MDD Flashcards
1
Q
s/s of MDD
A
Sleep Interest Guilt Energy Concentration Appetite Psychomotor Activity Suicidal ideation
2
Q
How long must symptoms be present for a major depressive episode
A
2 weeks
3
Q
how many symptoms must be present for a major depressive episode
A
5+
4
Q
List the specifiers for MDD
A
Melanchoic Atypical Psychotic Mixed Catatonia Seasonal Pattern Peripartum Onset Anxious distress
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
6
Q
features of atypical MDD
A
hypersomnia increased appetitie/weight gain worse in PM rejection sensitivity leaden paralysis irritable anxiety
7
Q
features of psychotic MDD
A
delusions and hallucinations
usually seen in elderly
8
Q
treatment options for psychotic MDD
A
ECT
Antidepressant and antipsychotic
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
10
Q
features of catatonic MDD
A
mutism
vegetative signs
echolalia
11
Q
features of seasonal MDD
A
relationship between time of year and depression s/s
regular remissions
12
Q
MDD appears when in peripartum onset
A
within 4 weeks of delivery
13
Q
features of anxious distress
A
keyed up or tense restless difficulty concentrating because of worry fear of something awful might lose control
14
Q
define full remission
A
symptoms gone < 2 months
15
Q
define partial remission
A
no longer MDD but still some symptoms
16
Q
define recovery
A
symptoms gone 2+ months
17
Q
define relapse
A
return of symptoms within 2 months
18
Q
define recurrence
A
return of symptoms after 2 months; new episode
19
Q
length of treatment for first episode of MDD
A
remission of symptoms + 6-12 months
20
Q
length of treatment for second episode of MDD
A
remission of symptoms + 2 years
21
Q
What factors should be considered for hospitalization of MDD pts
A
suicide
physical health
support system
catatonia
22
Q
Which antidepressants can be fatal if OD’d
A
MAOI
TCAs
amoxapine
maprotiline
23
Q
which antidepressants are safest for OD potential
A
SSRI
SNRI
Buproprion
24
Q
Secondary causes of depression
A
drugs drug abuse metabolic disorders neurologic disorders nutritional disorders
25
most common cause of secondary depression
hypothyroidism
26
which drugs cause secondary depression
```
reserpine
beta blockers
alpha-methyldopa
levodopa
estrogens
corticosteroids
cholinergics
benzos
barbituates
ranitidine
calcium channel blockers
```
27
Non pharm treatments for MDD
```
ECT
TMS
Light therapy
Psychotherapy (CBT)
Exercise
herbals
VNS
Folic Acid
```
28
ECT
electroconvulsive therapy
29
ECT seizure lasts how long
25 seconds to under 2 minutes
30
indications for ECT
```
psychotic depression
catatonic depression
refractory depression
acute mania
pregnant with bipolar
```
31
AEs of ECT
memory loss
32
Contraidications for ECT
recent MI
| brain lesions
33
TMS
transcranial magnetic stimulation
34
AEs of TMS
headache
| lightheadedness
35
CBT
cogntive behavioral therapy
36
Herbal used for MDD
St. Johns Wort
37
St John's wort active ingrediant
hypericum perforatum
38
st john's wort dose
300 mg TID
39
how long until effect of st john's wort is seen
4 weeks
40
AEs of st john's wort
nausea
photosensitivity
fatigue
41
VNS
vagus nerve stimulation
42
who gets VNS
treatment resistant depression
43
Folic acid dose for MDD
15 mg with an SSRI
44
Citalopram brand name
celexa
45
escitalopram brand name
lexapro
46
fluoxetine brand name
prozac
47
fluvoxamine brand name
luvox
48
paroxetine brand name
paxil
49
sertraline brand name
zoloft
50
vilazodone brand name
viibryd
51
name the SSRIs
```
citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
vilazodone
```
52
name the SNRIs
desvenlafaxine
duloxetine
levomilnacipran
venlafaxine
53
desvenlafaxine brand name
pristiq
54
duloxetine brand name
cymbalta
55
levomilnacipran brand name
fetzima
56
venlafaxine brand name
effexor
57
name the Triazolopyridines
nefazodone
| trazodone
58
nefazodone brand name
serzone
59
trazodone brand name
