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60 Cards in this Set
- Front
- Back
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What are three types of depression?
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Major Depressive Disorder
Dysthymic Disorder Depressive Disorder Not Otherwise Specified |
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5 or more of the below symptoms for 2 weeks and which cause significant impairment in social, academic and occupational functioning.
*depressed mood *lack of enjoyment in pleasurable activities changes in weight changes in sleep decreased concentration thoughts of suicide psychomotor agitation or retardation fatigue or lack of energy feelings of worthlessness or excessive guilt |
Major Depressive Episode
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Depressed mood for more days than not for at least 2 years. While depressed patient must have 2 or more of the following:
-poor appetite or overeating -insomnia or hypersomnia -low energy or fatigue -low self-esteem -poor concentration or difficulty making decisions -feelings of hopelessness |
Dysthymia
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It can take up to six months to diagnose this?
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Dysthymia
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This drug can induce depression at high doses?
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Propranolol
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These two drugs can cause episodes of acute depression in patients.
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Interferon and Steroids
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What drugs in general can induce depression?
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propranolol
interferon steroids benzodiazepines clonidine opiates barbiturates |
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What diseases can induce depression?
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hyperthyroidism
hypothyroidism chronic pain drug toxicity and withdrawal metabolic disorders |
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What is a two question screener for depression?
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During the last month have you been down, depressed or hopeless?
During the last month have you had little interest or pleasure in doing things? A positive response to either suggests that a more thorough psychiatric evaluation should be conducted |
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Effective as monotherapy for mild depression
perhaps moderate depression though data is controversial. Useful in moderate to severe depression when added to medication, especially in patients with psychosocial stressors, Axis II disorders, or interpersonal difficulties. Benefit in geriatric depression over pharmacotherapy is contradictory.1,2 |
Cognitive Behavioral Therapy and Interpersonal Therapy have both been shown to be effective strategies.
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The following drugs belong to what class?
Fluoxetine Paroxetine Sertraline Fluvoxamine Citalopram Escitalopram |
Selective Serotonin Reuptake Inhibitors
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Which SSRI is not used a lot because it is dosed twice a day and causes a lot of nausea issues.
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Lovox (fluvoxamine)
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This SSRI is not recommended in the elderly?
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Paxil
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What two SSRI's have the highest rate of diarrhea?
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Sertraline
Fluoxetine |
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What SSRI has the lowest rate of diarrhea?
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Fluvoxamine
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What two SSRI's has the highest rate of nausea/vomiting?
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Fluvoxamine
Paroxatine |
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What SSRI has the lowest rate rate of nausea/vomiting?
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fluoxetine
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What two SSRI's have the highest rate of headache?
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Sertraline
Paroxetine |
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What SSRI hast he lowest incidence of headache?
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escitalopram
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What two SSRIs have the highest rate of somnolence?
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Fluvoxamine
Citalopram |
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What SSRI has a low rate of somnolence?
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Escitalopram
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Which SSRI has the highest rate of sexual dysfunction as a side effect?
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Paxil-Paroxetine
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What SSRI can have the highest risk of weight gain?
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Paxil-Paroxetine
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If a patient is not going to have good compliance, what SSRI should you avoid giving?
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Paxil and Luvox
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What two SSRI's have the worst withdrawal syndrome?
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Fluvoxamine
Paroxetine |
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This drug can kill a patient if the patient is taking a lot of other drugs that use CYP 450 2D6?
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Paroxetine-Paxil
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This is a good SSRI to use if a patient is taking a lot of drugs?
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Citalopram and Escitalopram - both have weak inhibition of 2D6
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Minimum anti-depressant therapy is how long? And what do you do when you are taking a patient off of an anti-depressant?
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Minimum anti-depressant therapy is six months. If taking a patient off of a drug, reduce dose by 1/8th of dose each week.
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Pharmacology
serotonin and NE reuptake pump inhibitor 5HT2 receptor blocker other receptor effects moderate antihistaminic and anticholinergic effects Drug interactions dynamic serotonin syndrome risk with proserotonergic medications Kinetic Potent inhibitor of CYP450 3A4 |
Nefazodone
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What are the adverse effects of nafazodone?
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Adverse effects
sedation nausea headache Other effects hepatotoxicity promoter of good sleep |
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Pharmacology
alpha 2 blocker 5HT2 and 5HT3 blocker other receptor effects histamine1 blocker muscarinic 1 blocker Drug interactions dynamic serotonin syndrome, hypertensive crisis kinetic uses multiple pathways for metabolism not an inducer or an inhibitor |
Mirtazapine
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What are the adverse effects of Mirtazapine
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Adverse effects
sedation weight gain dry mouth constipation Other effects hyperglycemia hypertriglyceridemia, hypercholesterolemia agranulocytosis antiemetic |
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What do you have to monitor closely with nefazodone?
