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Advanced Pharma > MDD > Flashcards

MDD Flashcards

1
Q

symptoms

A

affecting mood, thinking, physical health, work, and relationships
* inadequately treated MDD increases the risk of suicide*

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2
Q

pathophysiology

A

-genetics: 2-4x more likely if a first-degree relative has it (4 different genes responsible)
-stress: acute stressors may precipitate depression
-biogenic amine & receptor hypothesis

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3
Q

biogenic amine & receptor hypothesis

A

a deficit of norepinephrine (NE), dopamine (DA), or serotonin (5-HT) at the synapse is the cause of depression

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4
Q

monoamine

A

neuromodulators derived from single amino acids; major representatives are dopamine, noradrenaline, octopamine, and serotonin

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5
Q

attenuate

A

reduce the force, effect, or value of

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6
Q

MDE (abbr)

A

major depressive episode

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7
Q

diagnosis of MDE

A

requires the presence of five symptoms for a minimum of 2 weeks that cause clinically significant distress or impairment

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8
Q

diagnosis of MDD

A

based on the presence of one or more MDEs during a person’s lifetime

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9
Q

MDE can happen in

A

bipolar disorder (hypomanic, manic, or mixed episodes) during the course of their illness

NOT w/ MDD individuals

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10
Q

conditions that may coexist w/ MDD (major depressive disorder)

A

anxiety, eating, personality, and substance use disorders
-DM, CAD

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11
Q

the longer an individual is in remission

A

the lower their risk of recurrence

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12
Q

MDD is a risk factor for

A

suicide

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13
Q

treatment goals for MDD

A

-resolution of depressive symptoms
-return to euthymia
-prevention of relapse and recurrence of symptoms

prevention of suicide and suicide attempts

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14
Q

nonpharmacologic therapy

A

-initial tx: psychotherapy for mild-to-moderate depression & combined with pharmacotherapy for severe depression
-interpersonally & cognitive-behavioral therapy

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15
Q

ECT

A

80% response (w/ psychotic features, severe suicidality, refusal to eat, pregnancy, or contraindication or nonresponse to pharmacotherapy (6-12tx w/ response in 10-14d)

-antidepressants are started/continued when initiating the therapy; when therapy ends, antidepressants help maintain response
-s/e: temporary confusion, retrograde and anterograde amnesia

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16
Q

amnesia

A

the loss of memories, including facts, information and experiences.

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17
Q

light therapy

A

mild-to-moderate depression associated with seasonal (eg, winter) exacerbations

MOA: readjustment of circadian rhythms
ADRs: eye strain, headache, nausea, and sedation

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18
Q

other non-pharmacologic therapy options

A

-vagus nerve stimulation (VNS) (for tx-resistant depression)
-transcranial magnetic stimulation (after 1 failed trial antidepressant)
-physical exercises (mild-to-moderate)

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19
Q

selective serotonin reuptake inhibitors (SSRIs)

A

prevent postsynaptic reuptake of serotonin, resulting in increased serotonin in the synaptic cleft

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20
Q

paroxetine

A

mild anticholinergic effects

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21
Q

citalopram

A

mild antihistaminic effects

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22
Q

fluoxetine

A

antagonizes the 5-HT2c receptor, resulting in antibulimic effects

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23
Q

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

A

Venlafaxine, desvenlafaxine, duloxetine, and levomilnacipran

-venlafaxine & desvenlafaxine=more SRI & dose-related affinity for NRI
-duloxetine = more balanced between SRI & NRI
-levomilnacipran=higher NRI than SRI

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24
Q

Norepinephrine Dopamine Reuptake Inhibitor (NDRIs)

A

Bupropions: effects on NRI and dopamine reuptake inhibition (DRI) are weak, but it is an efficacious antidepressant
-useful at improving energy, alertness

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25
Q

Serotonin Antagonist and Reuptake Inhibitors (SARIs)

A

Nefazodone and trazodone
-block 5-HT2A receptors, which allow more 5-HT to interact at postsynaptic 5-HT1A sites

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26
Q

mirtazapine

A

(newer antidepressant) a noradrenergic and specific serotonergic antidepressant (NaSSA)

-blocks presynaptic α2 autoreceptors on noradrenergic neurons and α2 heteroreceptors on serotonergic neurons, resulting in increases in NE and 5-HT synaptic concentrations
-induces sleep & wt gain (higher doses offset it)

