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Pharmacology > Psych > Flashcards

Psych Flashcards

1
Q

primary biogenic amine hypothesis of MDD

A

biogenic amine hypothesis which states deficit of norepinephrine, dopamine, or serotonin at the synapse= depression

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2
Q

receptor hypothesis of MDD

A

suggests depression is r/t up-regulation of monoamine neurotransmitter receptors in response to depletion of monoamine neurotransmitters
therefore antidepressants alter receptor sensitivity= desensitization or downregulation of monoamine neuro receptors = therapeutic response

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3
Q

what’s required for dx for major depressive episode and depression

A

episode: 5 sx x2 weeks that cause significant distress/impairment
- depressed mood, diminished interest/pleasure ADL decreased weight, appetite, sleep, increase/decrease psychomotor, fatigue, worthlessness/guilt, can’t think, SI

depression 1 or more MDEs during a lifetime

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4
Q

one extremely important tx goal of MDD

A

prevent suicide and suicide attempts

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5
Q

when is electroconvulsive therapy (ECT) indicated

A

MDD that’s complicated with psychotic features, severe suicidality, refusal to eat, pregnancy, or contraindication/non-response to pharmacotherapy

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6
Q

SE of ECT

A

temp. confusion and retrograde and anterograde amnesia

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7
Q

vagus nerve stim & SE

A

treatment-resistant depression
pulse generator surgically implanted around vagal nerve sends signals to brain to relieve sx
SE altered voice, hoarseness, dyspnea, neck pain

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8
Q

transcranial magnetic stimulation

A

non-invasive
approved after one failed trial of antidepressants

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9
Q

SE of SSRIs

A

sexual dysfunction, CNS stim (nervous, insomnia), nausea, diarrhea, weight gain, anhedonia fatigue

*nausea, anxiety, fatigue, HA usually transient

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10
Q

adjunct therapy with SSRI to improve sexual dysfunction

A

bupropion, cyproheptadine, sildenafil

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11
Q

SE and contraindications bupropion

A

insomnia, nightmares, decreased appetite, anxiety, tremors, SEIZURES*

contraindicated: seizure disorder, head trauma, anorexia, bulimia

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12
Q

Common SNRI SE

A

similar to SSRI

venlafaxine & desvenlafaxine = nausea (give w/ food, lower starting dose). High BP- monitor

duloxetine > hepatic injury so contraindicated heavy alcohol use or liver disease

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13
Q

mirtazapine/Remron SE

A

sedation & weight gain
serotonergic but RARELY causes serotonin-related effects like sexual dysfunction

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14
Q

2 antidepressants that need to go through REMS program

A

Esketamine d/t sedative and dissociative effects
Brexanolone d/t sedation and sudden LOC

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15
Q

SE of TCAs

A

sedative, anticholinergic, cardiovascular
Toxic at overdose at just less than 1 month supply

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16
Q

antidepressant with one of the longest half lives

A

fluoxetine (4-6 days)
requires 5 week washout before starting MAOI

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17
Q

how long of washout sufficient for serotonergic agents before MAOI

A

fluoxetine= 5 weeks d/t long half life
others= 2 weeks

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18
Q

most concerning pharmacodynamic interactions with antidepressants

A

hypertensive crisis and serotonin syndrome

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19
Q

what can cause hypertensive crisis

A

MAOI therapy and:
meds= ephedrine, pseudoephedrine, phenylephrine, stimulants
foods high in tyramine= aged cheese, beer, dry sausage, tofu

20
Q

serotonin syndrome (hunter serotonin toxicity criteria)

