Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHAR 253 - Therapeutics (2) > Major Depressive Disorder & Psych Intro > Flashcards

Major Depressive Disorder & Psych Intro Flashcards

1
Q

What is mental health?

A

state of well-being and can cope with normal stressors
DOES NOT Mean not having a mental illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

True or Flase mental health means not having a mental illness

A

FALSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the difference between mental health disorders and mental health problem?

A

Disorder= significant changes in emotional state, behavior or ability to function- psychiatric diagnosis
problem=does not meet diagnostic criteria but may disrupt life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a brief timeline of the evolution of mental illness?

A

punishment/possesion
fluid imbalance
emotions then with christian back to punishment
natural physical causes
psychological and social stress
bio and social and psychological causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who is the father of psychiatry?

A

Emil Kraepelin- ‘invented’ mental illness being biological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the issue with being too focused on the biological causes of mental illness?

A

very subjective and not fully understood rn with current biological theories.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many people have had or will have a mental illness by age 40?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How many people do not seek out treatment when having a mental health problem?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which sex has a higher rate of successful suicide?

A

men-more lethal means

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can culture influence mental illness?

A

Each culture has a different perspective on mental health or even level of concern for it, and how to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

True or false: white people are less likely to seek treatment

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does the Medical Health Services Act do?

A

assist people suffering from serious in receiving treatment
encourage voluntary receipt of services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the three methods of involuntary hospitalization?

A

physician, police, court judge
need 2 G forms to be admitted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What 3 criteria for being involuntarily hospitalized

A

mental disorder needing inpatient care
not capable of making a decision
likely to harm self or others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the difference between physical vs mental health diagnosis?

A

Physical= signs and sx, history, labs
test
Psychiatry= impression on thoughts and feelings, use symptoms to cross-reference in diagnosis manual.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Problems with psychiatric diagnosis?

A

current= symptom x,y,z= schizo
may not have all sx
is criteria even valid?
no objective tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pros and cons of DSM-5

A

Pros= criteria, reliable diagnosis, standardized
Cons= some illnesses are close to normal(overdiagnose), based on opinion, oversimplified human behavior, misdiagnose, stigma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Components of psychiatric interview?

A

Patient demographics
chief complaint
history
past psychiatric/substance use
family history
social history
meds
risk assessment-suicide, murder
differential diagnosis
impression
plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a mental status exam?

A

observe the patient- get a picture of the patient= look at appearance, thought process, mood, attention.
kind of like a physical exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does affect mean in the mental status exam?

A

takes mood terms and makes them objective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are 3 questions to assess suicide risk?

A

Have you thought of suicide
What actions have you taken to prepare? (will, note)
Whether they have attempted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the core symptoms of depression (SIG E CAPS)

A

Sleep
Interest decrease
Guilt or worthless
Energy decrease
Concentration issues
Appetite disturbance
Psychomotor retard/agitate
suicidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is measurements-based care for mental illness?

A

systematic tools and scales to support decision-making and monitor progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Give an example of a MBS

A

PHAQ-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Barriers to MBS

A

underutilized
time effort and cost
negative attitudes toward test
sx may not be on scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Problems with current psychotropic nomenclature?

A

based on arbitrary first indications of meds
flawed and misleading- can use antipsychotics in depression
outdated
confusing stigma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is neuroscience-based nomenclature?

A

based on the method of action = SSRI’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the problem with stigma?

A

fear of stigma delays treatment
won’t admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How can we reduce stigma?

A

initiative- bell let’s talk
change language
nonjudgmental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the definition of major depressive disorder?

A

Persistent and abnormal low mood, sad, emptiness, and irritability accompanied by cognitive changes that significantly impact the capacity to function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which gender is more likely to have depression?

A

female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the prevalence of depression?

A

11-18%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What risks are associated with depression?

A

increased CVD, morbidity, complications
lower QOL, social+ occupational

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the typical age of onset of depression?

A

late 20’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the monoamine hypothesis?

A

dysfunction in monoamine production= low 5HT (serotonin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the neuroplasticity hypothesis?

A

low amount of BDNF= growth factor for survival of neurons, important for structural integrity
chronic stress may suppress DNF expression in hippocampus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the endocrine and immune system abnormality hypothesis?

