Psych

Question 1

How do we screen for depression?

Answer 1

PHQ-2 screening tool and if it is +’ve do the longer PHQ-9 (a score of 5 or more likely means depression)

Question 2

What are first line meds for depression?

Answer 2

SSRI and SNRIs

Question 3

SSRIs

Answer 3

Fluoxetine (Prozac) - jittery long half (not good for those with anxiety or elderly), great for bulemia (wt neutral)
Paroxetine (Paxil)- MOST sedating, great for OCD, and commonly used off label for PMS and menopause, infamous for sexual dysfunction
Escitalopram (lexapro) - fast onset and Sertraline (zoloft) - great for elderly, low side effects

Question 4

SNRI

Who should avoid SNRIs?

Answer 4

Cymbalta - helpful for neuropathic pains
Effexor
Avoid SNRI’s in those w/ HTN as BP issues may occur

Question 5

what is serotonin syndrome?

Answer 5

agitation, tachy, shivering, tremors, seizures and potentially death

Question 6

How do we screen for anxiety?

Answer 6

GAD -7

Question 7

TCA’s

Answer 7

End in “-tryptyline”
S/E: wt gain, LOTS of anti-cholinergic effects, cardiac issues (slow down heart conduction and can lead to arrhythmias and heart blocks), easy to overdose with this class (only 5x the therapeutic dose to OD)
Safety alert: GET an EKG for everyone over 40 yo

Question 8

MAOI’s

Avoid what type of foods?

Answer 8

-Commonly used with those w/ refractory or atypical depression
-Ex) Rasagiline, Selegiline
-3rd line anti-depressant bc of S/E and drug interactions
-Do NOT prescribe with other anti-depressants d/t serotonin syndrome likely
Avoid Tyramine containing foods while taking MAOIs as it will cause a hypertensive crisis (cured meats, aged cheese, sausage, yogurt)
-Also avoid grapefruit while on MAOIs

Question 9

Atypical antipsychotics

• avoid prescribing in pts w/…
• S/E:

Answer 9

• Ex. seroquel, Risperdal
• avoid prescribing in pts w/ metabolic dx d/t S/E of wt gain, hyperlipidemia and hyperglycemia
• S/E: galactorrhea, tardive dyskinesia, metabolic syndrome issues

Question 10

Buspirone (Buspar)
-used for…
-what do we need to warn our patients about?
Do not use with…

Answer 10

Buspar is used for anxiety
What do we need to warn our pts about? Tend to see GI effects/dizziness (take after a full meal)
Do not use with grapefruit juice or MAOI drugs concurrently

Question 11

Lithium is used for___
Therapeutic range, Toxic level
Long term concerns:
Do not use with __

Answer 11

-Lithium is used for bipolar disorder
-Therapeutic range 0.6-1.2, Toxic >2.0
-Long term concerns: pts may grow a goiter and have hypothyroid issues; kidney issues w/ long long term use too
Do not use with grapefruit juice

Question 12

SNRI’s like Venlafaxine (Effexor) is inappropriate for those with ___

Answer 12

HTN

Question 13

what are the 2 most common reasons to stop an SSRI like sertraline (zoloft)?

Answer 13

sexual dysfunction and wt gain

Question 14

Most appropriate drug for postpartum depression tx?

Answer 14

Sertraline (zoloft) 25mg/day

Question 15

Pt reports she had an EKG prior to starting what new antidepressant?

Answer 15

Clomipramine (Anafranil) is a TCA and TCA’s cause changes in hearts conduction so getting a baseline EKG is important

Question 16

Which SSRI should be avoided in the elderly?

Answer 16

Prozac d/t its long half life

Question 17

What does CYP3A4 do?

Question 18

CYP2C19 does what?

Answer 18

Asian population specifically this affects their ability to metabolize pain meds bc/ CYP2C19 is missing

Question 19

What SSRI is not appropriate for obese pts?

Answer 19

Paxil would not be appropriate for obese patients as it is frequently known to cause issues with additional weight gain

Question 20

Effexor would be inappropriate would be bad for someone with ____

Answer 20

hypertension or migraines (on triptans) or liver issues

SNRIs potentially increase BP and therefore should be avoided in those with uncontrolled hypertension. 
Concurrent use of the triptan drug class and SNRIs may lead to the development of serotonin syndrome. SNRIs are also processed in the liver, and if a patient has a liver condition, it may cause the drug to clear slowly.

Question 21

For patients with seasonal affective disorder (SAD), first-line treatment includes…

Answer 21

light therapy, antidepressants such as an SSRI, and incorporation of psychotherapy such as CBT.

Question 22

It is important to complete a thorough cardiac assessment and ECG prior to prescribing which antidepressant medications?

Answer 22

Tricyclic antidepressants such as Elavil are associated with heart blocks, ventricular arrhythmias, and even sudden death so pts need cardiac evaluation prior to beginning this class of medication.

Question 23

bulimia tx

Answer 23

fluoxetine (Prozac)

Question 24

notoriously one of the most sedating selective serotonin reuptake inhibitors (SSRI) available.

Answer 24

Paroxetine (Paxil) is one of the most sedating SSRI’s available. Also, decreased libido and weight gain are common side effects of the whole SSRI drug class.

Question 25

which SSRI is notorious for issues with both sedation and erectile dysfunction.

Answer 25

Paroxetine (Paxil) is notorious for issues with both sedation and erectile dysfunction. Therefore, Wellbutrin is commonly prescribed alongside this medication to combat that issue.

Question 26

which med option for depression is not recommended for those with seizures?

Answer 26

Wellbutrin

Question 27

SNRIs are known to potentially increase blood pressure and therefore should be avoided in those with uncontrolled hypertension already. Concurrent use of the triptan drug class and SNRIs may lead to the development of serotonin syndrome. SNRIs are also processed in the liver, and if a patient has a liver condition, it may cause the drug to clear slowly.

Question 28

It is imperative to complete a thorough cardiac assessment and electrocardiogram (ECG) prior to prescribing which of the following antidepressant medications?

Answer 28

Tricyclic antidepressants such as Elavil are associated with heart blocks, ventricular arrhythmias, and even sudden death, which is why patients need cardiac evaluation prior to beginning this class of medication.