Therap Final: Depression

Front 1

what is the precursor of 5HT?

Back 1

tryptophan

Front 2

what is the precursor of NE?

Back 2

tyrosine

Front 3

how do antidepressants work? (MOAs) (5)

Back 3

1. block alpha 2 on pre synaptic
2. block NE reuptake
3. activate alpha 1 on post syn
4. activate beta 1 on post syn
5. prevent NE breakdown

Front 4

_____ 5HT1a, 1b, 1d (autoRc) on ___ synaptic

(activate / inhibit) (pre / post)

Back 4

inhibit 5HT1a, 1b, 1d (autoRc) on pre synaptic

Front 5

_____ 5HT1a on ___ synaptic

(activate / inhibit) (pre / post)

Back 5

activate 5HT1a on post synaptic

Front 6

_____ 5HT2a on ___ synaptic

(activate / inhibit) (pre / post)

Back 6

inhibit 5HT2a on post syn

Front 7

name the DSM 4 depression criteria (9)

Back 7

D SIG E CAPS
1. depressed mood
2. sleep
3. interest
4. guilt
5. energy
6. concentration
7. appetite
8. psychomotor
9. suicidal ideation

Front 8

___/+ Sx must be present during the ___ __ (#) wk period & at least 1 of those Sx must be _____ ____ or loss of _____ to be considered depression

Back 8

5/+ Sx must be present during the SAME 2 wk period @ at least 1 of those Sx must be DEPRESSED MOOD or loss of PLEASURE/INTEREST to be considered depression

Front 9

what must you always ask a PT about when Dxing depression?

Back 9

suicidal ideation

Front 10

what are the stages of depression, how long does each last, what is the goal of each stage? (3)

Back 10

1. acute; 6-10 wks; remission
2. continuation; 4-9 mo after remission achieved; recovery (eliminate residual Sx & prevent relapse)
3. maintenace; at least 12-36 mo; prevent recurrence

Front 11

if you have
1 episode Tx lasts __ (#) yr
2 episode Tx lasts __ (#) yr
3 episode Tx lasts __ (#) yr

Back 11

1 episode Tx lasts 1 yr
2 episode Tx lasts 1.5 yr
3 episode Tx lasts the rest of your life bc will have recurrent episodes

Front 12

you relapse faster if you don't go thru which phase? (acute/continuation/maintenace)

Back 12

continuation

Front 13

how many shots do you have at achieving remission?

Back 13

2, the first 2

Front 14

antidepressant trials last at least __ (#) wks bc it sometimes takes longer to reach remission

Back 14

at least 8 wks

Front 15

T/F The preferred goal of treatment is to achieve at least partial remission.

Back 15

False. goal is to achieve remission bc partial remission will relapse unless 1) augment w/ med w/ diff MOA 2) inc dose 3) switch agent

Front 16

For most antidepressants if they aren't working you switch to a drug with a diff MOA, all except which class?

Back 16

SSRI

Front 17

what are some non pharmacologic options for depression? (5)

Back 17

1. psychotherapy (cognitive behavioral therapy, interpersonal psychotherapy)
2. light therapy (Vit D)
3. herbal meds (St John's Wort)
4. Vagus Nerve Stimulation Therapy (L vagus nerve, alters NE release)
5. Electroconvulsive therapy (severe/psychotic suicidal)

usually used in combo

Front 18

What are some advantages & disadvantages of electroconvulsive therapy?

Back 18

(+) very effective, most effective agent for Txing dep
(+)can use on pregos

(-) high relapse rates
(-) many SE/AE

Front 19

T/F MAOIs are first line antidepressants

Back 19

F. MAOIs should be reserved for PTs that have failed other TXs

Front 20

What is the most impt thing to consider when choosing 1st line meds?

Back 20

SE

Front 21

T/F tertiary amines have more anticholinergic SE than secondary amines

Back 21

True

Front 22

which tertiary amine also treats OCD?

Back 22

clomipramine (anafranil). it's also the best TCA for dep but not Rx'd much bc SE

Front 23

amoxapine is a TCA that has anti ______ props

Back 23

anti psychotic props

Front 24

TCA MOA?