A

higher cortisol= increased peripheral cytokine= hypothalamic-pituitary axis
higher release of stress hormones causes detrimental effects on the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the structural and functioning alterations hypothesis of depression?

A

reduced volume or reactivity in the prefrontal cortex, hippocampus, amygdala= causes brain functioning issues
MAY be modulated by monamines= some cross-over in hypothesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

True or false One hypothesis of depression is sufficient.

A

FALSE= very complicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What new target is being explored for depression, specifically treatment-resistant depression?

A

glutaminergic transmitters= modulate through ketamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the 5 common risk factors of MDD?

A

Genetics= blood relatives’ history of mental illness
Life experiences traumatic or stressful events
Personality disorders= traits such as low self-esteem, overly dependant, self critical
Substance use
Medical comorbidities= Anemia, HIV, Heart, hypothyroid, cancer, pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What percentage of people with MDD have a medical comorbidity?

A

85%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What percentage of people with MDD also have a personality disorder?

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the DSM-5 diagnostic criteria for MDD?

A

Need at least 5 symptoms
at least 1 sx must be depressed mood or anhedonia (lack of pleasure)
not caused by a substance or other mental illness
NO manic episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is classified as mild MDD?

A

5 or 6 sx with minimal functional impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is classified as severe MDD?

A

nearly all sx with significant impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is a persistent depressive disorder?

A

depressive mood for >2 years with sx free period no greater than 2 months
need only 2 sx of depression
No MDD in first 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is a substance-induced depressive episode?

A

disturbance in the mood with diminished interest
caused by substance duh or even withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What other things could depression be other than MDD?

A

bipolar- mania with/or hypomania
anxiety- may cooccur
Other medical condition-hypothyroid, autoimmune, pain
grief
PMS
sad
irritable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What medications is associated with MDD?

A

Anticonvulsants (topiramate, phenobarbital), Hormonal agents (CS, tamoxifen), interferon alpha

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Which beta-blocker may be associated with MDD?

A

propranolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the 5 different MDD rating scales?

A

PHQ-9- Clinical practice
QIDS- Both
Beck Depression Inventory Both
HAM-D-research
MADRS-research

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which rating scales are done by the patient?

A

PHQ-9, QIDS, Beck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is considered moderate on the HAM-D test? WHat is considered a response and remission?

A

14-18
Response- >50% reduction inscore
Remission= score <7 for at least 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is considered moderate on the PHQ-9 test? WHat is considered a response and remission?

A

10-14 Moderate
response is >50%
remission is <5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is a quick screen for MDD in pharmacy?

A

PHQ-2= 2 questions
3+ score for positive screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How does suicide rate change with each episode of depression?

A

increases with each episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is life time risk of suicide if MDD is untreated?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the suicide risk factors? (IS PATH WARM)

A

Ideation
Substance use

Purposelessness
Anxiety
Trapped
Hopeless

Withdrawl
Anger
Recklessness
Mood changes (dramatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

WHat percentage of people dont achieve remission?

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How many people recover in 3 months, 6 months, 12 months?

A

3= 40%
6=60%
12=80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

When is first response and when is peak?

A

first response= 2 weeks
peak= 4-6 weeks but may be up to 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

True or false: Response declines with each subsequent treatment trial?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the difference between a relapse and a recurrence?

A

relapse is back into a depressive state when getting a response from the drug
recurrence is when they are back into a depressive state after remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the criteria to be in recovery?

A

full remission for at least 2 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the criteria to be chronic in nature?

A

> 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are the criteria for treatment resistance?

A

episode that has failed to respond to 2 separate trials of different antidepressants of adequate dose and duration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the factors that predict remission of MDD?

A

female
white
higher level of education and income
employed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Give some non-pharmacological treatment for MDD.

A

+ life changes-diet,exercise, yoga, music
natural drugs-
psychological= counselling, psychotherapy
neurostimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are some natural products that MAY (prob not) have an effect for MDD?

A

St Johns- good!
methionine
Omega 3’s
methylfolate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

WHy are we worried about St johns wort?

A

OTC= maybe serotonin syndrome, BLEEDING
LOTS OF interactions because of CYP450

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

MOA of St johns wort?

