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Therapeutics 2 > Week 3: Depression/anxiety/insomnia > Flashcards

Week 3: Depression/anxiety/insomnia Flashcards

1
Q

What screening tool would you use to asses for depressive symptoms during pregnancy?

A

The Edinburgh Postnatal Depression Scale (EPDS)

can be used during pregnancy and postpartum

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2
Q

What is a quick alternative to the PHQ9 scale?

A

Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16) is a widely used alternative to the PHQ-9.

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3
Q

with antidepressants when would you see early improvement?

A

early improvement is noticed at the 2 week mark, and common unwanted side effects usually subside after 2 weeks

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4
Q

Please list 6 SSRI

A
  1. Citalopram
  2. Escitalopram
  3. Fluoxetine (prozac)
  4. Fluvoxamine (Luvox)
  5. Paroxetine
  6. Setraline (zoloft)
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5
Q

What medication classes are used to treat depression

A

First line
SSRI
SNRI
Novel ACtion
Bupropion (wellbutrin)
Mitrazapine (Remerson)
RIMA (reversible monoamine oxidase inhibitor)

Second line
Trazadone
Moclobemide

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6
Q

What SSRI can treat both anxiety and depression, and which one is BEST for both>

A
  1. Cipralex (escitalopram) - best
  2. Paroxetine
  3. Setraline
  4. Effexor
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7
Q

please list X3 SNRI that are used to treat depression

A
  1. Desvenlafaxine (pristiq)
  2. Duloxetine (Cymbalta)
  3. Venalafaxine
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8
Q

Second line medications for depression are Tricyclic antidepressants, please list them

A
  1. Amitriptyline
  2. Clomipramine
  3. Desipramine
  4. Imipramine
  5. Nortriptyline
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9
Q

What class of medication is Duloxetine (Cymbalta) and what does it treat?

A

SNRI

and used to treat depression

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10
Q

What class of medication is paroxetine, and what does it treat?

A

Paroxetine is an SSRI that can treat both depression, anxiety,OCD, and panic disorder

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11
Q

What class of medication is Fluvoxamine?

A

SSRI that treats depression and depression

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12
Q

What class of medication is Fluoxetine (Prozac)

A

SSRI and it treats:

Depression
OCD
and bulimia

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13
Q

What is your first line treatment for severe depression in comparision to mild to moderate depression?

A

first line is pharmacotherapy for severe
Mild to moderate psychotherapy is first line

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14
Q

If you were to start antidepressant tx during pregnancy, what dosing would you use?

A

the lowest effective dose

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15
Q

if antidepressants are indicated during pregnancy, what are your first line?

A

Generally SSRI are not major teratogens, first line would be:
- citalopram
- escitalopram
- setraline

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16
Q

What SSRI are second line options during pregnancy and why?

A

Fluoxetine and paroxetine are second line as they are both associated with risk for major malformations

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17
Q

Would you start a pregnant person on MAOIs or Doxepin?

A

no please avoide during pregnancy

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18
Q

Jane has just started taking Escatilopram for her depression, it has been 3 weeks and she hasnt improved what would you do next?

A

you have options you can:

  • switch her to another first class
  • ADD another pharmacotherapy
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19
Q

Jane has been taking Effexor for X2.5 weeks for her depression and has not seen an improvement, she was previously on Escatilopram and also did not see an improvement.

What would you do next?

A

Effexor is an SNRI and Escatilopram is an SSRI, both are first line treatments for depression

You can ADD a pharmacotherapy
OR since you have tried two medications that are both first class you can try a second class medication

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20
Q

What are the symptoms of serotonin syndrome and which class of drugs are most likley to induce this?

A

Serotonin syndrome (dilated pupils, hyperreflexia, sweating, fever, agitation, nystagmus, clonus, delirium)

STOP THE MEDS

often its MAIO

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21
Q

What is antidepressant discontinuation syndrome ?

A

This occurs when patients rapidly discontinue or reduce the dose of their antidepressant, often an SSRI

Worse with meds like paroxetine and venlafaxine

These symptoms include:
anxiety, crying, headache, increased dreaming, insomnia, irritability, myoclonus, nausea, electric shocks, tremor, flulike symptoms, imbalance and sensory disturbance.

22
Q

How can you reduce the risk of a patient developing antidepressant dicontinuation syndrome?

A

Taper antidepressant doses gradually by approximately 25% per week and monitor for a re-emergence of depressive symptoms

taper slowly over 4–6 weeks. This is particularly important for paroxetine and venlafaxine.

23
Q

IF you just start a patient on an antidepressant how long should you keep them on?

A

at least 9 months to prevent a remission, ifthey have complex psych co-morbidities then at least 2 years

24
Q

What is Treatment Resistant Depression?

A

failure to respond after 2 or more treatments

25
Q

True or false

A combination of pharmacotherapy and psychotherapy is superior to either modality alone?

A

True

26
Q

would you use benzodiazepines to treat depression?

A

no

In general, benzodiazepines are not recommended in the management of depression due to concerns about dose escalation and dependence. On the other hand, there may be a role in the initial phase of treatment in the acutely agitated patient or during drug discontinuation.

27
Q

When would you refer your patient to psych?

A

Refer for psychiatric consultation if the patient has psychotic symptoms or acute suicidal ideation, or after failure of 3 treatment trials.

