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PHRM 845 > Ott Depression > Flashcards

Ott Depression Flashcards

1
Q

risk of reoccurrence with 1 episode
2 episodes
3 episodes

A

50-60%
70%
90%

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2
Q

risk of recurrence over time

A

decreases as the duration of remission increases
(longer time in remission = decreased risk)

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3
Q

predictor of recurrence?

A

persistent mild symptoms during remission

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4
Q

at least one sx must be what for depression dx?

A

depressed mood or loss of interest/pleasure in doing things

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5
Q

depression diagnostic mnemonic

A

SIGE CAPS
sleep
interest decreased
guilt / worthlessness
energy loss

concentration
appetite changes
psychomotor agitation
suicidal

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6
Q

what rating scale screens for depression?

A

PHQ-9

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7
Q

which rating scale is used to rule out bipolar?

A

MDQ (mood disorder questionaire)

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8
Q

4 goals of depression treatment

A

reduce / eliminate signs
restore functioning to baseline
reduce risk of relapse
reduce risk of suicide

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9
Q

Box warning for antidepressants

A

suicidal ideation in all pts 24 or younger
(counsel them all)

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10
Q

which med has QTC prolongation?

A

citalopram

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11
Q

citalopram substrate

A

2C19 and 3A4

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12
Q

fluoxetine CYPs

A

2D6 inhibitor
3A4 inhibitor (norfluoxetine) (active metabolite)

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13
Q

which drug has activating potential?

A

fluoxetine
take in morning

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14
Q

which SSRI is the longest acting?

A

fluoxetine (96-144 hours)

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15
Q

fluvoxamine CYPs

A

inhibitor 1A2
inhibitor 2C19

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16
Q

paroxetine CYPs

A

inhibitor 2D6
inhibitor 2B6

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17
Q

which SSRi is the hardest to stop?

A

paroxetine, anticholinergic effects

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18
Q

paroxetine side effects

A

weight gain, sedation (take at night)

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19
Q

which drug has septal wall defect risk

A

paroxetine

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20
Q

sertraline side effect

A

more GI / nausea effect than others

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21
Q

which SSRI is weight gain

A

paroxetine

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22
Q

which SSRI is weight loss

A

fluoxetine

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23
Q

adverse effects of SSRIs

A

sexual dysfunction
hyponatremia (in elderly)
increased bleeding risk (platelet inhibition)

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24
Q

active metabolite of venlafaxine

A

desvenlafaxine

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25
Q

desvenlafaxine CYPS

A

none :)

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26
Q

side effect of desvenlafaxine

A

nasua: dose limiting

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27
Q

which drug has FDA warning for hepatotoxicity

A

duloxetine

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28
Q

duloxetine CYP

A

inhibitor 2D6

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29
Q

levomilnacipran CYP

A

substrate 3A4

30
Q

which drug must we adjust in renal impairment or strong 3A4

A

levomilnacipran

31
Q

venlafaxine CYPs

A

2D6 inhibitor at high doses

32
Q

venlafaxine dosing considerations

A

must be >150 mg for NE effects
(pretty serotonin selective)

33
Q

SNRIs useful in what disease states

A

pain syndrome
musculoskeletal pain
fibromyalgia
neuropathic pain

34
Q

duloxetine considerations

A

obtain LFTs at baseline and when symptomatic or every 6 months

35
Q

SNRIs adverse effects

A

increased BP
nausea

36
Q

amitriptyline is a ____ amine

A

tertiary

37
Q

amitriptyline use

A

lower doses for neuropathic pain

38
Q

TCA CNS side effects

A

CNS: sedation, reduced seizure threshold, confusion

39
Q

TCA anticholinergic side effects

A

blurry vision
urinary retention
constipation

40
Q

TCA CV effects

A

orthostatic hypotension
tachycardia

41
Q

TCA other side effects

A

weight gain
sexual dysfunction

42
Q

TCA risk

A

doses as low as 1000 mg (4-10 tabs) - arrhythmia or seizure

43
Q

washout period with MAOs

A

2 week washout before switching
3 week with fluoxetine

44
Q

requirement of MAOs
and exception

A

tyramine diet
(except selegiline 6 mg patch)

45
Q

caution with MAOs

A

hypertensive crisis
serotonin syndrome

46
Q

bupropion MOA

A

dopamine and NE reuptake inhibitor

47
Q

buproprion stimulates what

A

insomnia
appetite supression

48
Q

which form of bupropion is used

A

XL

49
Q

buproprion CYP

A

inhibitor 2D6

50
Q

buproprion contraindications

A

seizure disorder
eating disorder

51
Q

can we use bupropion with SSRIs/SNRIs?

A

yes

52
Q

mirtazapine warnings

A

agranulocytosis
increased cholesterol

53
Q

can mirtazapine be used with SSRI/SNRI

A

yes

54
Q

what occurs with mirtazapine lower doses?

A

<15 mg / day = sedation and increased appetite

55
Q

what doses needed for trazodone in depression

A

higher doses

56
Q

side effects trazodone

A

orthostatic hypotension
priapism (EMERGENCY)

57
Q

vilazodone MOA

A

SSRI with some 5HT1 agonism
(anxiolytic effects)

58
Q

can we use vilazodone with SSRI/SNRI?

A

no

59
Q

vilazodone tips

A

take with food
bioavailability better with food
nausea without food

60
Q

vilazodone CYP

A

substrate 3A4

61
Q

vortioxetine MOA

A

SSRI + 5HT1A agonist + 5HT3 antagonist

62
Q

can we use vortioxetine with SSRI/SNRI?

A

no

63
Q

vortioxetine pearl

A

less sexual dysfunction
NAUSEA

64
Q

vortiozetine CYP

A

substrate 2D6

65
Q

serotonin syndrome is a ______

A

medical emergency

66
Q

serotonin blocker in serotonin syndrome

A

cyproheptadine

67
Q

what can happen with all antidepressants except fluoxetine

A

withdrawal syndrome

68
Q

antidepressants with ____ should be tapered immediately

A

anticholinergic activity

69
Q

FDA approved augmentation agents

A

Atypical Antipsychotics
aripiprazole
brexiprazole
cariprazine
quetiapine

70
Q

increase in what during first few weeks of therapy

A

suicidal thinking

PHRM 845 (38 decks)

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