A

MAO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

True or false St johns wort can be used as first line for moderate to severe MDD

A

NO
only for mild-moderate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

For people with MDD what should they always get as treatment?

A

ALWAYS PSYCHOTHERAPY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are some psychological treatments that can be done?

A

CBT
BA
self help groups

76
Q

What is Transcranial Magnetic Stimulation (TMS)? and what is it indicated for?

A

use magnetic fields to stim nerve cells in mood regions
for treatment resistance

77
Q

What is the issue with TMS?

A

effective BUT lasts only for 4 weeks

78
Q

What can be some side effects of TMS?

A

headache and scalp issues

79
Q

What is electroconvulsive therapy ECT?

A

electrodes to stimulate and make a seizure

80
Q

What is ECT indicated for and who does it work better in?

A

severe depression
Older people get more benefit

81
Q

What are some side effects of ECT?

A

headache, confusion, memory issues

82
Q

What should you not use while on ECT?

A

anticonvulsant meds should be minimal because it will minimize seizure
lithium should be minimal as it could prolong seizure

83
Q

What did the Cipriani MA tell us?

A

all drugs new and old are effective
old is usually second line due to side effects and interactions

84
Q

Even with Cipriani results which drugs GENERALLY may have higher response with decent tolerability?

A

escitalopram, sertraline, mirtazapine, venlafaxine, vortioxetine

85
Q

From the Star study what did we learn?

A

First option= generally 1/3 remission
With each new addition or switch we see a decline in the rate that reach remission
Also no difference between switching or augmenting

86
Q

True or false the more treatment steps someone has the more likely for relapse

A

True

87
Q

What is the general time to see an response/remission from a medication for MDD?

A

5-7 weeks

88
Q

Drugs Compared to placebo, what is the increase in response rates?

A

10%

89
Q

What are the 1st line augmenters?

A

aripiprazole, quetiapine, risperidone

90
Q

What are the 2nd line augmenters?

A

bupropion, lithium, mirtzapine, TCA, ketamine

91
Q

What are the CANMAT 1st line agents?

A

SSRI’s, SNRI’s NDRI (bupropion), mirtazapine, vortioxetine

92
Q

What are the SSRI’s?

A

Citalopram, escitalopram, fluoxetine, paroxetine, sertraline

93
Q

What is MOA of SSRI?

A

inhibit 5-HT reuptake = more serotonin in cleft

94
Q

What is the GENERAL onset of action of SSRI?

A

couple of days= help with agitation, anxiety, sleep, appetite
1-3 weeks= more activity, sex drive, memory
2-4 weeks= no more depress

95
Q

What is s/e of SSRI (HANDS) and how long do they last for

A

headache
anxiety
nausea
diarrhea/Gi
Sleep change

ANTICHOLINERGIC
sex dysfucntion
blunting
first 2 weeks usually

96
Q

If there is an issue with blunting with taking SSRI’s what can we do?

A

switch to bupropion or lower dose

97
Q

What is the condition SSRI’s can cause and explain it?

A

SIADH

lethary, low sodium, pain, vomit

98
Q

Which SSRI is more associated with SIADH and what can we do to stop it?

A

venlafaxine, d/c

99
Q

Which drugs are we worried about QTc prolongation?

A

citalopram and escitalopram

100
Q

What issues can arise for elderly with SSRI’s?

A

fracture risk

101
Q

True or false SSRIs are generally non-sedating and have no weight gain?

A

True

102
Q

Which SSRI can cause the most sedation and weight gain?

A

Paroxetine

103
Q

Which SSRI can be stimulating?

A

fluoxetine

104
Q

Which SSRIs are the most tolerable?

A

escitalopram and sertraline

105
Q

Which SSRIs are we worried about interactions and which CYP do they affect?

A

Fluoxetine and paroxetine at CYP 1A2, 2D6

106
Q

IS bleeding a significant contraindication of SSRI’s and NSAIDS/ other?

A

no

107
Q

Which SSRI’s are we worried about in liver dysfunction?

A

fluoxetine, citalopram, sertraline

108
Q

Which SSRI’s bioavailability increases with food?

A

sertraline

109
Q

What drug can we give if sexual dysfunction is a problem?

