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Psychiatry > Major Depressive Disorders > Flashcards

Major Depressive Disorders Flashcards

1
Q

What medications are associated with depression symptoms?

A
  1. Beta-blockers
  2. Clonidine
  3. Interferons
  4. Isotretinoin
  5. Levetiracetam
  6. Methyldopa
  7. Oral contraceptives
  8. Steroids
  9. Triptans
  10. Topiramate
  11. Varenicline
  12. Vigabatrin
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2
Q

What are the cognitive/emotional symptoms of MDD?

A
  1. Decreased concentration
  2. Loss of interest
  3. Anxiety
  4. Irritability
  5. Worthlessness
  6. Inappropriate guilt
  7. Suicidal ideation
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3
Q

What are the physical symptoms of MDD?

A
  1. Disturbed sleep
  2. Decreased energy
  3. Fatigue
  4. Body aches/pains
  5. Changes in appetite/weight
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4
Q

What are the treatment goals for a patient with MDD?

A
  1. Short-term (acute phase): reduce symptoms, achieve remission
  2. Long-term (cont. and maintenance phase): prevent relapse or recurrence
  3. Improve functioning and QOL
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5
Q

How long does the acute phase of MDD therapy last?

A

6-12 weeks

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6
Q

How long does the continuation phase of MDD therapy last?

A

4-9 months

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7
Q

How long does maintenance phase of MDD therapy last?

A

1 or more years

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8
Q

What are the first-line treatment options for MDD?

A
  1. SSRIs
  2. SNRIs
  3. Bupropion
  4. Mirtazepine
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9
Q

What are the non-first-line treatment options for MDD?

A
  1. Trazodone
  2. TCAs
  3. MAOIs
  4. Vilazodone
  5. Vortioxetine
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10
Q

What are possible options of adjunctive therapy in MDD?

A
  1. Lithium
  2. Liothyronine
  3. Atypical antipsychotics
  4. Anticonvulsants: CBZ, lamotrigine, valproic acid
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11
Q

What is the initial/usual dose of citalopram?

A
  1. Initial: 20 mg/day
  2. Usual: 20-40 mg/day
  3. Doses > 40 mg/day increase the r/k of QT prolongation
  4. Doses > 20 mg/day are not recommended in:
    A. Patients w/ hepatic impairment
    B. 2C19 poor metabolizers
    C. 2C19 inhibitors
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12
Q

What is the initial/usual dose of escitalopram?

A
  1. Initial: 10 mg/day

2. Usual: 10-20 mg/day

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13
Q

What is the initial/usual dose of fluoxetine?

A
  1. Initial: 20 mg/day
  2. Usual: 20-60 mg/day
  3. Longest half-life of all SSRIs (4-6 days for parent, 4-16 days for active metabolite)
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14
Q

What is the only SSRI not FDA approved for MDD?

A

Fluvoxamine (only approved for OCD)

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15
Q

What is the initial/usual dose for paroxetine?

A
  1. Initial: 20 mg/day
  2. Usual: 20-60 mg/day
  3. Shortest half-life for all SSRIs: 21 hours
  4. Most dose-dependent SEs of SSRIs
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16
Q

Which SSRI is the only one that is pregnancy category D?

A
  1. Paroxetine (all others are C)

2. CV defects in infants exposed in utero

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17
Q

What is the initial/usual dose of sertaline?

A
  1. Initial: 50 mg/day

2. Usual: 50-200 mg/day

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18
Q

What are the PK interactions with SSRIs?

A
  1. 2D6/3A4

2. Most commonly seen w/ fluoxetine, fluvoxamine, paroxetine

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19
Q

Which medications can double the risk of GI bleeding w/ SSRIs?

A
  1. NSAIDs

2. Caution with warfarin

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20
Q

What are the common Res w/ SSRIs?

A
  1. GI
  2. Anxiety (initially)
  3. Insomnia
  4. Sexual dysfunction
  5. HA
  6. Weight gain
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21
Q

What is the initial/usual dose of vortioxetine?

A
  1. Initial: 10 mg/day
  2. Usual: 10-20 mg/day
  3. Only approved for MDD
  4. Long half-life (66 hours)
22
Q

What are the SNRIs used to treat MDD?

A
  1. Venlafaxine
  2. Desvenlafaxine
  3. Duloxetine
  4. Milnacipran
  5. Levomilnacipran
23
Q

What is the initial/usual dose of venlafaxine?

A
  1. Initial: 37.5 mg/day
  2. Usual: 75-375 mg/day
  3. < 150 mg works on 5-HT
  4. > 150 mg works on 5-HT and NE
  5. > 300 mg works on DA
24
Q

What is the initial/usual dose of desvenlafaxine?

A
  1. Initial: 50 mg/day

2. Usual: 50-400 mg/day

25
Q

What is the initial/usual dose of duloxetine?