Back 24

inhibit 5HT & NE reuptake

Front 25

T/F TCAs are considered first line antidepressants

Back 25

False too many SE

Front 26

which SSRI at high doses causes antichol SE? which population is it esp problematic for?

Back 26

paroxetine (paxil); HIV PTs on ritonavir

Front 27

which SSRI causes wt gain?

Back 27

citalopram (celexa); affinity for H1 Rc --> wt gain & sedation

Front 28

what is the S enantiomer of celexa? Is it better tolerated than celexa?

Back 28

Escitalopram (lexapro). Yes it's better tolerated than celexa bc less SE, dec drug interaxns, & 0 interaxns w/ HIV protease inhs

Front 29

how long is the wash out period if you're switching from SSRI to MAOI?

Back 29

5 wks

Front 30

which SSRI has the longest t1/2?

Back 30

fluoxetine (prozac)

Front 31

which SSRI used to TX OCD? (it's been D/C in US)

Back 31

fluvoxamine

Front 32

what SE is common among SNRI?

Back 32

1. nausea
2. dose related HTN
3. inc HR

Front 33

what else does cymbalta TX other than depression?

Back 33

DM neuropathy

Front 34

what is a SE of cymbalta?

Back 34

inc LFTs

Front 35

which has more BP effects effexor or pristiq?

Back 35

pristiq

Front 36

which drug is the most tolerable, good for seasonal affective disorder, has the least amt of sexual SE, but isn't good for PTs w/ Hx of seizures or already have sleeping issues bc it can cause insomnia?
a. venlafaxine (effexor)
b. trazodone (desyrel)
c. bupropion (wellbutrin)
d. fluoxetine (prozac)

Back 36

c. bupropion (wellbutrin)

most tolerable, good for seasonal affective disorder, has the least amt of sexual SE, but isn't good for PTs w/ Hx of seizures or already have sleeping issues bc it can cause insomnia

Front 37

MOA of 5HT modulators:

Back 37

inhibit 5HT2a post syn

Front 38

[Trazodone (Desyrel) / Nefazodone (Serzone)] has helped w/ psychotic depression, but also causes hepatotoxicity.

Back 38

Nefazodone (Serzone)

has helped w/ psychotic depression, but also causes hepatotoxicity.

Front 39

mirtazapine (remeron) acts at 3 locations

Back 39

1. inhibits alpha 2 on pre syn
2. inhibits 5HT2a on post syn
3. inhibit 5HT3

Front 40

SE of mirtazapine include:

Back 40

1. wt gain
2. sedation

but it prevents nausea

Front 41

matching:
1. psychotic dep
2. substance abuse
3. narcolepsy


a. modafinil
b. lamotrigine
c. Lithium
d. buspirone
e.aripiprazole

Back 41

c. Li 1. psychotic dep
d. buspirone 2. substance abuse
a. modafinil 3. narcolepsy

Front 42

when using combo therapy for TXing dep, you should use 2 drugs with (same/diff) MOA and use the (partial/full) doses of each

Back 42

when using combo therapy for TXing dep, you should use 2 drugs with DIFF MOA and use the FULL doses of each

Front 43

how long does it typically take before you see any effects of anti depressants?

Back 43

2-4 wks

Front 44

how long does it typically take for remission to occur?

Back 44

4-8 wks

Front 45

_____ Sx improve before _____ Sx

(cognitive, vegetative)

Back 45

VEGETATIVE Sx improve before COGNITIVE Sx

Front 46

T/F Antipsychotics are an appropriate TX option for major depression

Back 46

False. Don't use anti psychs for major dep

Front 47

T/F Antidepressants are considered very unsafe for children & adolescents bc it causes suicidal ideation

Back 47

True black box warning for children & adolescents

Front 48

which types of anti deps cause anticholinergic SE? (3)

Back 48

1. TCAs
2. MAOIs
3. paroxtine at high doses

TX w/ increased fluids & fiber, dec dose, switch agent

Front 49

which anti deps (classes) have CV SE?
arrhythmias (1), orthostatic hypotension (3), HTN (2)

Back 49

arrhythmias
1. TCAs
orthostatic hypotension
1. TCAs
2. MAOIs
3. 5HT modulators (nefazodone mild)
HTN
1. SNRIs (dose related)
2. MAOIs w/ inc ingestion of tyramine foods --> HTN crisis

Front 50

which anti deps cause wt gain?
short term? long term?