A

Vortioxetine= less than SSRI’s

110
Q

What is MOA of vortioxetine?

A

serotonin reuptake inhibitor PARTIAL agonist= potentially less side effects

111
Q

What are the SNRIs and whats special about each

A

Venlafaxine= bind to serotonin at low doses both at high and even dopamine at higher
duloxetine= more NET inhibition and more anitcholinergic

112
Q

What is MOA of SNRI’s

A

stop serotonin and norepinephrine reuptake

113
Q

Why are SNRIs perhaps better than SSRIs?

A

more antidepressive action due to nor e and perhaps dopamine in cleft

114
Q

What is SNRI onset of action and what could happen more than SSRIs?

A

exactly the same onset
maybe more agitation and anxiety

115
Q

What is s/e of SNRIs compared to SSRI’s? HANDS

A

same as SSRIs
less sex issues in duloxetine
SAIDH worse in venlafaxine
more anticholinergic
more NE s/e
less blunting
no fractures

116
Q

Which SNRI are we worried about if liver issues?

A

duloxetine

117
Q

Why cant you just stop SNRIs?

A

because of norepinephrine harder and worse withdrawl

118
Q

CI of SNRIs

A

HTN, urinary retention, alcoholic, liver problems

119
Q

At what age can ALL AD increase the suicide rate?

A

<24

120
Q

What is MOA of bupropion?

A

inhibit NE and DA NO 5-HT

121
Q

What is bupropion’s place in therapy?

A

augment with SSRI and SNRI
for ADHD like sx
smoking

122
Q

What are the s/e of bupropion?

A

more anxiety, agitate, insomnia, sweat= NE
MAYBE seizure

123
Q

What is a condition you do NOT want to use bupropion in?

A

eating disorder because reduced appetite
kidney issues= how it is excreted
seizure

124
Q

What is MOA of mirtazapine?

A

antagonize 5-HT, H receptors= more NE and 5HT
Causes calming effect

125
Q

What patients would mirtazapine be good for?

A

insomnia, reduced appetite, sex problems

126
Q

WHat side effects does mirtazapine cause?

A

sedation, weight gain,

127
Q

What clearance mechanism are we worried about in regards to disease for mirtazapine?

A

none only caution at low function for both renal and hepatic

128
Q

True or false mirtazapine loses its sedation at higher doses?

A

true

129
Q

What is the overview of second-line agents for MDD?

A

TCA
SNRI-levmilnacipran
Moclobemide
trazodone
quetiapine
vilazodone

130
Q

What are the main TCA?

A

amitriptyline-tertiary amine
nortriptyline-secondary amines

131
Q

What is TCA MOA?

A

inhibit serotonin and NE reuptake

132
Q

Which type of amine is more NE activity and better tolerated?

A

secondary amines- nortriptyline

133
Q

WHat is the issue with TCA?

A

very dirtttttty (like Carter)
act on multiple receptors like Histamine muscarinic, sodium channels

134
Q

When would we opt for TCA?

A

for insomnia, chronic pain (neuropathic)

135
Q

When is TCA contraindicated?

A

liver impairment, CVD, qt prolongers, elderly

136
Q

What do we need to do when we dispense TCA?

A

not too much as overdose is very lethal
only need 3 x max dose= low BP

137
Q

What are the symptoms of anticholinergic activity?

A

hot, mydriasis, dry mouth, flushed, confused

138
Q

What are some additional side effects of TCA?

A

weight gain, sex problems, rash, seizure, tremors

139
Q

What drug causes urine discoloration?

A

amitriptyline

140
Q

How does trazodone work?

A

inhibit sert and NET and serotonin receptors and others

141
Q

S/E of trazodone

A

dizzy, sedate, headahce, prolong QT

142
Q

What side effect is less in trazodone?

A

sexual dysfunction

143
Q

How does moclobemine work?

A

reversible MAO inhibitors

144
Q

What is the issue with moclobemine?

A

at higher doses the selectivity for MAOa goes down which is bad because over stim due to tyramine

145
Q

What happens with too much NE?

A

hypertensive crisis

146
Q

S/E of moclobemide

A

tachycardia, hypotension, sleep disturbance,

147
Q

True or false moclobemide has more sexual dysfunction and anticholinergic effects than SSRIs?

