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NAPLEX review 2024 RXPrep Book > Psychiatric Conditions: Depression > Flashcards

Psychiatric Conditions: Depression Flashcards

1
Q

DSM-5 Criteria

A

at least 2 of the following symptoms present during the same two week period

Mood = Depressed
Sleep = inc/dec
Interest/pleasure = diminished
Guilt or feelings of worthlessness
Energy = decreased
Concentration = decreased
Appetite = inc/dec
Psychomotor agitation or retardation
Suicidal ideation

M SIG E CAPS

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2
Q

Bipolar disorder should be ruled out before starting antidepressant therapy to….

A

avoid inducing mania or causing rapid-cycling

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3
Q

Natural products that maybe helpful for depression

A

St John’s Wort
SAMe
valerian
5-HTP

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4
Q

How long is suitable trial for depression

A

4-8 weeks, if drug doesn’t work then reassess

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5
Q

SSRI use in pregnant women warning

A

risk of persistent pulmonary hypertension of newborn

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6
Q

Symptoms of serotonin syndrome

A

severe nausea
dizziness
headache
diarrhea
agitation
tachycardia
hallucinations
muscle rigidity

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7
Q

How to discontinue antidepressant

A

taper over a few weeks to avoid withdrawal

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8
Q

boxed warnings for all antidepressants

A

possible increase in suicidal thoughts or actions in some children, teenagers, young adults in first few months of txm or when dose changed

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9
Q

SSRIs

A

Citalopram = Celexa
Escitalopram = Lexapro
Fluoxetine = Prozac
Paroxetine = Paxil
Sertraline = Zoloft

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10
Q

Citalopram (Celexa) dosing

A

20-40mg
Max: 40mg/day, 20mg in > 60yrs old

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11
Q

Escitalopram (Lexapro) dosing

A

Max 20mg/day, 10mg/day elderly

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12
Q

Fluoxetine (Prozac) dosing

A

Max 80mg/day

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13
Q

SSRI Contraindications

A

dont use with MAOi, Linezolid, IV methylene blue

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14
Q

SSRI warnings

A

QT prolongation: dont give more than 20mg citalopram elderly, 10mg escitalopram elderly

SIADH, hyponatremia, fall risk
Bleeding

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15
Q

SSRI side effects

A

Sexual side effects
Somnolence, insomnia, nausea, dry mouth, weakness, tremors, dizziness, headache

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16
Q

Most activating SSRI

A

Fluoxetine, take in AM

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17
Q

Most sedating SSRI

A

paroxetine, fluvoxamine, take in PM

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18
Q

SSRI preferred for patients with cardiac risk?

A

Sertraline

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19
Q

Washout period for SSRI and MAOi

A

2 weeks for most, 5 wks for Fluoxetine

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20
Q

Vilazodone (Viibryd) MOA

A

SSRI and 5-HT1A partial agonist

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21
Q

Vortioxetine (Trintellix) MOA

A

SSRI, 5-HT3 receptor antagonist, 5-HT1A agonist

22
Q

Vilazodone (Viibryd) & Vortioxetine (Trintellix) CI, warnings, SE

A

CI: dont use within 14 days of MAOi
Warnings: seizures, avoid pts with seizure hx
Side effects: N/V/D, less sexual side effects

23
Q

SNRI

A

Venlafaxine = Effexor
Duloxetine = Cymbalta
Desvenlafaxine = Pristiq

24
Q

SNRI contraindications

A

Dont use SNRI/MAOi combo

25
Q

SNRI warnings

A

fall risk, SIADH/hyponatremia, bleeding

26
Q

SNRI side effects

A

similar to SSRI
inc HR, dilated pupils, dry mouth, excessive sweating and constipation due to inc NE

27
Q

Which SNRI has greatest risk of inc BP?

A

venlafaxine when dosed > 150mg/day

28
Q

Secondary vs Tertiary Amine TCA

A

Secondary = selective
Tertiary = can be more effective but worse side effects

29
Q

Tertiary Amines TCAs

A

Amitriptyline
Doxepin

Clomipramine
Imipramine
Trimipramine

30
Q

Secondary Amines TCAs

A

Nortriptyline = Pamelor

Amoxapine
Desipramine
Maprotiline
Protriptyline

31
Q

TCA contraindications

A

Dont use with MAOi, linezolid, IV methylene blue

32
Q

TCA side effects

A

Cardiotoxicity: QT prolongation with OD, orthostasis, tachycardia

Anticholinergic: Dry mouth, blurred vision, urinary retention, constipation, vivid dreams, weight gain, risk of calls

33
Q

Dopamine and NE reuptake inhibitor

A

Bupropion = Wellbutrin

34
Q

Bupropion max dose

A

450mg/day due to seizure risk

35
Q

Bupropion Contraindications

A

seizure disorder
hx of anorexia/bulimia
dont use with MAOi, linezolid, methylene blue

36
Q

Bupropion warnings

A

Neuropsychiatric adverse events when used for smoking cessation possible

37
Q

Bupropion side effects

A

Dry mouth
CNS stimulation
weight loss
sexual dysfunction is rare

38
Q

MAOi medications

A

Isocarboxazid = Marplan
Phenelzine = Nardil
Tranylcypromine = Parnate
Selegiline = Emsam = MAO-B selective

39
Q

MAOi contraindications

A

hx of CVD, cerebrovascular defect, HA, hepatic disease
severe renal disease

40
Q

MAOi warnings

A

hypertensive crisis or serotonin syndrome can occur with TCA, SSRI, SNRIs, tyramine rich foods

41
Q

MAOi side effects

A

anticholinergic effects
Orthostasis
Sedation
sexual dysfunction
weight gain

42
Q

Selegiline (Emsam) CI and side effects

A

CI: use with serotonergic drugs
Side effects: constipation, gas, dry mouth, loss of appetite, sexual dysfunction

43
Q

Tyramine containing foods

A

aged cheese
pickled herring
yeast extract
air-dried meats
sauerkraut
soy sauce
fava beans
some red wines and beers

aged, fermented or smoked foods

44
Q

Mirtazapine (Remeron) info

A

used often in one to help with sleep, inc appetite/ weight gain

45
Q

Trazodone info

A

used mostly off label for sleep

SE: sexual dysfunction and priapism

46
Q

Nefazodone info

A

rarely used due to hepatotoxicity, boxed warning

47
Q

Aripiprazole (Abilify) side effects

A

anxiety
insomnia
akathisia
constipation
agitation

48
Q

Olanzapine (Zyprexa) side effects

A

sedation, weight gain, inc lipids/glucose, EPS, QT prolongation - lower risk

49
Q

Quetiapine (Seroquel) side effects

A

sedation, orthostasis, weight gain, inc lipids/glucose, EPS - lower risk

50
Q

Brexpiprazole (Rexulti) side effects

A

weight gain, dyspepsia, diarrhea

51
Q

Esketamine (Spravato) info

A

C3, comes as nasal spray
Given under supervision of HCP
REMS program

NAPLEX review 2024 RXPrep Book (78 decks)

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