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Pnt Exam 2 > MDD > Flashcards

MDD Flashcards

1
Q

s/s of MDD

A 
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor Activity 
Suicidal ideation
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2
Q

How long must symptoms be present for a major depressive episode

A

2 weeks

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3
Q

how many symptoms must be present for a major depressive episode

A

5+

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4
Q

List the specifiers for MDD

A 
Melanchoic
Atypical 
Psychotic
Mixed
Catatonia
Seasonal Pattern
Peripartum Onset
Anxious distress
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5
Q

features of melancholic MDD

A 
anhedonia
lack of reactivity 
worse in AM
insomnia with early morning awakening 
guilt
psychomotor activity 
decreased appetite/weight loss
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6
Q

features of atypical MDD

A 
hypersomnia
increased appetitie/weight gain
worse in PM
rejection sensitivity
leaden paralysis
irritable
anxiety
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7
Q

features of psychotic MDD

A

delusions and hallucinations

usually seen in elderly

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8
Q

treatment options for psychotic MDD

A

ECT

Antidepressant and antipsychotic

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9
Q

features of mixed MDD

A 
3+ of the following: 
elevated mood
inflated self esteem
more talkative
FOI/racing thoughts
increase energy
inrease in potentially painful acitivities
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10
Q

features of catatonic MDD

A

mutism
vegetative signs
echolalia

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11
Q

features of seasonal MDD

A

relationship between time of year and depression s/s

regular remissions

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12
Q

MDD appears when in peripartum onset

A

within 4 weeks of delivery

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13
Q

features of anxious distress

A 
keyed up or tense
restless
difficulty concentrating because of worry
fear of something awful
might lose control
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14
Q

define full remission

A

symptoms gone < 2 months

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15
Q

define partial remission

A

no longer MDD but still some symptoms

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16
Q

define recovery

A

symptoms gone 2+ months

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17
Q

define relapse

A

return of symptoms within 2 months

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18
Q

define recurrence

A

return of symptoms after 2 months; new episode

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19
Q

length of treatment for first episode of MDD

A

remission of symptoms + 6-12 months

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20
Q

length of treatment for second episode of MDD

A

remission of symptoms + 2 years

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21
Q

What factors should be considered for hospitalization of MDD pts

A

suicide
physical health
support system
catatonia

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22
Q

Which antidepressants can be fatal if OD’d

A

MAOI
TCAs
amoxapine
maprotiline

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23
Q

which antidepressants are safest for OD potential

A

SSRI
SNRI
Buproprion

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24
Q

Secondary causes of depression

A 
drugs
drug abuse
metabolic disorders
neurologic disorders
nutritional disorders
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25
Q

most common cause of secondary depression

A

hypothyroidism

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26
Q

which drugs cause secondary depression

A 
reserpine
beta blockers
alpha-methyldopa
levodopa
estrogens
corticosteroids
cholinergics
benzos
barbituates
ranitidine
calcium channel blockers
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27
Q

Non pharm treatments for MDD

A 
ECT
TMS
Light therapy
Psychotherapy (CBT) 
Exercise
herbals
VNS
Folic Acid
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28
Q

ECT

A

electroconvulsive therapy

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29
Q

ECT seizure lasts how long

A

25 seconds to under 2 minutes

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30
Q

indications for ECT

A 
psychotic depression
catatonic depression
refractory depression
acute mania
pregnant with bipolar
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31
Q

AEs of ECT

A

memory loss

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32
Q

Contraidications for ECT

A

recent MI

brain lesions

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33
Q

TMS

A

transcranial magnetic stimulation

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34
Q

AEs of TMS

A

headache

lightheadedness

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35
Q

CBT

A

cogntive behavioral therapy

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36
Q

Herbal used for MDD

A

St. Johns Wort

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37
Q

St John’s wort active ingrediant

A

hypericum perforatum

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38
Q

st john’s wort dose

A

300 mg TID

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39
Q

how long until effect of st john’s wort is seen

A

4 weeks

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40
Q

AEs of st john’s wort

A

nausea
photosensitivity
fatigue

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41
Q

VNS

A

vagus nerve stimulation

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42
Q

who gets VNS

A

treatment resistant depression

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43
Q

Folic acid dose for MDD

A

15 mg with an SSRI

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44
Q

Citalopram brand name

A

celexa

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45
Q

escitalopram brand name

A

lexapro

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46
Q

fluoxetine brand name

A

prozac

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47
Q

fluvoxamine brand name

A

luvox

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48
Q

paroxetine brand name

A

paxil

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49
Q

sertraline brand name

A

zoloft

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50
Q

vilazodone brand name

A

viibryd

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51
Q

name the SSRIs

A 
citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
vilazodone
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52
Q

