Psych Flashcards
How do we screen for depression?
PHQ-2 screening tool and if it is +’ve do the longer PHQ-9 (a score of 5 or more likely means depression)
What are first line meds for depression?
SSRI and SNRIs
SSRIs
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
SNRI
Who should avoid SNRIs?
Cymbalta - helpful for neuropathic pains
Effexor
Avoid SNRI’s in those w/ HTN as BP issues may occur
what is serotonin syndrome?
agitation, tachy, shivering, tremors, seizures and potentially death
How do we screen for anxiety?
GAD -7
TCA’s
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
MAOI’s
Avoid what type of foods?
-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
Atypical antipsychotics
- avoid prescribing in pts w/…
- S/E:
- 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
Buspirone (Buspar)
-used for…
-what do we need to warn our patients about?
Do not use with…
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
Lithium is used for___
Therapeutic range, Toxic level
Long term concerns:
Do not use with __
-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
SNRI’s like Venlafaxine (Effexor) is inappropriate for those with ___
HTN
what are the 2 most common reasons to stop an SSRI like sertraline (zoloft)?
sexual dysfunction and wt gain
Most appropriate drug for postpartum depression tx?
Sertraline (zoloft) 25mg/day
Pt reports she had an EKG prior to starting what new antidepressant?
Clomipramine (Anafranil) is a TCA and TCA’s cause changes in hearts conduction so getting a baseline EKG is important
Which SSRI should be avoided in the elderly?
Prozac d/t its long half life
What does CYP3A4 do?
CYP2C19 does what?
Asian population specifically this affects their ability to metabolize pain meds bc/ CYP2C19 is missing
What SSRI is not appropriate for obese pts?
Paxil would not be appropriate for obese patients as it is frequently known to cause issues with additional weight gain
Effexor would be inappropriate would be bad for someone with ____
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.
For patients with seasonal affective disorder (SAD), first-line treatment includes…
light therapy, antidepressants such as an SSRI, and incorporation of psychotherapy such as CBT.
It is important to complete a thorough cardiac assessment and ECG prior to prescribing which antidepressant medications?
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.
bulimia tx
fluoxetine (Prozac)
notoriously one of the most sedating selective serotonin reuptake inhibitors (SSRI) available.
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.