Back 50

short term wt gain (2-5 lb/wk)
1. TCAs
2. mirtazapine
long term wt gain (20-40 lbs)
1. SSRIs

Tx: avoid/switch agent

Front 51

which drugs cause GU SE?

Back 51

ED:
1. TCAs
2. MAOIs, paroxetine, trazodone
Priapism (nonsexual erection):
1. trazodone
retrograde ejaculation:
1. alpha blockers
anorgasmia (inability to orgasm):
1. TCAs
2. MAOIs
3. SSRIs (paroxetine)

Front 52

which drugs have hepatic SE?

Back 52

1. TCAs
2. MAOIs
3. Nefazodone (black box hepatotoxicity)
(4. duloxetine inc LFTs)

Front 53

which drugs have neurologic SE?

Back 53

seizures
1. TCAs
2. bupropion

5HT syndrome
1. TCAs
2. MAOIs
3. SSRIs
4. venlafaxine, duloxetine, nefazodone, trazodone

sleepiness:
1. TCAs
2. trazodone
3. nefazodone
4. mirtazapine

insomnia
1. MAOIs
2. SSRIs
3. venlafaxine
4. duloxetine
5. bupropion

Front 54

which cause GI SE? (mainly nausea) (6)

Back 54

1. TCAs
2. MAOIs
3. SSRIs
4. venlafaxine
5. duloxetine
6. nefazodone

TX: take w/ food; wait/slow titration; dec dose; switch agent to H2 antag or 5HT3 antag (mirtazapine)

Front 55

which cause dermatologic SE?

Back 55

rash:
bupropion (high dose >300mg QD)

TX: switch med; dec dose

Front 56

what pregnancy category are all anti deps? what are the exceptions & their respective preg cat?

Back 56

1. all preg cat C
2. paroxetine & some TCAs -- D

Front 57

When do you most often see discontinuation syndrome?

Back 57

w/ paroxetine & SNRIs (sometimes TCAS & SSRIs NOT fluoxetine)

Front 58

how do you avoid D/C syndrome?

Back 58

taper gradually

Front 59

Jack has been taking Effexor for 1 yr. His sister Jill has been on Paroxetine for 5 yrs. Their dr has decided that neither of them need to be on anti depressants anymore. Would they both be tapered off for the same amt of time?

Back 59

No. Jill needs to be tapered for a longer period more slowly bc she was on it longer.

Front 60

Which class do these drugs belong to?
1. fluoxetine (prozac)
2. sertraline (zoloft)
3. paroxetine (paxil)
4. citalopram (celexa)
5. escitalopram (lexapro)
6. fluvoxamine

Back 60

SSRI

Front 61

Name the class:
1. amitriptyline
2. clomipramine
3. doxepin
4. imipramine

Back 61

TCA

Front 62

Name the class:
1. venlafaxine (effexor)
2. desvenlafaxine (pristiq)
3. duloxetine (cymbalta)

Back 62

SNRI

Front 63

Name the class:
1. bupropion (wellbutrin)

Back 63

Dpa/NE reuptake inh

Front 64

Name the class:
1. trazodone (desyrel)
2. nefazodone (serzone)

Back 64

5HT modulators

Front 65

Name the class:
1. mirtazapine (remeron)

Back 65

5HT/NE modulator

Front 66

Matching:
1. mirtazapine a. SSRI
2. venlafaxine b. SNRI
3. sertraline c. MAO I
4. bupropion d. Dpa/NERI
e. 5HT/NE modulator

Back 66

e. 5HT/NE modulator 1. mirtazapine
b. SNRI 2. venlafaxine
a. SSRI 3. sertraline
d. Dpa/NE RI 4. bupropion

Front 67

Matching:
1. clomipramine
2. trazodone
3. duloxetine
4. escitalopram

a. TCA
b. SSRI
c. SNRI
d. 5HT modulator
e. 5HT/NE modulator

Back 67

a. TCA 1. clomipramine
d. 5HT modulator 2. trazodone
c. SNRI 3. duloxetine
b. SSRI 4. escitalopram