name the SNRIs

A

desvenlafaxine
duloxetine
levomilnacipran
venlafaxine

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53
Q

desvenlafaxine brand name

A

pristiq

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54
Q

duloxetine brand name

A

cymbalta

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55
Q

levomilnacipran brand name

A

fetzima

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56
Q

venlafaxine brand name

A

effexor

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57
Q

name the Triazolopyridines

A

nefazodone

trazodone

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58
Q

nefazodone brand name

A

serzone

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59
Q

trazodone brand name

A

desyrel

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60
Q

name an aminoketone used for MDD

A

buproprion

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61
Q

bupropion brand name

A

wellbutrin

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62
Q

TCAs for MDD

A 
Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin
Imipramine
Maprotiline
Nortiriptyline
Protriptyline
Trimipramine
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63
Q

Amitriptyline brand name

A

elavil

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64
Q

amoxapine brand name

A

ascendin

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65
Q

clomipramine brand name

A

anafranil

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66
Q

desipramine brand name

A

norpramin

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67
Q

doxepin brand name

A

sinequan

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68
Q

imipramine brand name

A

tofranil

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69
Q

maprotiline brand name

A

ludiomil

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70
Q

nortriptyline brand name

A

pamelor

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71
Q

protriptyline brand name

A

vivactil

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72
Q

trimipramine brand name

A

surmontil

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73
Q

Tetracycline used for MDD

A

mirtazapine

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74
Q

mirtazapine brand name

A

remeron

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75
Q

MAOIs used for MDD

A

selegiline
phenelzine
tranylcypromine

76
Q

selegiline brand name

A

emsam

77
Q

phenelzine brand name

A

nardil

78
Q

tranylcypromine brand name

A

parnate

79
Q

novel agent used for MDD

A

vortioxetine

80
Q

vortioxetine brand name

A

brintellix

81
Q

therapeutic dose range for amitriptyline

A

120-250 ng/ml

82
Q

therapeutic dose range for desipramine

A

100-300 ng/ml

83
Q

therapeutic dose range for tofranil

A

200-350 ng/ml

84
Q

therapeutic dose range for nortriptyline

A

50-150 ng/ml

85
Q

black box warning on all antidepressants

A

risk of suicide

86
Q

factors to consider when choosing an antidepressant

A 
past response
familial response
specifier/subtype
side effects
medical history
drug-drug interactions
cost
87
Q

baseline monitoring for an SSRI

A 
history
PE
TFTs
CBC
Chem 7 
BP
Pulse
Weight
Pregnancy test
88
Q

citalopram pregnancy category

A

C

89
Q

citalopram usual dosing

A

20 mg AM

90
Q

citalopram doses > 40 mg QD risk

A

prolong QTC

91
Q

elderly dosing for SSRIs

A

50% of normal dose

92
Q

escitalopram usual dosing

A

10 mg AM

93
Q

escitalopram pregnancy cat

A

C

94
Q

Fluoxetine pregnancy cat

A

C

95
Q

Which SSRI is most likely to cause jitteriness

A

fluoxetine

96
Q

fluoxetine usual dose

A

20 mg AM

97
Q

Fluvoxamine approved uses

A

OCD

98
Q

fluvoamine dose

A

max 300 mg/day BID dosing start 50 mg HS

99
Q

fluvoxamine preg cat

A

C

100
Q

Paroxetine preg cat

A

D

101
Q

Paroxetine usual dose

A

20 mg AM;

