine

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26
Q

which SNRI is a 2D6 inhibitor at higher doses

A

Venlafaxine

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27
Q

Venlafaxine CYP(s)

A

2D6 at high doses, and 3A4

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28
Q

2 main SNRI Adverse effects that were highlighted

A

BP elevation and Nausea

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29
Q

when are SNRI especially useful

A

musculoskeletal pain, fibromyalgia, neuropathic pain

30
Q

which SNRI do you obtain LFTs at baseline and when symptomatic or every 6 months

A

duloxetine

31
Q

the one single TCA OTT wants us to know

A

amitriptyline

32
Q

TCA MOA

A

blockade of reuptake transporters for DAT NET and SERT

33
Q

TCA side effects that we care about:

A

CNS: sedation, reduced seizure threshold, confusion
anticholinergic: you know
cardiovascular: hypotn, tachy
other: weight gain, sexual dysfxn

34
Q

why are TCAs fatal in OD?

A

doses as low as 1000mg (4-10 tabs) can cause arrhythmias or seizures

35
Q

T or F: TCAs more useful in pain syndromes than in depression

A

true

36
Q

what class are the following?
Isocarboxazid, Phenelzine, Selegiline
Tranylcypromine

A

MAOi’s

37
Q

all maoi’s require what weird niche thing and with what exception?

A

tyramine diet, except for selegiline 6mg patch **

38
Q

caution in MAOis due to ____ and ____

A

htn crisis and serotonin syndrome

39
Q

MAOi must have __ week washout period before switching antidepressants

A

2 weeks, except fluoxetine which is 5 week bc half-life

40
Q

T or F: MAOis show more efficacy in combo with other antidepressants

A

F, should always be by themselves

41
Q

what are some foods included in the tyramine diet

A

meats, fish, sauerkraut, cheese, yeast extracts, flava beans, beer, wine

42
Q

tyramine foods in small amounts

A

beer, wine, avocados, meat extracts, caffeine, chocolate

43
Q

MOA of bupropion

A

DA and NE reuptake inhibitor

44
Q

bupropion stimulates what 2 things

A

insomnia, appetite supression

45
Q

bupropion cyp(s)

A

2d6

46
Q

bupropion contraindicated in what and what

A

seizure and eating disorders

47
Q

what makes mirtazapine a good adjunct drug with ssris?

A

it boosts effects of ssris

48
Q

mirtazapine:
Sedation and increased appetite occur with doses < __ mg/day

A

15, so lower doses

49
Q

two warnings associated with mirtazapine

A

agranulocytosis and increased cholesterol

50
Q

T or F: Lower doses of trazodone are more useful in depression while higher doses are for insomnia

A

false, other way around

51
Q

2 highlighted side effects of trazodone

A

orthostatic hypotension
risk of priapism -> medical emergency **

52
Q

Vilazodone:
primarily _____ (class), may have some ____ agonism which may provide anxiolytic effects

A

ssri, 5ht1A

53
Q

T or F: Vilazodone should not be used as a combo product

A

true

54
Q

T or F: Vilazodone should be taken with. food

A

true

55
Q

vilazodone cyp(s)

A

3a4

56
Q

vortioxetine (trintelllix):
_____ agonist and _____ antagonist

A

5ht1a, 5ht3

57
Q

vortioxetine (trintellix) clinical pearl

A

possibly less sexual dysfunction**

58
Q

vortioxetine (trintellix) cyp(s)

A

2d6

59
Q

highlighted adverse effect of vortioxetine (trintellix)

A

nausea

60
Q

T or F: unlike vilazodone, vortioxetine can be used as an adjunct therapy

A

false, still no… idiot

61
Q

T or F: serotonin syndrome is considered a medical emergency

A

true

62
Q

serotonin syndrome treatment:
- 1st step = ____
- could use serotonin blocker like _______

A

stop the offending agent
cyproheptadine

63
Q

T or F: antidepressant withdrawal symptom is a life-threatening medical emergency

A

false

64
Q

antidepressant withdrawal symptom is common among all antidepressants except ___

A

fluoxetine

65
Q

antidepressants with _____ activity should be tapered no matter what

A

anticholinergic

66
Q

4 fda approved atypicals for depression

A

quetiapine
aripiprazole
cariprazine
brexpiprazole

67
Q

2 drugs for post-partum depression (with dosage form)

A

brexanolone (iv only)
zuranolone (oral)

68
Q

medication used for treatment-resistant depression

A

esketamine nasal spray

69
Q

may take how long to see benefits of antidepressant

A

2-4 weeks

70
Q

how long do you need to take antidepressants to decrease risk of recurrence

A

6-9 months (nice)

71
Q

T or F: There is less risk associated with suicidal thinking within the first few weeks of treatment

A

false its actually higher

PHRM 845 (34 decks)

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