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Hepatotoxicity
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With SSRI's you need to monitor this every year?
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LFT's
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This drug is actually used as an anti-emetic, so if a patient is nauseous on other anti-depressants this can be a good option?
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Mirtazapine
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You should avoid this anti-depressant in diabetics?
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Mirtazapine
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This drug can be used in adults with ADHD and depression?
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Venlafaxine
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This drug can possibly cause serotonin syndrome and hypertensive crisis.
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Venlafaxine
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Everytime this anti-depressant is increased in dosage you have to measure BP a week later. BP increase is dose dependent.
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Venlafaxine
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What causes sexual dysfunction with anti-depressants?
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Seratonin 2 over stimulation
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This is a good antidepressant if you know that you have a patient that also needs norepinephrine, as in a patient who has neuropathic pain etc.
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Duloxetine
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If a patient is suffering from neuropathic pain and/or hepatitis C this would be a good antidepressant?
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Duloxetine
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This is the only non seratonin drug for depression?
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Bupropion
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You do not want to use this as an anti-depressant in a patient who has comorbid anxiety.
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Bupropion
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If a patient has baseline seizure disorder, you have to be extraordinarily careful with this drug?
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Bupropion
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Pharmacology
Blocks the reuptake of serotonin and NE Drug interactions dynamic serotonin syndrome, hypertensive crisis kinetic metabolized by CYP450 1A2 and 2D6 Moderate inhibitor of CYP 450 2D6 |
Duloxetine
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Adverse effects
headache nausea sex dysfunction Insomnia Urinary hesitation Other effects Very mild HR and BP increases Effective for neuropathy Possibly hepatotoxic (case reports have been published in patients with concurrent chronic alcohol dependence) |
Duloxetine
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Pharmacology
dopamine and norepinephrine reuptake pump inhibitors Drug interactions dynamic alpha 1 blockers (terazosin), dopamine blockers kinetic metabolized by CYP 450 2B6 to an active metabolite Mild to moderate inhibitor of 2D6 |
Bupropion
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Adverse effects
Agitation Insomnia Irritability Dry mouth Nausea Tachycardia Other effects Seizures-Results in dosing limits: IR 150mg TID SR 200mg BID XL 450mg QD promotes smoking cessation useful for drug induced sexual dysfunction |
Bupropion
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Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, and others.
Pharmacology inhibitor of serotonin and norepinephrine reuptake pumps other effects muscarinic, histamine 1, alpha 1 antagonism |
TCAs
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Adverse effects
constipation blurred vision sedation dry mouth headache sex dysfunction Other effects photosensitivity lowers seizure threshold cognitive impairment orthostasis hyperglycemia arrhythmias tachycardia deadly in overdose (one weeks worth of med) |
TCAs
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Monoamine oxidase inhibitor (MAOI).
Works in the CNS but does not effect GI located monoamine oxidase (MO). Avoidance of GI located (MO) allows the GI tract to still break down dietary tyramine before it is allowed into the blood stream. Therefore, selegiline patch is safer than other, older MAOIs. |
Selegiline Transdermal
EMSAM patch |
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Restlessness, akathisia, tremor, hypomania, confusion, hyperreflexia, myoclonus, diaphoresis, hyperthermia.
May cause death through anoxia, aspiration, or multiple organ failure. Symptoms will occur within hours. Resolves after 24 hours once the proserotonergic agents are stopped. |
Serotonin Syndrome
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You can treat seratonin syndrome how?
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Can treat with the 5-HT antagonist cyproheptadine 4 mg prn.
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This has a greater risk of causing seratonin syndrome more than SSRIs or Efexor?
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Mirtazipine
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What anti-depressants do you use in pregnancy?
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Sertraline and Citalopram
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What is important when treating an adolescent for depression?
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Monitor them very closely and see them every week for the first four weeks. Risk of suicidality is very high in adolescence.
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What anti-depressants are most likely safe for breast feeding?
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Sertraline and paroxetine have negligible levels in breast milk. Probably safest.
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What are two possible non-therapeutic options for depression?
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SAMe
Necessary for appropriate cell functioning. Folic Acid L-methylfolate 7.5-15mg a day. Requirement for the formation of SAMe. Shown value in the acute phase Long term data has not always shown benefit. |
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What is the primary treatment algorithm for depression?
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Meet with pt after 10-14 days to assess tolerability.
Meet in 4 weeks to assess efficacy. Meet 2 weeks later to measure maximal response. Meet every month for next 4-9 months during continuation phase. |