CR = 25 mg AM

102
Q

Which SSRI most likely to cause sexual dysfunction and wieght gain

A

Paroxetine

103
Q

SSRI most likely to cause nausea

A

Sertraline

104
Q

Sertraline dosing

A

50-100 mg AM

105
Q

sertraline preg cat

A

C

106
Q

Vilazodone MOA

A

SSRI + 5HT1A partial agonist

107
Q

Vilazodone dose

A

10 mg qd x 1 week, then 20 mg qd x 1 week, then 40 mg QD

108
Q

vilazodone pregnancy cat

A

C

109
Q

TCA drug interaction with SSRI

A

increase TCA concentration

lower TCA dose

110
Q

Fluvoxamine and Vilazodone drug interaction with warfarin

A

increase warfarin levels

decrease dose, monitor INR/Ptt

111
Q

SSRI interaction with MAOI

A

Serontonin synrome

AVOID

112
Q

SSRI interaction with L-tryptophan

A

serontonin syndrome

AVOID

113
Q

SSRI interaction with triptans

A

serotonin syndrome

AVOID

114
Q

SSRI interaction with hypoglycemic agents

A

increased hypoglycemia

Monitor

115
Q

SSRI interaction with type 1C antiarrhythmics

A

increase levels of antiarrhythmics

Caution

116
Q

SSRI interaction with beta blockers

A

increased beta blockers

monitor heart rate and adjust

117
Q

SSRI interaction with St John’s Wort

A

Serotonin syndrome

Stop SJW

118
Q

Common AEs of SSRI

A 
N/V
diarrhea
HA
insomnia
sexual dysfunction
119
Q

SSRI discontinuation syndrome seen most often with what SSRIs

A

sertraline

paroxetine

120
Q

Baseline labs for SSRIs

A 
CBC
chem 7 
TFT
BP
Pulse
Wt
pregnancy test
121
Q

labs for SSRIs at 2 weeks

A

Na+ levels

122
Q

monthly monitoring for SSRIs

A

resolution of symptoms

Na+ level

123
Q

Quarterly monitoring for SSRIs

A

resolution of symptoms
Na+
weight

124
Q

Monitoring q6 months for SSRIs

A

electrolytes

125
Q

Annual monitoring for SSRIs

A

CBC
chem 7
TFTs

126
Q

which SSRI has an active metabolite

A

fluoxetine

127
Q

how long are symptoms of SSRI discontinuation syndrome

A

3 days to 3 weeks

128
Q

symptoms of SSRI discontinuation syndrome

A 
nausea
dizziness
insomnia
vivid dreams
vertigo
malaise
headache
129
Q

What to do before starting an SNRI

A 
history
physical
CBC
TFT
Chem 7 
BP
pulse
weight
EKG
Pregnancy test
130
Q

max dose of venlafaxine IR

A

375 mg/day

131
Q

dosing frequency of venlafaxine IR

A

BID-TID

132
Q

dosing frequency of venlafaxine ER

A

QD

133
Q

Rare AE of venlafaxine

A

HTN

134
Q

Venlafaxine dosing must be what

A

titrated

135
Q

Max dose of venlafaxine ER

A

225 mg

136
Q

desvenlafaxine is the active metabolite of what

A

venlafaxine

137
Q

desvenlafaxine dosing

A

50 mg QD

138
Q

desvenlafaxine max

A

400 mg/day

139
Q

venlafaxine drug interactions

A 
MAOI
Indinavir
Triptans
SJW
Warfarin
140
Q

venlafaxine should be avoided with what

A

MAOI
Indinavir
Triptans
SJW

141
Q

Interaction between venlafaxine and MAOI

A

Serotonin syndrome/hypertensive crisis

142
Q

interaction between venlafaxine and Indinavir

A

decreased indinavir

143
Q

interaction between venlafaxine and Triptans

A

serotonin syndrom

144
Q

interaction between venlafaxine and SJW

A

serotonin syndrome

145
Q

interaction between venlafaxine and warfarin

A

increased Ptt, INR;