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27
Q

vilazodone

A

SRI and partial 5-HT1a receptor

-5-HT1A effect is thought to reduce negative feedback on endogenous serotonin receptors which may improve the medication’s antidepressant effect

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28
Q

vortioxetine

A

agonist/antagonist/partial agonist at various 5-HT receptors

-has affinity for β-adrenergic receptors which may be associated with side effects, and histaminic and acetylcholine receptors which may have a positive effect on memory

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29
Q

esketamine

A

acts by nonselective and noncompetitive inhibition at the N-methyl-D-aspartate (NMDA) receptor to decrease the effects of glutamate which can be elevated by stress

-Brexanolone provides positive allosteric modulation of γ-aminobutyric acid (GABA) receptors which restores progesterone levels in the postpartum period

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30
Q

monoamine oxidase inhibitors (MAO)

A

inhibit the enzyme responsible for the breakdown of 5-HT, NE, and DA

MAO-A & MAO-B located in the brain; MAO-A is also in the gut

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31
Q

MAO-A responsible for the breakdown of

A

5-HT, DA, NE, and tyramine

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32
Q

MAO-B responsible for

A

breakdown of dopamine, phenylethylamine, and tyramine

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33
Q

dietary restrictions limiting the consumption of

A

tyramine are necessary for orally available MAOIs due to inhibition of MAO-A in the gut

-Dietary restrictions are not required for the transdermal formulation of selegiline at the starting dose of 6 mg/24 hours

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34
Q

tricyclic antidepressants

A

both SRI & NRI properties
-block other receptors inc. α1-adrenergic, histamine-1, and muscarinic cholinergic receptors, which contribute to side effects

35
Q

CAM additional therapies

A

bright light therapy, exercise, St. John’s wort, and omega-3 fatty acids as monotherapies for mild-to-moderate depression or adjunctive therapies for moderate-to-severe depression

36
Q

St. John’s wort should be used cautiously because

A

risk of potential drug interactions and serotonin syndrome

37
Q

low doses of omega-3 fatty acids

A

eicosapentaenoic [EPA], docosahexaenoic [DHA] acid, or both

used adjunctively for depression

dose is 3 to 9 g of EPA in addition to 1 to 2 g of DHA daily
-usually well tolerated
-ARDs: nausea, diarrhea, and an aftertaste.

38
Q

ADRs: SSRIs

A

-sexual dysfunction
-CNS stimulation (nervousness, insomnia)
-N/diarrhea
-wt gain
-anhedonia
-fatigue

39
Q

anhedonia

A

reduced ability to experience pleasure

40
Q

strategies to manage ED

A

-waiting for symptoms to subside
-reducing the dosage
-permitting “drug holidays,”
-prescribing adjunctive therapy
-switching antidepressants

41
Q

adjunctive therapy for ED management

A

bupropion, cyproheptadine, and sildenafil
or
simply switch to antidepressants with less likelihood of causing these effects, such as bupropion, mirtazapine, nefazodone, or vortioxetine

42
Q

5-hydroxytryptamine (5-HT receptors)

A

serotonin receptor & vasoconstrictor

low level = depression

43
Q

bupropion (Wllbutrin): ARDs

A

insomnia, nightmares, decreased appetite, anxiety, and tremors, but the most concerning adverse effect is seizures

44
Q

bupropion (Wllbutrin): contraindicated for patients w/

A
  • a CNS lesion
  • history of seizure disorder
    -head trauma, anorexia
    -bulimia
45
Q

bulimia

A

A serious eating disorder marked by binging, followed by methods to avoid weight gain

46
Q

bupropion dosing

A

should not exceed 450 mg/day or any single dose of the immediate-release formulation should not exceed 150mg
-maximum dose of sustained release is 200mg twice daily
-if insomnia/nightmare +: move the last dose from bedtime to late afternoon

47
Q

SNRIs: ARDs

A

similar to SSRIs
N: venlafaxine & desvenlafaxine (fix: lower dose, give w/ food); also: elevation BP

48
Q

duloxetine should be avoided for which category of patietns

A

substantial alcohol use or chronic liver disease

49
Q

trazodone: ARDs

A

used adjunctively w/ other antidepressants for sleep rather than as an antidepressant
-priapism (rare but serious)

