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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
What is the initial/usual dose of duloxetine?
1. Initial: 60 mg/day 2. Usual: 60-120 mg/day 3. Reduce dose in renal impairment
26
What is the only SNRI that is not FDA approved for MDD?
Milnacipran (only used for fibromyalgia)
27
What is the initial/usual dose for levomilnacipran (Fetzima)?
1. Initial: 20 mg/day 2. Usual: 40-120 mg/day 3. Dose reduce in renal impairment
28
Which has more 2D6 inhibitory potential: duloxetine or venlafaxine?
Venlafaxine
29
What are the side effects associated with SNRIs?
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
Which SSRI is most associated with sexual dysfunction and minimal weight gain?
Venlafaxine
31
What is the initial/usual dose of bupropion?
1. Initial: 150 mg/day 2. Usual: 300-450 mg/day 3. Avoid in patients with seizures, eating disorders
32
What are the adverse effects ween with bupropion?
1. Anxiety 2. Insomnia 3. GI upset 4. Increased risk for seizures
33
What is the initial/usual dose for mirtazapine?
1. Initial: 15 mg/day | 2. Usual: 15-45 mg/day
34
What are the common AEs with mirtazapine?
1. Dry mouth 2. Weight gain 3. Sedation 4. Fewer GI effects
35
What TCAs are indicated for use in pediatric patients?
1. Clomipramine | 2. Imipramine
36
What SNRI is indicated for use in pediatric patients?
Duloxetine
37
What SSRIs are indicated for use in pediatric patients?
1. Escitalopram 2. Fluvoxamine 3. Sertraline
38
What are the symptoms of MDD in pediatric patients?
1. Boredom 2. Anxiety 3. Sleep disturbances
39
What are the s/s of serotonin syndrome?
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
What is the initial/usual dose of vilazodone (VIIbryd)?
1. Initial: 10 mg/day 2. Usual: 40 mg/day 3. Take w/ food 4. AEs similar to SSRIs
41
What is the MOA of TCAs?
1. Inhibits re-uptake of serotonin and norepinephrine | 2. Also acts on adrenergic, histamine, and muscarinic receptors
42
What are the main PK interactions with TCAs?
1. 3A4/2D6 inducers/inhibitors/substrates | 2. Other medications that are highly protein bound
43
What adverse effects of TCAs are more sensitive to the elders?
1. Blurry vision 2. Dry mouth 3. Constipation 4. Urinary retention 5. Orthostatic hypotension 6. Sedation
44
What are the common AEs or TCAs?
1. Blurry vision 2. Dry mouth 3. Constipation 4. Urinary retention 5. Orthostatic hypotension 6. Sedation 7. Weight gain 8. Tachycardia 9. Arrhythmias
45
What must be considered before beginning use of TCAs in, pediatric patients, patients > 40, and the elderly?
ECG should be completed fore initiating therapy in these patients
46
What is the MOA for MAOIs in depression?
MAOIs increase the concentrations of serotonin, norepinephrine, and dopamine
47
What are the MAOMIs available for use in depression?
1. Phenelzine (Nardil) 2. Tranylcypromine (Parnate) 3. Selegiline (Emsam)
48
What are the adverse effects of MAOIs?
1. Orthostatic hypotension 2. Weight gain 3. HA 4. Sexual dysfunction 5. Hypertensive crisis
49
What are the signs of hypertensive crisis?
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
When a patient is taking an MAOI, what food/medications should be avoided?
1. Foods/medications that contain tyramine | 2. Counsel patient to avoid these foods/medications

Psychiatry (4 decks)

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