A
  1. Initial: 60 mg/day
  2. Usual: 60-120 mg/day
  3. Reduce dose in renal impairment
26
Q

What is the only SNRI that is not FDA approved for MDD?

A

Milnacipran (only used for fibromyalgia)

27
Q

What is the initial/usual dose for levomilnacipran (Fetzima)?

A
  1. Initial: 20 mg/day
  2. Usual: 40-120 mg/day
  3. Dose reduce in renal impairment
28
Q

Which has more 2D6 inhibitory potential: duloxetine or venlafaxine?

A

Venlafaxine

29
Q

What are the side effects associated with SNRIs?

A
  1. Similar to SNRIs
  2. Dilated pupils
  3. Dry mouth
  4. Excessive sweating
  5. Constipation
  6. Increase pulse
  7. Increase in BP (mainly with velafaxine > 150 mg/day
30
Q

Which SSRI is most associated with sexual dysfunction and minimal weight gain?

A

Venlafaxine

31
Q

What is the initial/usual dose of bupropion?

A
  1. Initial: 150 mg/day
  2. Usual: 300-450 mg/day
  3. Avoid in patients with seizures, eating disorders
32
Q

What are the adverse effects ween with bupropion?

A
  1. Anxiety
  2. Insomnia
  3. GI upset
  4. Increased risk for seizures
33
Q

What is the initial/usual dose for mirtazapine?

A
  1. Initial: 15 mg/day

2. Usual: 15-45 mg/day

34
Q

What are the common AEs with mirtazapine?

A
  1. Dry mouth
  2. Weight gain
  3. Sedation
  4. Fewer GI effects
35
Q

What TCAs are indicated for use in pediatric patients?

A
  1. Clomipramine

2. Imipramine

36
Q

What SNRI is indicated for use in pediatric patients?

A

Duloxetine

37
Q

What SSRIs are indicated for use in pediatric patients?

A
  1. Escitalopram
  2. Fluvoxamine
  3. Sertraline
38
Q

What are the symptoms of MDD in pediatric patients?

A
  1. Boredom
  2. Anxiety
  3. Sleep disturbances
39
Q

What are the s/s of serotonin syndrome?

A

Triad of symptoms:

  1. Mental status changes (anxiety, delirium, disorientation)
  2. Autonomic hyperactivity (diaphoresis, tachycardia, hyperthermia, hypertension, vomiting, diarrhea)
  3. Neuromuscular abnormalities(tremor, muscle rigidity, myoclonus, hyperreflexia)
40
Q

What is the initial/usual dose of vilazodone (VIIbryd)?

A
  1. Initial: 10 mg/day
  2. Usual: 40 mg/day
  3. Take w/ food
  4. AEs similar to SSRIs
41
Q

What is the MOA of TCAs?

A
  1. Inhibits re-uptake of serotonin and norepinephrine

2. Also acts on adrenergic, histamine, and muscarinic receptors

42
Q

What are the main PK interactions with TCAs?

A
  1. 3A4/2D6 inducers/inhibitors/substrates

2. Other medications that are highly protein bound

43
Q

What adverse effects of TCAs are more sensitive to the elders?

A
  1. Blurry vision
  2. Dry mouth
  3. Constipation
  4. Urinary retention
  5. Orthostatic hypotension
  6. Sedation
44
Q

What are the common AEs or TCAs?

A
  1. Blurry vision
  2. Dry mouth
  3. Constipation
  4. Urinary retention
  5. Orthostatic hypotension
  6. Sedation
  7. Weight gain
  8. Tachycardia
  9. Arrhythmias
45
Q

What must be considered before beginning use of TCAs in, pediatric patients, patients > 40, and the elderly?

A

ECG should be completed fore initiating therapy in these patients

46
Q

What is the MOA for MAOIs in depression?

A

MAOIs increase the concentrations of serotonin, norepinephrine, and dopamine

47
Q

What are the MAOMIs available for use in depression?

A
  1. Phenelzine (Nardil)
  2. Tranylcypromine (Parnate)
  3. Selegiline (Emsam)
48
Q

What are the adverse effects of MAOIs?

A
  1. Orthostatic hypotension
  2. Weight gain
  3. HA
  4. Sexual dysfunction
  5. Hypertensive crisis
49
Q

What are the signs of hypertensive crisis?

A
  1. Acute onset
  2. Severe HA
  3. Nausea
  4. Confusion
  5. Stiffness
  6. Palpitations
  7. Sweating
  8. Confusion
  9. Sharp elevation in blood pressure
50
Q

When a patient is taking an MAOI, what food/medications should be avoided?

A
  1. Foods/medications that contain tyramine

2. Counsel patient to avoid these foods/medications

Psychiatry (4 decks)

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