PSYCH: DEPRESSION MEDS

Question 1

What medication is the gold standard for depression?

Answer 1

SSRI

Makes more serotonin available at the synapse

Question 2

Side Effects of SSRI’s

Answer 2

GI upset
Fatigue
Dry Mouth
Decreased libido

Question 3

What happens if an SSRI is abruptly discontinued?

Answer 3

Can develop SSRI Discontinuation Syndrome

Pt will feel like they have the flu

Question 4

Celexa (citalopram)
Lexapro (escitalopram)
Prozac (fluoxetine)
Luvox (fluvoxamine)
Paxil (paroxetine)
Zoloft (sertraline)

Answer 4

SSRI’s

Question 5

What is the feel good neurotransmitter?

Answer 5

Serotonin

Question 6

Serotonin Syndrome

Answer 6

Accumulation of Serotonin
Usually caused by a combination of substances
Everything is elevated, may be fatal

Question 7

What combination can cause Serotonin Syndrome?

Answer 7

SSRI + MAOI
SSRI + ecstasy
St. John’s Wart

Patients need weeks between SSRI’s and MAOI’s or St.John’s Wart

Question 8

What are the initial symptoms of Serotonin Syndrome? What might it progress to?

Answer 8

Initial symptoms: MS changes (restless/agitated), lethargy, flushing, confusion, tremors, diaphoresis, and ataxia

May progress to: hyperthermia, renal failure, hypertonicity, seizure, may be FATAL

Question 9

SNRI

Answer 9

dual action on serotonin and norepinephrine

Question 10

Possible side effects of SNRI’s

Answer 10

Cardiovascular risk
NV
Weight gain
Somatic symptoms (body ache)

Question 11

Effexor XR (venlafaxine)
Cymbalta (fluoxetine)
Pristiq (desvenlafaxine)

Answer 11

SNRI’s

Question 12

Side effects of Cymbalta?

Answer 12

Constipation
Headache
Nausea

Question 13

What SNRI is good for body aches?

Answer 13

Cymbalta

Question 14

Which SNRI has less sexual dysfunction?

Answer 14

Pristiq

single dose

Question 15

NDRIs

Answer 15

Norepi and Dopamine Reuptake Inhibitors

Question 16

Wellbutrin
Wellbutrin XL (bupropion)

Answer 16

NDRI

No weight gain
Nausea and headache
Few sexual side effects

Question 17

Wellbutrin is also commonly used for ______ ?

Answer 17

Smoking Cessation

Question 18

A major risk factor of Wellbutrin is …

Answer 18

Decreased Seizure Threshold

Question 19

Serotonin Antagonist & Reuptake Inhibitors

Answer 19

addresses the sleep and appetite more than anything

Question 20

Serzone (nefazadone) - hepatotoxicity
**Deseryl (trazedone) - powder doses for sleep only or augmentation (give at night)
Oleptro (pt may feel hungover)
** Remeron (mirtazapine) - helps sleep & appetite (causes weight gain)

Answer 20

SARI’s

Question 21

This type of medication can have an anticholinergic effect

Answer 21

TCA

Question 22

What is an anticholinergic effect? What population is at greatest risk?

Answer 22

DRY
Elderly (possible orthostatic HTN and increased risk for dysrhythmia)

Question 23

Elavil (amitriptyline)
Sinequan (doxepin)
Silenor (newer doxepin)
Tofranil (imipramine)
Anafranil (clomipramine)

Answer 23

TCA’s

Question 24

MAOI

Answer 24

Contraindicated with many things and not given often

Question 25

What is contraindicated with MAOI's

Answer 25

Nothing containing tyramine No aged food No fermented foods No OTC meds (not even a little bit)

Question 26

What could potentially happen if a person taking an MAOI eats food containing tyramine

Answer 26

``` HTN crisis (1st sign is headache commonly in back of head) Can cause stroke ```

Question 27

Nardil (heneizine) Parnate (tranlcypromine) Marplan (isocarboxacid) Emsam (selegiline) transdermal patch

Answer 27

MAOI's

Question 28

Atypical Antipsychotics

Answer 28

Not first generation and used for depression | Used for augmentation (helps to rapidly control sx)

Question 29

Atypical Antipsychotics are most commonly used to tx ....

Answer 29

Schizophrenia

Question 30

This medication is given in low doses to rapidly control symptoms of severe depression

Answer 30

Atypical Antipsychotics

Question 31

Zyprexa Seroquel Abilify

Answer 31

Atypical Antipsychotics

Question 32

Zyprexa and Seroquel carry a risk for ...

Answer 32

Metabolic Syndrome (fat gain; ex: fatty liver)