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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
Serotonin Antagonist and Reuptake Inhibitors (SARIs)
Nefazodone and trazodone -block 5-HT2A receptors, which allow more 5-HT to interact at postsynaptic 5-HT1A sites
26
mirtazapine
(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)
27
vilazodone
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
28
vortioxetine
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
29
esketamine
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
30
monoamine oxidase inhibitors (MAO)
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
31
MAO-A responsible for the breakdown of
5-HT, DA, NE, and tyramine
32
MAO-B responsible for
breakdown of dopamine, phenylethylamine, and tyramine
33
dietary restrictions limiting the consumption of
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
34
tricyclic antidepressants
both SRI & NRI properties -block other receptors inc. α1-adrenergic, histamine-1, and muscarinic cholinergic receptors, which contribute to side effects
35
CAM additional therapies
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
St. John's wort should be used cautiously because
risk of potential drug interactions and serotonin syndrome
37
low doses of omega-3 fatty acids
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
ADRs: SSRIs
-sexual dysfunction -CNS stimulation (nervousness, insomnia) -N/diarrhea -wt gain -anhedonia -fatigue
39
anhedonia
reduced ability to experience pleasure
40
strategies to manage ED
-waiting for symptoms to subside -reducing the dosage -permitting “drug holidays,” -prescribing adjunctive therapy -switching antidepressants
41
adjunctive therapy for ED management
bupropion, cyproheptadine, and sildenafil or simply switch to antidepressants with less likelihood of causing these effects, such as bupropion, mirtazapine, nefazodone, or vortioxetine
42
5-hydroxytryptamine (5-HT receptors)
serotonin receptor & vasoconstrictor low level = depression
43
bupropion (Wllbutrin): ARDs
insomnia, nightmares, decreased appetite, anxiety, and tremors, but the most concerning adverse effect is seizures
44
bupropion (Wllbutrin): contraindicated for patients w/
- a CNS lesion - history of seizure disorder -head trauma, anorexia -bulimia
45
bulimia
A serious eating disorder marked by binging, followed by methods to avoid weight gain
46
bupropion dosing
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
SNRIs: ARDs
similar to SSRIs N: venlafaxine & desvenlafaxine (fix: lower dose, give w/ food); also: elevation BP
48
duloxetine should be avoided for which category of patietns
substantial alcohol use or chronic liver disease
49
trazodone: ARDs
used adjunctively w/ other antidepressants for sleep rather than as an antidepressant -priapism (rare but serious)
50
nafozodone: black box warning
fatal hepatotoxicity
51
mirtazapine: ARDs
-sedation -wt gain (blockinh histamine-1 receptors) -rarely: sexual dysfn & N (blockade of postsynaptic 5-HT2 & 5-HT3 receptors)
52
esketamine: ARDs
-N -sedation -derealization -taste distors -anxiety -inc in BP
53
brexanolone: ARDs
-sedation or sudden loss of consciousness during administration -hot flashes & dry mouth
54
TCA: ARDs
-sedative -anticholinergic -cardiovascular
55
tertiary TCAs compared secondary TCAs
tertiary (amitriptyline, imipramine) are more sedating and anticholingeric than the secondary (desipramine, notriptyline)
56
lethal dose of a TCA
as little as 15mg/kg in a young adult, which is typically less than a 1-month supply
57
short half-lives when compared to other agents
paroxetine, nefazodone, and venlafaxine
58
long half-live (4-6d)
w/ chronic dosing: fluoxetine norfluoxetine: even longer req. a 5-wk washout before starting MAOI; for others washout is 2-wk
59
trazodone interacts w/ other drugs that cause
hypotension or anticholinergic effects
60
hypertensive crisis: sxs
-sharply elevated blood pressure -occipital headache -stiff or sore neck -N/V -sweating
61
hypertensive crisis: causing agents
-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
serotonin syndrome
implicated drugs such as dextromethorphan, meperidine, tramadol, linezolid, and methylene blue which are not primarily in serotonergic in nature
63
mild to severe depression recommendations:
SSRI, SNRI, bupropion, or mirtazapine
64
mild depression management
psychotherapy alone
65
pt education to manage side effects
-using sugarless chewing gum -hard candy -ice chips ....FOR dry mouth
66
pt w/ seizure hx cannot be rx
bupropion therapy
67
presence of commorbid psychiatric conditions can suggest the best
antidepressant to choose
68
which drug class can tx both MDD and panic disorder or MMD & chronic pain
SSRI
69
if pt can skin or overdose, which class be avoided
TCAs
70
how long till emotional symptoms such as sadness and anhedonia are see
2-4 wk
71
how long to see full antidepressant effcts?
6-8wks
72
taper off esp for drugs w/
short half-lives (venlafaxine, paroxetine)
73
paroxetine for pregnant pts
contraindicated due to inc risk of cardiac malformations
74
fluoxetine for pregnant pts
long half-life and is more like to be present at high levels in newborns after in utero exposure
75
brexanolone use during pregnancy
for postpartum depression
76
esketamine: use or not while breastfeeding
avoid
77
for geriatric depression, chose
SSRIs particularly desipramine and nortriptyline SNRIs bupropion, vortioxetine, and mirtazapine
78
maximum dose for _____ in pts over 60 years is
citalopram / 20mg due to risk of QT prolongation
79
name 2 antidepressants recommended for children under teh age of 18
fluoxetine and escitalopram
80
educate pt to adherence
sleep & appetite may improve in the 1st wk -take 4-8wks to see required optimal mood changes to occur
81
pts taking TCAs such amitriptyline, imipramine, nortriptyline, or desipramine should have
antidepressant serum levels checked if overdose, side effects, or nonadherence is an issue
82
if pt is taking 2 or more serotonergic meds, monitor for
serotonin syndrome
83
if changes made in pharmacotherapy, follow-up every
2-4 wks until pt reaches remission, then every 3 to 6 months

Advanced Pharma (27 decks)

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