Monitor

146
Q

Venlafaxine pregnancy cat

A

C

147
Q

Venalfaxine AEs

A 
HA
insomnia
drowsiness
dizziness
diaphoresiss
weight loss
nausea
dry mouth
anorexia
sexual dysfunction
weakness
148
Q

desvenlafaxine preg cat

A

c

149
Q

duloxetine dosing

A

20 mg BID up to 60 mg/day (30 mg BID or ^) qd)

150
Q

duloxetine AEs

A

N/V
sexual dysfunction
HTN

151
Q

duloxetine preg cat

A

c

152
Q

duloxetine should be avoided with what medications

A 
fluvoxamine
quinolone antibiotics
alcohol
SSRI
MAOI
TCA
triptans
153
Q

duloxetine should be monitored with what drug

A

smoking

154
Q

levomilnacipran preg cat

A

C

155
Q

levomilnacipran dosing

A

40 mg dialy ma 120/day

156
Q

AEs of levomilnacipran

A 
N/V
constipation
sweating
tachycardia
HTN
157
Q

levomilnacipran drug interactions to avoid

A

alochol
ketoconazole
NSAIDS
Warfarin

158
Q

SNRI monitoring at baseline

A 
CBC
Chem 7 
TFTs
EKG
BP
pulse
Weight
Pregnancy
159
Q

SNRI monitoring monthly

A

resolution of symptoms
BP
pulse
weight

160
Q

SNRI monitoring annually

A 
EKG
CBC
Chem 7 
TFTs
BP 
Pulse
weight
161
Q

SNRI indications

A 
GAD
MDD
Panic
SAD
neuropathy
fibromyalgia
162
Q

nefazodone dosing

A

300-600 mg /day given BID

163
Q

nefazodone AEs

A 
dizziness
blurred vision
dry mouth
constipation
HA
orthostasis
LITTLE TO NO SEXUAL
164
Q

black box warning of nefazodone

A

liver dysfunction

165
Q

nefazodone preg cat

A

c

166
Q

trazodone dosing

A

50 mg HS x 3 days up to 150 mg HS (max 600 mg/day)

167
Q

AEs of trazodone

A 
sedation
dry mouth
blurred vision
mental dullness
orthostasis
RARE- PRIAPISM
168
Q

trazodone preg cat

A

C

169
Q

Trazodone drug interactions to be avoided

A

CNS depressants

MAOI

170
Q

Nefazodone drug interactions to be avoided

A

general anesthetics
triptans
MAOI
Statins

171
Q

Nefazodone drug interaction with buspirone

A

decrease buspirone dose to 2.5 mg BID

172
Q

Baseline monitoring for Triazolopyridines

A 
CBC
Chem 7
TFT
EKG
BP
Pulse
weight
Preg
173
Q

Monthly monitoring of triazolopyridines

A

resolution of symptoms
BP
Pulse
Weight

174
Q

Annual monitoring of triazolopyridines

A 
EKG
CBC
Chem 7 
TFT
BP
pulse
Weight
175
Q

baseline monitoring for bupropion

A 
CBC
Chem 7 
TFTs
EKG
BP 
Pulse
Weight
Preg Test
176
Q

Monthly monitoring for buproprion

A

resolution of symptoms
BP
pulse
weight

177
Q

Annual monitoring for bupropion

A 
EKG
CBC
Chem 7 
TFT
BP 
pulse
weight
178
Q

bupropion dose IR

A

100 mg BID x 3 days
100 mg TID
MAx 450/day

179
Q

bupropion SR dose

A

150 mg x 5 days, then 150 mg BID

180
Q

bupropion XL dose

A

150 mg x 5 days, then 300 mg qd

181
Q

bupropion preg cat

A

C

182
Q

bupropion AEs

A 
HA
Nausea
tachycardia
dizziness
insomnia
agitation 
weight loss
dry mouth
NO SEXUAL
RARE- SEIZURE
183
Q

avoid what drugs with bupropion

A

MAOI
Ritonavir
Drugs that lower seizure threshold

184
Q

Bupropion drug interaction with beta blocker

A

decreased BP, HR

adjust dose of beta blocker

185
Q

Bupropion drug interaction with SSRI

A

reduce dose of SSRI

186
Q

Bupropion drug interaction with warfarin

A

monitor INR, increased bleeding

Pnt Exam 2 (11 decks)

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