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Therapeutics > Therapy of Depression > Flashcards

Therapy of Depression Flashcards

1
Q

When starting antidepressants, what should you inform the patient of?

A

That adverse effects might occur
immediately, while resolution of symptoms may take 2 - 4 weeks or longer.

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2
Q

Which of these is best tolerated? SSRIs, TCAs, or MAOIs?

A

SSRIs

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3
Q

Which acne treatment is associated with or exacerbates depressive symptoms?

A

Isotretinoin

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4
Q

Which Anticonvulsants are associated with or exacerbate depressive symptoms?

A

1) Levetiracetam
2) Topiramate
3) Vigabatrin

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5
Q

Which Antimigraine agents are associated with or exacerbate depressive symptoms?

A

Triptans

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6
Q

Which Cardiovascular medications are associated with or exacerbate depressive symptoms?

A

1) β-Blockers
2) Clonidine
3) Reserpine
4) Methyldopa

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7
Q

Which hormonal therapies are associated with or exacerbate depressive symptoms?

A

1) Gonadotropin-releasing hormone
2) Oral contraceptives
3) Steroids (Prednisone)
4) Tamoxifen

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8
Q

Which Immunologic agents are associated with or exacerbate depressive symptoms?

A

Interferons

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9
Q

Which smoking cessation medications are associated with or exacerbate depressive symptoms?

A

Varenicline

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10
Q

Which medical conditions are associated with depression?

A

1) Stroke
2) Parkinson’s disease
3) Traumatic brain injury
4) Hypothyroidism
5) Withdrawal from cocaine and other stimulants

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11
Q

The goals of depression treatment are:

A

1) The resolution of current symptoms (remission)
2) The prevention of further episodes (relapse or recurrence)

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12
Q

The decision to hospitalize a depressive patient depends on:

A

1) Patient’s risk of suicide
2) Physical state of health
3) Social support
4) Presence of a psychotic depression

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13
Q

What are the phases of depression therapy?

A

1) Acute phase
2) Continuation phase
3) Maintenance phase

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14
Q

How long does the acute phase of depression therapy last?

A

6-12 weeks

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15
Q

How long does the continuation phase of depression therapy last?

A

4-9 months

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16
Q

How long does the maintenance phase of depression therapy last?

A

12-36 months

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17
Q

What is the goal of the acute phase of depression therapy?

A

Remission (disappearance of symptoms)

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18
Q

What is the goal of the continuation phase of depression therapy?

A

Eliminate residual symptoms or prevent relapse (return of symptoms within 6 months of remission)

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19
Q

What is the goal of the maintenance phase of depression therapy?

A

Prevent recurrence (a separate episode of depression which returns months-years after recovery)

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20
Q

The duration of antidepressant therapy depends on the:

A

Risk of recurrence

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21
Q

Risk of depression recurrence increases as:

A

The number of past episodes increases

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22
Q

Some recommend life-long maintenance therapy for which patients?

A

1) Patients >40 years of age
WITH ≥2 prior episodes
AND
2) Patients of any age with ≥3 prior episodes.

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23
Q

An alternative approach is to treat for at least ___ in patients considered to be at high risk for relapse.

A

2 years

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24
Q

The decision when to taper/discontinue an antidepressant regimen depends on:

A

1) Patient-specific variables
2) Drug-specific variables

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25
Q

The precise rate of the antidepressant taper typically depends on:

A

1) Medication half-life
2) Patient sensitivity to withdrawal symptoms

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26
Q

Monitoring for what is very necessary when treating for depression?

A

1) Discontinuation signs and symptoms
2) For a return of depressive symptoms

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27
Q

Can you treat depression with psychotherapy alone?

A

NO

28
Q

___ is a safe and effective treatment for certain severe mental illnesses, including MDD.

A

Electroconvulsive therapy (ECT)

29
Q

Which psychotherapies can be used for depression?

A

1) Cognitive therapy
2) Behavioral therapy
3) Interpersonal psychotherapy
4) Electroconvulsive therapy (ECT)

30
Q

What are the classes of therapeutic drugs?

A

1) Selective Serotonin Reuptake Inhibitors (SSRIs)
2) Norepinephrine - Dopamine Reuptake Inhibitors (NDRI)
3) Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)
4) Mixed Serotonergic Effects
5) Serotonin and α2-Adrenergic Antagonists
6) Monoamine Oxidase Inhibitors (MAOIs)

31
Q

Which drugs are Selective Serotonin Reuptake Inhibitors (SSRIs)?

A

1) Citalopram
2) Escitalopram
3) Fluoxetine
4) Fluvoxamine
5) Paroxetine
6) Sertraline

32
Q

Which SSRIs demonstrate the ‘best’ effect and safety profile?

A

1) Escitalopram
2) Sertraline

33
Q

Which drug is an NDRI?

A

Bupropion

34
Q

What is Bupropion usually used for?