A
  1. spontaneous clonus OR
  2. inducible clonus w/ agitation or diaphoresis OR
  3. ocular clonus w/ agitation or diaphoresis OR
  4. tremor and hyperreflexia OR
  5. hypertonia, temp > 100.4, ocular or inducible clonus
21
Q

starting dose for most SSRI, desvenlafaxine, duloxetine, mirtazapine

A

often therapeutic dosage

22
Q

efficacy of paharmacotherapy for MDD

A

each med 50%-75% response rate
no med or class more efficacious than another

23
Q

*first line tx mild-severe depression

A

SSRI, SNRI, bupropion, or mirtazapine
mild may be managed with psychotherapy alone

24
Q

most reliable predictor of response to antidepressants

A

pt hx of response
second best- first-degree relative’s response

25
Q

what meds to avoid if pt at risk for accidental OD

A

TCAs (OD is lethal)

26
Q

how long until most antidepressants work

A

2-4 weeks for emotional sx
6-8 weeks to see full effect

27
Q

what is pt has partial response to antidepressive? options?

A

extend med trial, higher dose within range, (augmentation) add non-antidepressant like lithium, buspirone, triiodothyronine

28
Q

Approved adjunct tx class/ex of meds for tx MDD along with antidepressant

A

second generation antipsychotics
abilify, brexpiprazole, ER quetiapine

29
Q

advantages of switching antidepressant class even in partial response

A

adherence, decreased cost, less concern over drug-to-drug interactions

30
Q

Duration of MDD therapy (acute, continuation maintenance phase)

A

acute phase= 6-12 weeks
bc MDE lasts 6 or more months, if interrupted after acute phase, relapse to depressive episode.

***when tx first depressive episode, antidepressants should be given for additional FOUR TO NINE months in continuation phase to prevent relapse

31
Q

when is maintenance on antidepressants recommended

A

after 3 MDEs d/t risk of recurrence

32
Q

general rule for d/c antidepressant tx

A

tapered by no more than 25% per week to minimize withdrawal sx & to spot early signs of depression returning

33
Q

what should NOT be considered as first line antidepressant in pregnancy

A

paroxetine d/t increased risk cardiac malformations

34
Q

most common antidepressant for geriatric

A

SSRI d/t favorable SE profile and low toxicity

35
Q

only antidepressants FDA approved for MDD in children < 18 y/o and SE

A

fluoxetine and escitalopram
“behavioral activation”- silliness, impulsivity, daring conduct, agitation

36
Q

black box warning for all antidepressants

A

increased SI/behavior in children and young adults

37
Q

patient education for antidepressants

A

sleep/appetite improvement in first week but 4-8 week for optimal mood changes
common SE, how long they’ll last, simple remedies (ice chips, gum for dry mouth)
sexual dysfunction & weight gain discussed
SNRI= high BP so monitor each visit
ECG if > 40 or cardiovascular risk factors prior to TCA
serum levels for TCA
monitor for serotonin syndrome if taking 2+ serotonergic meds

38
Q

meds of choice for PTSD

A

sertraline, fluoxetine, paroxetine

39
Q

tx of choice for panic disorder

A

SSRI, sometimes bzo
*venlfaxine XR
4 weeks for onset, 6-12 weeks for full effect

40
Q

mosts likely SE of SSRI with panic disorder

A

stimulant effects so start low

41
Q

tx of choice for social anxiety disorder

A

SSRI (paroxetine, sertraline, escitalopram, fluvoxamine)
and venlafaxine

42
Q

how long does It take for meds to work in social anxiety disorder

A

8-12 weeks for onset and should cont. x1 year

43
Q

preferred tx PTSD

A

trauma-based therapy over anything else. Success results x10 years.
If meds: fluoxetine, paroxetine, sertraline, venlafaxine
*Prazosin for nightmares

44
Q

simple patho of narcolepsy

A

type 1- loss of neurons in hypothalamus that produce orexin
type 2- damage to same neurons to lesser degree

45
Q

simple patho restless leg

A

iron & dopamine dysfunction
low serum ferritin levels seen

46
Q

gold standard for dx sleep disorder

A

PSG (attended polysomnography)

Pharmacology (12 decks)

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