A

false

148
Q

What are some IRREVERSIBLE MAO inhibitors?

A

phenelzine, tranylcypromine (like METH)

149
Q

How does ketamine work?

A

work on NMDA receptors, opioid and AMPA= more protein synthesis and restore synaptic connectivity

150
Q

Which form of ketamine is available in Canada

A

racemic and S for nasal spray for treatment resistant MDD

151
Q

What could be the advantage of R ketamine?

A

less potent but longer lasting and with fewer side effects

152
Q

What are the side effects of ketamine?

A

headache, anxiety, dissociation, pee lots, blurred vision

153
Q

What can we do if they have GI effects?

A

lower dose, food

154
Q

Which drugs cause GI more often?

A

Venlafaxine SSRI,

155
Q

When does Gi effects atart and how long can they last?

A

2 weeks and up to 3 months

156
Q

Which drug causes the worst constipation?

A

paroxetine

157
Q

When do we see a correlation with suicide for these drugs?

A

under 18 for first 3 months

158
Q

At what age do we see protective effect of suicide for medications

A

> 25

159
Q

Which drug has the lowest risk of sex dysfunction?

A

bupropion>mirtazapoine, trazadone, moclobemide

160
Q

hich drug has the highest risk of sex issues?

A

SSRIs, TCA

161
Q

What can we do if theres sex issues?

A

may fix by itself, reduce dose, drug holidays, add bupropion or mirt, PDE4

162
Q

Which drugs are we reallhy worried about QTc interval prolongers?

A

TCA, citalopram, escitalopram, venlafaxine

163
Q

What is serotonin syndrome?

A

-when multiple serotonin agents
get mental changes, autonomic hyperactivity, neuromuscular abnormalities in 6 hours

164
Q

What is discontinuation syndrome? What is the worst culprit and what is the best?

A

feel like the flu
worst= venlafaxine, paroxetine
best= fluoxetine

165
Q

What are the sx of discontinuation syndrome? (FINISH)

A

flu
insomnia
nausea
imbalance
sensory disturbances-shock sensation
hyperarousal-anxiety

166
Q

When does discontinuation syndrome start and when can it resolve?

A

1-3 days after stopping medication
lasts for 1-2 weeks maybe months

167
Q

How can we prevent discontinuation syndrome?

A

taper
or switch to fluoxetine

168
Q

The patient comes in and is still not feeling better what should we do and what options are there?

A

are they taking it
has it been 6-8 weeks
switch or augment

169
Q

GENERALLY when should we switch or augment medication?

A

switch if no response= <25% sx improve
augment if partial response

170
Q

What is the definition of treatment resistant?

A

<20% improvement on 2 or more trials of meds

171
Q

WHen do we need a washout period?

A

if starting a MAO

172
Q

WHat should we do if we are switching drugs?

A

cross taper

173
Q

What are the first line augmentor

A

s?aripiprazole, quetiapine, risperidone

174
Q

What are the second line augmenters

A

bupropion, mirtazapine, lithium, t3

175
Q

Is lithium a suitable option? How long to see the benefit?

A

yes
see in 3-4 weeks

176
Q

Which is better lithium or T3

A

t3 has better tolerability
but lithium is better for CVD people

177
Q

What is the difference between a continuation phase and a maintenance phase?

A

continuation phase= 4-9 months at same dosage
maintenance= lifelong

178
Q

Patient comes in and is elderly, what is our go to drugs?

A

duloxetine, bupropion, sertraline

179
Q

Patient comes in and is a child/adolescent, what drugs are our go tos?

A

fluoxetine, sertraline, cilaopram, escitalopram

180
Q

When should a medication be given to a pregnant woman?

A

if moderate-sever
suicidal

181
Q

Which drugs are we giving if needed in pregnancy?

A

SSRIs= sertraline, cilaopram, escitalopram

182
Q

Which drugs if breastfeeding?

A

citalopram, sertraline, paroxetine= because less in milk

183
Q

What drug causes cardiac malformations in fetus?

A

Paroxetine

184
Q

Can fetus get withdrawl?

A

yes but is often self limiting

185
Q
A
186
Q
A

PHAR 253 - Therapeutics (2) (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions