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57 Cards in this Set
- Front
- Back
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Serotonin Syndrome |
Serotonin Syndrome |
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SSRI Withdrawal
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SSRI Withdrawal |
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SSRI Withdrawal Sx
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SSRI Withdrawal Sx: |
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Paroxetine = Paxil
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Paroxetine = Paxil |
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FDA-Approved Indications
• Mirtazapine = Remeron |
Mirtazapine = Remeron
– Depression |
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FDA-Approved Indications for Bupropion = Wellbutrin
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Bupropion = Wellbutrin
– Depression, smoking cessation (Zybn) – “Its claim to fame is no sexual side effects.” |
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FDA-Approved Indications for Venlafaxine = Effexor |
Venlafaxine = |
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FDA-Approved Indications for
Duloxetine = Cymbalta |
Duloxetine = Cymbalta
– Depression – Pain of diabetic peripheral neuropathy |
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Fibromyalgia FDA-Approved Agents
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Fibromyalgia FDA-Approved Agents
• Pregabalin (Lyrica) – GABA analog • Duloxetine (Cymbalta) – SNRI • Milnacipran (Savella) – SNRI |
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1st Line Antidepressants
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1st Line Antidepressants
SSRIs |
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SSRI’s |
SSRI’s: |
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Sertraline = Zoloft
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Sertraline + Zoloft AE’s:
o Insomnia o GI AE’s o $15-20/month |
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Fluoxetine = Prozac
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Fluoxetine = Prozac
o |
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5 ANTIDEPRESSANT CLASSES
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Antidepressant Classes
1) Tricyclic antidepressants (TCAs) 2) Monoamine oxidase inhibitors (MAOIs) 3) Selective 5-HT reuptake inhibition (SSRIs) 4) Miscellaneous – newer non-SSRI agents 5) Serotonin/NE reuptake inhibitor (SNRI) |
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Prozac (fluoxetine)
(from Nikki) |
Prozac (fluoxetine):
• Increased energy • Increased anxiety? • Insomnia • Decreased appetite • Prozac weekly = Sarafem |
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Paxil (parexetine)
(from Nikki) |
Paxil:
• Increased weight • Sedation (with Paxil, relax & packs the wt on) |
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Celexa (citalopram)
(from Nikki) |
Celexa (citalopram):
• Good for elderly • Few drug interactions |
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Celexa (citalopram)
(from Nikki) |
Celexa (citalopram):
• Good for elderly • Few drug interactions Imagine an old person in a pram |
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Lexapro (escitalopram)
(from Nikki) |
Lexipro (escitalopram) |
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Luvox (fluvoxamine)
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Luvox (fluvoxamine):
• “Old”, per Nikki • Clarens uses for OCD & Social anxiety (pretend to have flu and/or ox due to social anXiety) |
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SNRI list
(from Clarens) |
SNRI list
• Effexor (venlaxafine) • Pristiq (desvenlafaxiene) $$$ • Cymbalta (duloxetine) $$$ • Mirtazapine (Remeron) |
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Cymbalta is also approved for --
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Cymbalta is also approved for --
• Diabetic neuropathy • Fibromyalgia |
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Wellbutrin
(from Nikki) |
Wellbutrin |
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Remeron
(from Nikki) |
Wellbutrin
• Increased anxiety • Tremor • Insomnia • May decrease sz threshold |
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Mood Stabilizer list
(from Nikki) |
Mood Stabilizer list:
1) Depakote (divalproex sodium) 2) Tegretol (carbamazepine) 3) Trileptal (oxcarbazepine) 4) Lamicatal (Lamotrigine) 5) Topamax (topirimate) |
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Depakote (divalproex Na+) labs
(from Epocrates) |
Depakote (divalproex sodium) monitoring:
• LFTs @ baseline & then frequently, esp in 1st 6 mos • Platelet & coag levels @ baseline & periodically • Before planned surgeries • Serum levels • Ammonia |
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Tegretol (carbamazepine) labs
(from Epocrates) |
Tegretol (carbamazepine) monitoring:
• At baseline, then periodically: Creat, CBC,BUN, LFTs, lipids, plt, reticulocytes, iron, opthal. • Serum levels |
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Trileptal (oxcarbazepine) labs
(from Epocrates) |
Trileptal (oxcarbazepine) monitoring:
• Creat at baseline • Sodium |
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Lamictal (Lamotrigine) labs
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Lamicatal (Lamotrigine) labs
• Creatinine at baseline • Opthal exams if long-term tx |
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Topamax (topiramate) monitoring
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Neuroleptic (antipsychotic) list:
• Seroquel = quetiapine $$$ • Zyprexia = olanzapine $$$ • Risperdal = risperidone $$$ • Geodon = ziprasidone • Abilify = aripiprazole |
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Seroquel $, Zyprexia$, Risperdal $AE
(from Nikki) |
Seroquel, Zyprexia, Risperdal AE:
• Weight gain • Sedation Think: need $$ for groc but too tired to work for a RSZ (raise). |
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How Geodon & Abilify compare to Seroquel, Zyprexia, & Risperdal
(from Nikki) |
Geodon & Abilify are:
• Wt neutral • Less sedating |
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Abilify: start on low dose because -
(from Nikki) |
Abilify: |
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Lithium (Eskalith)