desyrel
60
name an aminoketone used for MDD
buproprion
61
bupropion brand name
wellbutrin
62
TCAs for MDD
```
Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin
Imipramine
Maprotiline
Nortiriptyline
Protriptyline
Trimipramine
```
63
Amitriptyline brand name
elavil
64
amoxapine brand name
ascendin
65
clomipramine brand name
anafranil
66
desipramine brand name
norpramin
67
doxepin brand name
sinequan
68
imipramine brand name
tofranil
69
maprotiline brand name
ludiomil
70
nortriptyline brand name
pamelor
71
protriptyline brand name
vivactil
72
trimipramine brand name
surmontil
73
Tetracycline used for MDD
mirtazapine
74
mirtazapine brand name
remeron
75
MAOIs used for MDD
selegiline
phenelzine
tranylcypromine
76
selegiline brand name
emsam
77
phenelzine brand name
nardil
78
tranylcypromine brand name
parnate
79
novel agent used for MDD
vortioxetine
80
vortioxetine brand name
brintellix
81
therapeutic dose range for amitriptyline
120-250 ng/ml
82
therapeutic dose range for desipramine
100-300 ng/ml
83
therapeutic dose range for tofranil
200-350 ng/ml
84
therapeutic dose range for nortriptyline
50-150 ng/ml
85
black box warning on all antidepressants
risk of suicide
86
factors to consider when choosing an antidepressant
```
past response
familial response
specifier/subtype
side effects
medical history
drug-drug interactions
cost
```
87
baseline monitoring for an SSRI
```
history
PE
TFTs
CBC
Chem 7
BP
Pulse
Weight
Pregnancy test
```
88
citalopram pregnancy category
C
89
citalopram usual dosing
20 mg AM
90
citalopram doses > 40 mg QD risk
prolong QTC
91
elderly dosing for SSRIs
50% of normal dose
92
escitalopram usual dosing
10 mg AM
93
escitalopram pregnancy cat
C
94
Fluoxetine pregnancy cat
C
95
Which SSRI is most likely to cause jitteriness
fluoxetine
96
fluoxetine usual dose
20 mg AM
97
Fluvoxamine approved uses
OCD
98
fluvoamine dose
max 300 mg/day BID dosing start 50 mg HS
99
fluvoxamine preg cat
C
100
Paroxetine preg cat
D
101
Paroxetine usual dose
20 mg AM;
| CR = 25 mg AM
102
Which SSRI most likely to cause sexual dysfunction and wieght gain
Paroxetine
103
SSRI most likely to cause nausea
Sertraline
104
Sertraline dosing
50-100 mg AM
105
sertraline preg cat
C
106
Vilazodone MOA
SSRI + 5HT1A partial agonist
107
Vilazodone dose
10 mg qd x 1 week, then 20 mg qd x 1 week, then 40 mg QD
108
vilazodone pregnancy cat
C
109
TCA drug interaction with SSRI
increase TCA concentration
| lower TCA dose
110
Fluvoxamine and Vilazodone drug interaction with warfarin
increase warfarin levels
| decrease dose, monitor INR/Ptt
111
SSRI interaction with MAOI
Serontonin synrome
| AVOID
112
SSRI interaction with L-tryptophan
serontonin syndrome
| AVOID
113
SSRI interaction with triptans
serotonin syndrome
| AVOID
114
SSRI interaction with hypoglycemic agents
increased hypoglycemia
| Monitor
115
SSRI interaction with type 1C antiarrhythmics
increase levels of antiarrhythmics
| Caution
116
SSRI interaction with beta blockers
increased beta blockers
| monitor heart rate and adjust
117
SSRI interaction with St John's Wort
Serotonin syndrome
| Stop SJW
118
Common AEs of SSRI
```
N/V
diarrhea
HA
insomnia
sexual dysfunction
```
119
SSRI discontinuation syndrome seen most often with what SSRIs
sertraline
| paroxetine
120
Baseline labs for SSRIs
```
CBC
chem 7
TFT
BP
Pulse
Wt
pregnancy test
```
121
labs for SSRIs at 2 weeks
Na+ levels
122
monthly monitoring for SSRIs
resolution of symptoms
| Na+ level
123
Quarterly monitoring for SSRIs
resolution of symptoms
Na+
weight
124
Monitoring q6 months for SSRIs
electrolytes
125
Annual monitoring for SSRIs
CBC
chem 7
TFTs
126
which SSRI has an active metabolite
fluoxetine
127
how long are symptoms of SSRI discontinuation syndrome
3 days to 3 weeks
128
symptoms of SSRI discontinuation syndrome
```
nausea
dizziness
insomnia
vivid dreams
vertigo
malaise
headache
```
129
What to do before starting an SNRI
