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Mood Dosorders I > Lecture 1 > Flashcards

Lecture 1 Flashcards

1
Q

Pt is diagnosed with MDD, he cannot take any 1st-line tx. We decide to give a 2nd-line tx. Additionally, the patient has a 30 pack year smoking history and wants to start quitting smoking. What medication would you prescribe?

A

Bupropion

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2
Q

Pt is diagnosed with MDD, he cannot take any 1st-line tx. We decide to give a 2nd-line tx. Additionally, the patient has a 30 pack year smoking history and wants to start quitting smoking. Further questioning reveals that the patient has a hx of anorexia and is at high seizure risk. What medication would you NOT prescribe?

A

Bupropion

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3
Q

Bupropion
- SE
- Indication
- CI

A
  • SE: Dry mouth, insomnia, n/v, increased risk for seizures (dose dependent), loss of appetite.
  • Indication: MDD patients that want to quit smoking
  • CI: Anorexia/ bulimia, high risk for seizure.
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4
Q

What medication works by inhibiting alpha-2 adrenergic receptors, 5-HT2, and 5-HT3 receptors; causing an increase in serotonin and NE?

A

Mirtazapine

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5
Q

A patient has been diagnosed with MDD + has a hard time falling asleep (insomnia). What medication would be best for him? (Pick a second line tx).

A

Mirtazapine

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6
Q

Which atypical antidepressant has a SE of drowsiness, sedation, increase appetite, weight gain, and sexual dysfunction.

A

Mirtazapine

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7
Q

Which medication category is a second line therapy due to the patient not being able to tolerate SSRI that blocks reuptake of 5-HT? What medications fall under this class?

A
  • Serotonin modulators
  • Nefazodone
  • trazodone
  • vilazodone
  • Vortioxetine
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8
Q

Serotonin Modulators
- Dosing
- Clearance
- SE

A
  • QD or BID
  • Cleared by the Liver
  • Headache, diarrhea, nausea ARE VERY COMMON!!, serotonin syndrome
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9
Q

Which serotonin modulator medication has a BBW of HEPATOTOXICITY and should not be given to a patient with liver disease? Additionally, this medication causes prolonged erection (xerostomia)

A

Nefazodone

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10
Q

How is ketamine given? What about esketamine?

A
  • Ketamine: IV
  • Esketamine: Nasal spray
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11
Q

Which medication is given to tx severe, refractory depression w/o psychosis, especially when patients has failed or not responded to ECT.

A
  • Ketamine/ Esketamine
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12
Q

A patient presents to the clinic and you need to give him a second generation antidepressant. He has previously failed or not responded to ECT. The patient has a fear of Needles and wont let you stick him with a needle or IV. You decide to give him the medication through a nasal spay. Which medication do you choose?

A
  • Esketamine ( given through a nasal spray) & used for treating a patient that has severe, refractory depression w/o psychosis.
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13
Q

A patient presents to the clinic and you need to give him a newly approved antidepressant to treat MDD. He has previously failed or not responded to ECT and has sever, refractory depression w/o psychosis. The patient has a nose bleed so you can’t give the medication through the nose, you then decide to give him the medication through IV. Which medication would you give IV?

A

Ketamine

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14
Q

Patient diagnosed MDD and needs meds. He doesn’t want to take many pills. what medication do you prescribe? what should you counsel him about? if the patient had breast cancer and was being treated with tamoxifen, would you need to do something?

A

Fluoxetin
SE anxiety
Do not take with tamoxifen

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15
Q

Patient with MDD needs Rx (SSRI), Hx constipation and Ø want a drug that causes lots of drowsiness. Additionally he is taking Rx to QT prolongation. What medication do you give? Would you change the treatment if the patient had breast cancer and was being treated with Tamoxifen?

A

Sertraline
No need to change the Tx

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16
Q

Pt MDD needs Rx; Hx polyuria, diarrhea, too much mucous in membranes. What medication would you give.Would you change the treatment if the patient had breast cancer and was being treated with Tamoxifen?

A

Paroxetin
Yes, we cannot give this medication with tamoxifen.

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17
Q

Pt MDD, needs Rx, Hx insomnia and would like to take a pill daily, what med would you give?