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Lithium (Eskalith): |
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Lithium drug levels daily if:
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Lithium drug levels daily if:
Dehydration On ACE or diuretic Significant renal dz Na+ depletion Severe debilitation Cardiovascular dz |
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FDA-approved indications for Bupopion (Wellbutrin)
(From Clarens) |
Bupopion (Wellbutrin)
• Depression, smoking cessation (Zyban) • “It’s claim to fame is no sexual side effects” |
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FDA-approved indications for
Venlaxaine (Effexor) (From Clarens) |
Venlaxafine (Effexor):
• Depression • SAD (ER caps) • GAD (ER caps) generized anxiety disorder “If SSRI doesn’t work, going to Venlaxafine won’t helps. • NEED TO MONITOR BP with pts on Venlaxafine (Venlaxafine is EFFEctive & works FINE VEN (when) you have SAD OR GAD but is LAX to help VEN other SSRIs don’t work. |
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FDA-approved indications for Cymbalta (duloxetine)
(From Clarens) |
FDA-approved indications for Cymbalta (duloxetine): |
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FDA-Approved Fibromyalgia Agents
(From Clarens) |
FDA-approved fibromyalgia agents:
• Cymbalta (duloexetine) – SNRI • Milnacipran (Savella) – SNRI • Pregabalin (Lyrica) GABA analog Pregabalin (lyrica) Pam Bell gabbing & singing lyrics Cymbalta – Pam is also playing cymbals Savella – saving Pam Bell from fibro pain |
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Seratonin Syndrome
(class notes) |
Seratonin syndrome: Clinical triad but not consistently present in all pts:
1) Mental status changes 2) Autonomic hyperactivity 3) Neuromuscular abnormalities |
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SSRI Withdrawal
(class notes) |
SSRI Withdrawal:
• ANY SSRI. “This is true with any anti-depressant.” • Fluoxetine has the least w/d due to long t½ • Paxil(paroxetine) “more frequent & severe than other SSRIs • “NEVER ABRUPTLY STOP PAROXETINE IF YOU CAN HELP IT.” (Paxil Packs a Punch when stoPPed) |
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SSRI Withdrawal Sx
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SSRI withdrawal Sx:
• Agitation, anxiety, anorexia • Confusion, impaired coordination • Diarrhea • h/a, insomnia, sensory disturbances • sweating, tremor, emesis • SHOCK-LIKE SENSATIONS & flu-like illness |
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Paxil = paroxetine
(From Clarens) |
Paxil = paroxetine
• Mildly sedating/calming • Mildly anti-cholinergic • More wt gain, sexual effects & w/d sx than other SSRIs (Packing on pounds & no money for groc due to too sedated/tired to work with the pair of ox) |
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FDA –approved indications for Remaron = mirtazapine
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FDA-approved indication for Remaron = mirtazapine:
• Depression Myrtle felt depressed because doc/PA gave her the run-around when she asked for mirtazapine, since he had never heard of it before. |
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TCA Mechanism of Action
(From Clarens) |
TCA mechanism of action:
Combined NE & serotonin reuptake inhibition |
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Olanzapine (Zyprexa) & FLuoxetine (Prozac) = Symbyax for Bipolar
(From Clarens) |
Olanzapine (Zyprexa) & FLuoxetine (Prozac) = Symbyax for Bipolar:
Better than placebo or olanzapine alone. |
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Antidepressant Cautions/Warnings in Pregnancy
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Antidepressant Cautions/Warnings in Pregnancy
Category C – Sertaline (Zoloft), fluoxetine (Prozac), citalopram (Cylexa). Use only when clearly needed. Category D – paroxetine (Paxil) “teratongenci effects). The poor baby’s face looks like a pair of ox. |
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Neonatal w/d syndrome
(From Clarens) |
Neonatal w/d syndrome:
• SSRIs before delivery • Irritability • Sz due to neonatal w/d |
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Antidepressant Cautions/Warnings in Lactation
(From Clarens) |
Antidepressant Cautions/Warnings in Lactation:
• “Unknown, really.” • Fluoxetine, paroxetine, citalopram (Celexa) are excreted in breast milk. • Setraline (Zoloft) – unkown. (Certainly, don’t leave baby in za (the) loft). |
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Patient Education (classnotes)
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Patient education:
• 1st sx to improve are physical signs • Disturbed sleep • Appetite • Agitation Fatigue |
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Patient Education (classnotes)
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Patient Education:
• 2nd to improve are pysch sx: • poor concentration, apathy, etc • "Might take 2-3 mos" |
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1st Line Antidepressants
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1st Line Antidepressants:
SSRIs |
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Superior Efficacy
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Superior efficacy:
1. Escalopram (Lexapro) 2. Sertraline (Zoloft) $15-$20/month |
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Phases of Tx
(From Clarens) |
Phases of Tx:
1. Acute phase lasting 6-10 wks: Goal is remission. 2. Continuation phase lasting 4-9 mos after remission is achieved. Goal is elimination or residual sx or prevent relapse. 3. Maintenance phase lasting at least 12-36 mos. Goal is to prevent recurrence. |
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Drugs with higher incidence of w/d
(From Clarens) |
Drugs with higher incidence of w/d:
• Paroxetine (Paxil) • Venlaxafine (Effexor) (think Ex-Lax) |
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Bipolar Rx
(From Clarens) |
Bipolar Rx:
• Lithium is antimanic (added to antidepressants, not monotx) • Lamotrigine (Lamictal) o Augmenting agent for MDD o Treats/prevents depressive relapse • Other mood stabilizers o Valproic acid, divalproax, caramazepine |
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Atypical anti-psychotics
(From Clarens) |
Atypical antipsychotics:
• Olanzapine = Zyprexa • Risperidone = Risperdal |