50
Q

nafozodone: black box warning

A

fatal hepatotoxicity

51
Q

mirtazapine: ARDs

A

-sedation
-wt gain (blockinh histamine-1 receptors)
-rarely: sexual dysfn & N (blockade of postsynaptic 5-HT2 & 5-HT3 receptors)

52
Q

esketamine: ARDs

A

-N
-sedation
-derealization
-taste distors
-anxiety
-inc in BP

53
Q

brexanolone: ARDs

A

-sedation or sudden loss of consciousness during administration
-hot flashes & dry mouth

54
Q

TCA: ARDs

A

-sedative
-anticholinergic
-cardiovascular

55
Q

tertiary TCAs compared secondary TCAs

A

tertiary (amitriptyline, imipramine) are more sedating and anticholingeric than the secondary (desipramine, notriptyline)

56
Q

lethal dose of a TCA

A

as little as 15mg/kg in a young adult, which is typically less than a 1-month supply

57
Q

short half-lives when compared to other agents

A

paroxetine, nefazodone, and venlafaxine

58
Q

long half-live (4-6d)

A

w/ chronic dosing: fluoxetine
norfluoxetine: even longer

req. a 5-wk washout before starting MAOI; for others washout is 2-wk

59
Q

trazodone interacts w/ other drugs that cause

A

hypotension or anticholinergic effects

60
Q

hypertensive crisis: sxs

A

-sharply elevated blood pressure
-occipital headache
-stiff or sore neck
-N/V
-sweating

61
Q

hypertensive crisis: causing agents

A

-ephedrine
-pseudoephedrine
-phenylephrine
-stimulants such as amphetamines or methylphenidate
-foods rich in tyramine (tap beers, aged cheese, fava beans, yeast extracts, liver, dry sausage, sauerkraut, or tofu)

62
Q

serotonin syndrome

A

implicated drugs such as dextromethorphan, meperidine, tramadol, linezolid, and methylene blue which are not primarily in serotonergic in nature

63
Q

mild to severe depression recommendations:

A

SSRI, SNRI, bupropion, or mirtazapine

64
Q

mild depression management

A

psychotherapy alone

65
Q

pt education to manage side effects

A

-using sugarless chewing gum
-hard candy
-ice chips
….FOR dry mouth

66
Q

pt w/ seizure hx cannot be rx

A

bupropion therapy

67
Q

presence of commorbid psychiatric conditions can suggest the best

A

antidepressant to choose

68
Q

which drug class can tx both MDD and panic disorder or MMD & chronic pain

A

SSRI

69
Q

if pt can skin or overdose, which class be avoided

A

TCAs

70
Q

how long till emotional symptoms such as sadness and anhedonia are see

A

2-4 wk

71
Q

how long to see full antidepressant effcts?

A

6-8wks

72
Q

taper off esp for drugs w/

A

short half-lives (venlafaxine, paroxetine)

73
Q

paroxetine for pregnant pts

A

contraindicated due to inc risk of cardiac malformations

74
Q

fluoxetine for pregnant pts

A

long half-life and is more like to be present at high levels in newborns after in utero exposure

75
Q

brexanolone use during pregnancy

A

for postpartum depression

76
Q

esketamine: use or not while breastfeeding

A

avoid

77
Q

for geriatric depression, chose

A

SSRIs
particularly desipramine and nortriptyline
SNRIs
bupropion, vortioxetine, and mirtazapine

78
Q

maximum dose for _____ in pts over 60 years is

A

citalopram / 20mg due to risk of QT prolongation

79
Q

name 2 antidepressants recommended for children under teh age of 18

A

fluoxetine and escitalopram

80
Q

educate pt to adherence

A

sleep & appetite may improve in the 1st wk
-take 4-8wks to see required optimal mood changes to occur

81
Q

pts taking TCAs such amitriptyline, imipramine, nortriptyline, or desipramine should have

A

antidepressant serum levels checked if overdose, side effects, or nonadherence is an issue

82
Q

if pt is taking 2 or more serotonergic meds, monitor for

A

serotonin syndrome

83
Q

if changes made in pharmacotherapy, follow-up every

A

2-4 wks until pt reaches remission, then every 3 to 6 months

Advanced Pharma (27 decks)

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