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25 Cards in this Set
- Front
- Back
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average age of depression onset? how much more likely are women prone to getting depression? what is depression ranked in global burden of disease? |
mid 20s 2x 4th |
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what things should you assess when a patient might have depression? what is used for diagnosis? |
family and social history DSM IV-TR or DSM 5 |
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what are the symptoms of depression? |
sig e caps sleep, intereest, guilt, energy, concentration, appetite, psychomotor sucicidal thoughts |
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what are some emotional symptoms of depression? what are some physical symptoms of depression? |
inability to feel pleasure, sadness, feeling emptiness, irritability, anxiety, thoughts of death disturbed sleep, psychomotor changes, decreased energy, fatigue, body pain |
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what are cognitive symptoms of depression? what are the atypical/pschotic sympotoms of depression? |
impaired concentration, indecisiveness, poor memory, hallucinations, delusions reactive mood, increase appetite and weight gain, hypersomnia, heavy feelings in arms and legs, sesitivity to rejection |
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how many and how long do you need the symptoms to be diagnosed? what other illnesses may be related to depression? what medications can cause symptoms of depression? |
5 symptoms for at least 2 weeks bipolar, substance abuse, anxiety, hypothyroid, anemia, cv diseased benzos, narcotics, steroids, contraceptives, isotretinoin, BB |
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how long is a depressive episode usually? if you have had 3 prior episode, how likely are you to have a fourth episode? what tool is used to determine depression? |
6 months, 90% likely PHQ-9 (patient health questionaire), good for looking at progress of treatment |
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could depression be treated with non pharm therapy? what ssri is approved for OCD? what snri is approved for FM? |
yes, for mild and moderate fluvoxamine milnacipran |
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what are some snris? what drug is a nore and dopa reuptake inhibitor? what are the unique ssris? what drugs block histamine, alpha and 5ht? |
venlafaxine, des"", duloxetine buproprion vilazodone, vortioxetine(5ht 3 and 1A) mirtazapine, trazodone |
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what are some TCA's? what drug does st johns wort act like? inhbitor or inducer when does it not work? |
amitriptyline, imipramine, nortiptyline, doxepin maoi, induces cyp3a4 moderate to severe depression |
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most common side effect of serotonergic antidepresseants? best way to treat this? what ssri has a an extremely long half life and should be avoided in elderly patients? |
sexual dysfunction at bupropion or mirtazapine, or switch antidpresseants all together fluoxetine |
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what are the dirty receptors? which onne leads to weight gain? |
M, H1, alpha1 H1 |
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what causes serotonin syndrome? what are the side effects? what is hypertensive crisis? what are the side effects? |
increased in CNS serotoneginc activity hyperflexion, sweating, n/v/d, tachycardia (wet dog shakes) very quick increase in blood pressure high bp, headache, stiff/sore neck, nose bleed |
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what can cause HTN crisis? how do you prevent it? what causes serotonin syndrome? how do you treat it? |
maoi, stimulants, tyramine foods consult doc, diet counsleing triptans, tramadol, detromorphan d/c bad drug, antihypertensive, cyproheptadine (h1 and 5ht anatgonist) |
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are all antidepressant treated equally? what is the genarly response rate from an antidepressant? what is first line for depression? could you use a ssri and snri together? |
not much difference in efficacy between them 60-80% ssris, snris, mirtazapine, bupropion dont do it |
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what are the second line antidepressants? if you use first line and have some benefit with no s/e, what should you do? what drugs are consider agumentation? |
tcas and maois augmentation therapy buspirone, atypical antipsychotic, lithium, antidepressant from another class |
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what drugs should you never give if a patient has a history of siezures? describe the progression of antidepressant therapy from the first week to the 12th week |
maois, tcas, bupropion 1st week physical symptoms 2-4 weeks, emotional symptoms 6-8 weeks, full effect 12 weeks full trial complete |
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what things should be assessed before determining a treatment failure? what things can be done if a patient gets a partial response from a medication? |
dose and duration, adherence, comborbid disease, stressors that are adding to depression increase dose, continue trial, adjuctive therapy |
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what is the down side of swithching antidepressants? what antipsychotics are used in depression? how many times should you try monotherapy beofore moving on to augmentation? |
loss of time, loos previous therapetuic effect and therapy resets apripiprazole, quitiapine, olanazapine 2-3 |
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what is the maintence phase of therapy? does everyone need this? |
teratment after the acute phase of a major depressive episode to prevent recurrance no, depends on number of episodes and seperation between episodes |
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what three things determine if you are on antidepressants for life? why should you taper when you d/c antidepressants? what anitdepressants are more likely to have withdrawal? |
number of prior episodes, liklihood of future episodes, severity of prior episodes can cause withdrawal symptoms and depression can return those with shorter half life |
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what are the safest antidepressants to use during pregnancy and lactation? what antidepressants should be avoided? why? |
citalopram, fluoxetine, TCA paroxetine, citalopram, sertaline, other ssris can cause septal heart defects |
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what is masked depression should you use tcas in the elderly populatoin? good antidepressant for the elderly? |
other complaints and physical symptoms cover the underlying offending disorder no, anticholiergic, cv effects, and sedation, use short half life meds venlafaxine, desvenlafaxine, bupropion |
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what antidepressants are approved in children? what drug should be avoided in children? what organ system should be assessed before? what class of medications should be avoided if a patient is actively sucididal or has a history of suicide? |
fluoxetine and escitalopram desirpramine CV TCAs and MAOIs |
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What are some important counseling points? |
medication works by affecting chemical in the brain non addicting routine use, works only if taken everyday several weeks to see effect take for 6-12 months ask doc before d/c aboid alcohol since it can worsen depression be alert for suicide |