```
history
physical
CBC
TFT
Chem 7
BP
pulse
weight
EKG
Pregnancy test
```
130
max dose of venlafaxine IR
375 mg/day
131
dosing frequency of venlafaxine IR
BID-TID
132
dosing frequency of venlafaxine ER
QD
133
Rare AE of venlafaxine
HTN
134
Venlafaxine dosing must be what
titrated
135
Max dose of venlafaxine ER
225 mg
136
desvenlafaxine is the active metabolite of what
venlafaxine
137
desvenlafaxine dosing
50 mg QD
138
desvenlafaxine max
400 mg/day
139
venlafaxine drug interactions
```
MAOI
Indinavir
Triptans
SJW
Warfarin
```
140
venlafaxine should be avoided with what
MAOI
Indinavir
Triptans
SJW
141
Interaction between venlafaxine and MAOI
Serotonin syndrome/hypertensive crisis
142
interaction between venlafaxine and Indinavir
decreased indinavir
143
interaction between venlafaxine and Triptans
serotonin syndrom
144
interaction between venlafaxine and SJW
serotonin syndrome
145
interaction between venlafaxine and warfarin
increased Ptt, INR;
| Monitor
146
Venlafaxine pregnancy cat
C
147
Venalfaxine AEs
```
HA
insomnia
drowsiness
dizziness
diaphoresiss
weight loss
nausea
dry mouth
anorexia
sexual dysfunction
weakness
```
148
desvenlafaxine preg cat
c
149
duloxetine dosing
20 mg BID up to 60 mg/day (30 mg BID or ^) qd)
150
duloxetine AEs
N/V
sexual dysfunction
HTN
151
duloxetine preg cat
c
152
duloxetine should be avoided with what medications
```
fluvoxamine
quinolone antibiotics
alcohol
SSRI
MAOI
TCA
triptans
```
153
duloxetine should be monitored with what drug
smoking
154
levomilnacipran preg cat
C
155
levomilnacipran dosing
40 mg dialy ma 120/day
156
AEs of levomilnacipran
```
N/V
constipation
sweating
tachycardia
HTN
```
157
levomilnacipran drug interactions to avoid
alochol
ketoconazole
NSAIDS
Warfarin
158
SNRI monitoring at baseline
```
CBC
Chem 7
TFTs
EKG
BP
pulse
Weight
Pregnancy
```
159
SNRI monitoring monthly
resolution of symptoms
BP
pulse
weight
160
SNRI monitoring annually
```
EKG
CBC
Chem 7
TFTs
BP
Pulse
weight
```
161
SNRI indications
```
GAD
MDD
Panic
SAD
neuropathy
fibromyalgia
```
162
nefazodone dosing
300-600 mg /day given BID
163
nefazodone AEs
```
dizziness
blurred vision
dry mouth
constipation
HA
orthostasis
LITTLE TO NO SEXUAL
```
164
black box warning of nefazodone
liver dysfunction
165
nefazodone preg cat
c
166
trazodone dosing
50 mg HS x 3 days up to 150 mg HS (max 600 mg/day)
167
AEs of trazodone
```
sedation
dry mouth
blurred vision
mental dullness
orthostasis
RARE- PRIAPISM
```
168
trazodone preg cat
C
169
Trazodone drug interactions to be avoided
CNS depressants
| MAOI
170
Nefazodone drug interactions to be avoided
general anesthetics
triptans
MAOI
Statins
171
Nefazodone drug interaction with buspirone
decrease buspirone dose to 2.5 mg BID
172
Baseline monitoring for Triazolopyridines
```
CBC
Chem 7
TFT
EKG
BP
Pulse
weight
Preg
```
173
Monthly monitoring of triazolopyridines
resolution of symptoms
BP
Pulse
Weight
174
Annual monitoring of triazolopyridines
```
EKG
CBC
Chem 7
TFT
BP
pulse
Weight
```
175
baseline monitoring for bupropion
```
CBC
Chem 7
TFTs
EKG
BP
Pulse
Weight
Preg Test
```
176
Monthly monitoring for buproprion
resolution of symptoms
BP
pulse
weight
177
Annual monitoring for bupropion
```
EKG
CBC
Chem 7
TFT
BP
pulse
weight
```
178
bupropion dose IR
100 mg BID x 3 days
100 mg TID
MAx 450/day
179
bupropion SR dose
150 mg x 5 days, then 150 mg BID
180
bupropion XL dose
150 mg x 5 days, then 300 mg qd
181
bupropion preg cat
C
182
bupropion AEs
```
HA
Nausea
tachycardia
dizziness
insomnia
agitation
weight loss
dry mouth
NO SEXUAL
RARE- SEIZURE
```
183
avoid what drugs with bupropion
MAOI
Ritonavir
Drugs that lower seizure threshold
184
Bupropion drug interaction with beta blocker
decreased BP, HR
| adjust dose of beta blocker
185
Bupropion drug interaction with SSRI
reduce dose of SSRI
186
Bupropion drug interaction with warfarin
monitor INR, increased bleeding