A

Smoking cessation programs

35
Q

Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs) are divided into:

A

1) Tricyclic antidepressants (TCAs)
2) Newer-generation SNRIs

36
Q

Tricyclic antidepressants (TCAs) consist of which drugs?

A

1) Amitriptyline
2) Desipramine
3) Doxepin
4) Imipramine
5) Nortriptyline

37
Q

TCAs affect other receptor systems, such as:

A

1) Cholinergic receptors
2) Histaminergic receptors
3) α-adrenergic receptors

38
Q

TCAs have ___(many/few) adverse effects.

A

Many

39
Q

Newer-generation SNRIs consist of which drugs?

A

1) Desvenlafaxine
2) Duloxetine
3) Venlafaxine
4) Levomilnacipran

40
Q

Which newer-generation SNRI may be associated with higher rates of response and remission?

A

Venlafaxine

41
Q

Which drugs have Mixed Serotonergic Effects?

A

1) Nefazodone
2) Trazodone
3) Vilazodone
4) Vortioxetine

42
Q

Trazodone act as both:

A

1) 5-HT2 antagonists
2) 5-HT reuptake inhibitors

43
Q

Trazodone enhances:

A

5-HT1A-mediated neurotransmission

44
Q

What mechanism of action does Trazodone have that leads to increased adverse effects (dizziness and sedation) that limit its use?

A

It blocks α1-adrenergic and histaminergic receptors

45
Q

Trazodone may be used adjunctively (in low doses) to induce ___ among depressed patients who are taking other antidepressant medications.

A

Sleep (Trazzzodone)

46
Q

Which drug is a Serotonin and α2-Adrenergic Antagonist?

A

Mirtazapine

47
Q

Which drugs are Monoamine Oxidase Inhibitors (MAOIs)?

A

1) Phenelzine
2) Selegiline
3) Tranylcypromine

48
Q

MAOIs inhibit the MAO enzyme, therefore increasing the concentrations of:

A

1) NE
2) 5-HT
3) DA

49
Q

Chronic therapy of MAOIs causes downregulation of:

A

1) β-adrenergic receptors
2) α-adrenergic receptors
3) Serotonergic receptors

50
Q

Which MAOIs are nonselective inhibitors of MAO-A and MAO-B?

A

1) Phenelzine
2) Tranylcypromine

51
Q

Which MAOI inhibits both MAO-A and MAO-B in the brain, yet has reduced effects on MAO-A in the gut?

A

Selegiline

52
Q

Selegiline inhibits both MAO-A and MAO-B in the __.

A

Brain

53
Q

Selegiline has reduced effects on ___ in the gut.

A

MAO-A

54
Q

Antidepressants are considered first-line treatment for:

A

Moderate -severe depressive episodes

55
Q

Why is the choice of antidepressant empiric?

A

Because one cannot predict which antidepressant will be the most effective in an individual patient.

56
Q

Factors that often influence the choice of an antidepressant include:

A

1) The patient’s history of response
2) Presenting symptoms
3) Potential for drug–drug interactions
4) Adverse effect profile
5) Patient preference
6) Drug cost

57
Q

Preferred antidepressants for symptoms of Anxiety?

A

Selective Serotonin Reuptake Inhibitors

58
Q

Preferred antidepressants for symptoms of Weight loss and Reduced appetite?

A

Serotonin and α2-Adrenergic Antagonists (Mirtazapine)

59
Q

Preferred antidepressants for symptoms of Sleep disturbance and Insomnia?

A

1) Mirtazapine
2) TCAs
3) Mixed Serotonergic drugs (Trazodone)

60
Q

Preferred antidepressants for symptoms of Cognitive difficulties?

A

Selective Serotonin Reuptake Inhibitors

61
Q

The most common adverse effects of SSRIs are:

A

1) Nausea
2) Vomiting
3) Diarrhea
4) Sexual dysfunction
5) Headache
6) Insomnia
7) Withdrawal syndrome

62
Q

Citalopram and Escitalopram produce dose-dependent:

A

Prolongation of QT interval

63
Q

The most common adverse effects of TCAs (SNRIs) are:

A

1) Dose-related Anticholinergic effects:
a) Dry mouth
b) Constipation
c) Blurred vision
d) Urinary retention
e) Dizziness
f) Tachycardia
g) Memory impairment
h) Delirium

2) Weight gain
3) Sexual dysfunction
4) Orthostatic hypotension
5) Cardiac conduction delays and heart block

64
Q

TCA overdose can cause:

A

Severe cardiac arrhythmias and increased risk of death

65
Q

The most common adverse effects of Venlafaxine are:

A

1) Sexual dysfunction
2) Nausea and Vomiting
3) Dose-related increase in blood pressure
4) Dry mouth
5) Constipation
6) Decreased appetite
7) Insomnia
8) Increased sweating

Therapeutics (23 decks)

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