28
Q

true or false?

A washout period usually is not necessary when switching between most antidepressants (except to and from MAOIs).

A

true

Therefore, the second antidepressant can usually be started at low dose while tapering off the first antidepressant (the X approach).

29
Q

What re the indications for Trazadone?

A

Depression, used by some to treat agressive disorders and cocaine withdrawl

30
Q

What are some side effects of Trazadone?

A

Rash, HTN, Tachycardoia, decreased appetite, severe daytime sedation

31
Q

Is breastfeeding contraindicated with an antidepressant treatment?

A

no

32
Q

What are your first line treatments for elderly antidepressants

A
33
Q

if a patient is taking Citalopram or Escitalopram you should avoid combination with what drugs?

A
  • Any that increases QT interval
  • Linezolid
  • MAO
    -Pimozide
  • Moclobemide
33
Q

if a patient is taking Citalopram or Escitalopram you should avoid combination with what drugs?

A
  • Any that increases QT interval
  • Linezolid
  • MAO
    -Pimozide
  • Moclobemide
34
Q

What is the difference between the X approach, and the V approach to tapering off antidepressants?

A

In the X approach you can start a low dose of the second antidepressant while tapering off the first antidepressant

in patients who appear sensitive to side effects, you can do the V approach which is where you taper off the first antidepressant before starting the second

35
Q

When should you refer patients to a psychiatrist

A
  • patients who fail to achieve remission
  • pts who experience psychosis
  • pts who fail to eat or drink
  • patients who have other comorbid psych illness
36
Q

What is the Sad person scale?

A

3 to 4: Close follow-up; consider hospitalization
5 to 6: Strongly consider hospitalization, depession
7 to 10: Hospitalize or referral to psych

37
Q

John has depression and wants to start taking St. Johns Warts, would you advise this?

A

there is evidence to support St. Johns Worts as an effective first line monotherapy treatment for patients with mild-moderate depression

it induces CYP3A4 AN CAN DECREASE THE BIOAVAILABILITY OF OTHER DRUGS

you must avoid this with SSRI. only use mono therapy

38
Q

if you started john on an antidepressant and 2 weeks later he says he is not improving what would you do?

A

CANMAT recommends increasing the antidepressant dose for non-improvers at 2 to 4 weeks if the medication is tolerated and switching to another antidepressant if tolerability is a problem” (Kennedy, 2016, p. 11)

39
Q

How can you diagnose insomina

A

Sleep disturbance causes distress/impairment of functioning AND occurs at least:

  • 3X/week
  • for at least 3 months and is not substance related

if symptoms last less than 3 months it is acute insomnia

40
Q

What is the first line treatment for insomnia?

A
  1. non pharm (CBT)
    2nd line: OTC meds like melatonin or diphenhydramine

if those both fail then “Z drugs” and X4 Benzodiazepines

41
Q

what Z drugs are indicated for insomnia, what should we look out for?

A

1.eszopiclone
2. zopiclone
3. zolpidem

Eszopiclone and Zopiclone = you cant operate a car for 12 hours

Zolpidem= only 8 hours till you can drive

42
Q

If someone is pregnant what considerations would you make to treat insomnia?

A

non pharm is not only option unfortunatley, no research on melatonin, gravel etc

43
Q

If someone is breastfeeding how can you treat their insomnia?

A

Short acting Benzodiazepines like Temazepam
OR Z- drugs appear safe

The safety of other hypnotics in breastfeeding is unknown, although trazodone is transferred to breast milk in low amounts, its not expected to affect the infant

BUT doxepin and diphenhydramine should not be used while breastfeeding

44
Q

True or false regarding insomnia treatment

The degree of daytime impairment directs the intervention: if there is an acute change in daytime functioning, a short course of hypnotics may be indicated; if the daytime impairment is mild or chronic, try a behavioural intervention (e.g., sleep restriction) first.

A

true

45
Q

What are first line treatments for OCD?

A

Nonpharm (CBT, takes 4 weeks to see results)
SSRI (takes 6 weeks to start to see results)

46
Q

What antipsychotic medications are associated with body temperature dysregulation and heat stroke?

A

2nd generation Antipsychotic

  1. Quetiapene
  2. Apiprazole
  3. Risperidone
47
Q

What class of meds is Lamotrigine? and what side effects can it cause?

A

mood stabilizer, can produce a rash, and dont take with Divalproex doubles blood level of lamotrigine

48
Q

When treating schizophrenia, are first generation antipsychotics more beneficial compared to second generation?

A

the results have been mixed and greater efficacy for SGAs has not been consistently demonstrated.​[34] No differences in effect on quality of life have been found between FGAs and SGAs

no.

49
Q

True or false

Most people who experience trauma do not go on to develop either acute stress disorder or PTSD. In the first 4 weeks following a traumatic event, psychotherapy or pharmacotherapy, including benzodiazepines, is usually not required.

A

true

50
Q

if a 70 year old patient with anxiety was taking benzodiazepines, what considerations do you need to make?

A

Elders are more likley to experience adverse CNS effects (Ataxia, fatigue) due to slow hepatic metabolism

Therefore the dose should be at least half or one third AND best choice is shorter acting

Triazolam should be avoided!

Therapeutics 2 (12 decks)

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