A

Fluvoxamine

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18
Q

Pt MDD and needs Rx, we need to prolong his QT and we also need a drug that is least inhibited by the liver

A

Citalopram or Escitalopram

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19
Q

which of the serotonin modulators has SE of sedation? meaning it will make you fall asleep

A

Trazodone

20
Q

Which medication(s) are of SHORT-TERM ONLY! when it comes to second generation?

A

Ketamine/esketamine

21
Q

If ketamine/esketamine are used in the long-term, what SE will take placE?

A
  • Neurotoxicity (limb weakness or numbness, loss of memory, vision, intellect, headache, sexual dysfunction, cognitive and behavior problems, paralysis, depression, imbalance)
  • bladder toxicity
  • hepatotoxicity
22
Q

Which second generation category or medication is an Opioid and glutamate agonist?

A

Ketamine/Esketamine

23
Q

Which medications are considered First generation?

A

MAOI (monoamine oxidase inhibitor), TCAs (Tricyclic antidepressants), TeCAs (tetracyclic antidepressants)

24
Q

Which is the first class of antidepressants used clinically

A

MAOIs

25
Q

Which MAOI works by breaking down serotonin and norepinephrine?

A

MAOa

26
Q

Which MAOI works by breaking down dopamine with the help of MAOa?

A

MAOb

27
Q

What is the downside of using MAOIs?

A

Extensive SE, DDIS, & dietary restrictions

28
Q

MAOIs are only used for what purpose?

A

ONLY for treatment-resistant or atypical depression

29
Q

which MAOI is also used for parkinsons?

A

Selegiline

30
Q

Which drugs are considered MAOIs?

A
  • Tranylcypromine
  • Phenelzine
  • Isocarboxazid
  • Selegiline
31
Q

MAOIs contraindication?

A
  • Cardiovascular disease, hepatic or renal impairment, use within 2 weeks of serotonergic drugs
  • Hypertensive Crisis - foods with tyramine (aged cheese, soy sauce, cured meat, tap beer, tofu)
32
Q

MOAIs are considered first treatment for 1st generation; which is considered second generation?

A

TCAs

33
Q

What will happen if you overdose a patient on TCA?

A

They patient will die since the brain cannot tolerate big doses of this medication.

34
Q

If you are giving an MOAI, can you also give a TCA?

A

No! TCAs are CI to give with MAOIs, you must wait 2 weeks of an MAOI

35
Q

How do TCAs work?

A

Inhibit reuptake of 5HT and NE

36
Q

Why do we use Lithium?and how is it used?

A

Tx bipolar
used as an add-on

37
Q

What is another name for PDD (persistent depressive disorder)?

A

Dysthymia

38
Q

How does a patient qualify for Persistent Depressive Disorder (PDD)?

A

Ongoing depressive symptoms for two or more years & pt does not need to be in full major depressive episode for the two years.

39
Q

How does PDD present

A

2+ years of depressive mood with no more than 2 months free of s/s, + two or more :
appetite changes, sleep changes, fatigue or loss of energy, diminished ability to concentrate, low self-esteem, feelings of hopelessness

40
Q

What is the most efficacious tx for PDD?

A

Pharmacology –>1st line (SSRIs) –> 2nd line (MAOIs or TCAs) + psychotherapy

41
Q

Which of the antidepressants are most commonly used?

A

SSRIs
SNRIs
Serotonin Modulators
TCAs

42
Q

How long should we wait to see if an antidepressant works?

A

4 -6 weeks

43
Q

Lets say a patient has been on antidepressants for 5 weeks and the s/s have improved and the patient is feeling good. Do we need to continue therapy or stop it?

A

Continue therapy for 6+ months

44
Q

A patient with depression heard from a friend that you can take OTC herbals to help her condition. She doesn’t know what her friend gave her but it seems to work. Which Herbals would you suspect she is taking?

A

St. John’s Wort
Saffron
Ginkgo Biloba

45
Q

St. John’s Wort
MOA
SE

A
  • Increases SEROTONIN
  • GI upset, Serotonin syndrome (because it increases serotonin), photosensitivity
46
Q

Which MDD Herbal improves mood in pts being treated for ______; and may increase _______

A

memory loss
Serotonin

Mood Dosorders I (1 decks)

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