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60 Cards in this Set

  • Front
  • Back
Giving a bipolar patient what type of medication will induce mania?
antidepressants
(will see sx in 6 months)
There is a clear link between the pathophysiology of depression and what other condition?
heart disease
What condition is the development of emotional and/or behavioral symptoms within 3 months after an identifiable stressor?
adjustment disorder
How many months does adjustment disorder usually last?
< 6 months after stressor
What class of meds treat anxiety but not depression?
benzos
What meds may cause symptoms of depression?
propranolol
interferons
steroids
benzos
clonidine
opiates
barbiturates
What two questions are asked in the depression screener?
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?
Psychotherapy is effective as monotherapy for what type of depression?
mild depression
What meds are recommended first line in the treatment of older depressed pts?
SSRIs
What are the SSRIs?
fluoxetine
paroxetine
sertraline
fluvoxamine
citalopram
escitalopram
What SSRI has the highest anticholinergic effects and should be avoided in elderly?
paroxetine (paxil)

(constipation, cognition effects)
Higher activation of seritonin receptors causes what side effects?
diarrhea
nausea/vomiting
What SSRI has the highest serotonin receptor agonism, causing diarrhea and nausea/vomiting?
fluvoxamine (luvox)
What SSRI has the highest incidence of headache?
sertraline (zoloft)
What SSRI has the highest rate of somnolence?
fluvoxamine (luvox)
What SSRI has the highest rate of sexual dysfunction?
paroxetine (paxil)
What SSRI causes the most weight gain?
paroxetine (paxil)
What side effect of SSRIs do not usually go away after 3 months?
sexual dysfunction
What SSRI has the highest rates of withdrawal syndrome?
fluvoxamine (luvox)
What SSRI is a potent inhibitor of CYP2D6?
paroxetine (paxil)
What SSRIs inhibit 2D6 weakly and is easier to take with other drugs?
citalopram
escitalopram
What SSRIs increase DES levels the most?
fluoxetine
paroxetine
What SSRI causes an increase of theophylline by 300%?
fluvoxamine
What is minimum duration of antidepressant therapy before a med can be switched?
6 months
What antidepressants block reuptake of seritonin and NE?
nefazodone
duloxetine
TCAs
Nefazodone should be avoided in pts with what condition?
liver dysfunction
How does mirtazapine work?
alpha 2 blocker
5HT2 and 5HT3 blocker
histamine 1 blocker
muscarinic 1 blocker
What are adverse effects of mirtazapine?
weight gain
hypercholesterolemia
hyperglycemia
sedation
constipation
What antidepressant should be avoided in diabetic pts?
mirtazapine
What antidepressant has effects on serotonin, NE, and dopamine reuptake pumps?
venlafaxine
What antidepressant is good for adult patients with depression and ADHD or neuropathy?
venlafaxine
What andidepressants increases BP?
venlafaxine
desvenlafaxine
What antidepressant is effective for neuropathy as well as depression?
duloxetine
What is the only antidepressant that does not affect seritonin?
bupropion
Bupropion may worsen what psychiatric condition?
anxiety (by increasing dopamine)
What side effect of bupropion causes dosing limits ?
seizures
What antidepressant also promotes smoking cessation?
bupropion
What antidepressant is useful for drug induced sexual dysfunction?
bupropion
What are the TCAs?
imipramine
amitriptyline
desipramine
nortriptyline
clomipramine
What are other effects of TCAs besides inhibition of serotonin and NE reuptake?
muscarinic
histamine 1
alpha 1 antagonism
What are adverse effects of TCAs?
muscarinic (dry mouth, constipation)
histaminic (sedation)
sexual dysfunction
seizures
hyperglycemia
tachycardia
arrhythmias
What is a safer MAOI to treat depression?
selegiline transdermal (EMSAM patch)
What diet restriction must be incorporated with the high dose MAOI selegiline patch?
tyramine restriction
What are the higher doses of selegiline patches?
9 mg/24 hr
12 mg/24 hr
What drugs given with SSRIs could potentially cause serotonin syndrome?
TCAs
venlafaxine
desvenlafaxine
duloxetine
nefazodone
mirtazapine
MAOIs
What non-antidepressant drugs could cause serotonin syndrome if given with a serotonergic drug?
st. johns wort
tramadol
meperidine
tryptophan
dexfenfluramine
isoniazid
What is the treatment for serotonin syndrome?
cyproheptadine 4mg prn
What drugs increase NE and could cause a hypertensive crisis?
TCAs
venlafaxine
desvenlafaxine
duloxetine
mirtazapine
bupropion
MAOIs
TCAs should be avoided with what drugs due to an increased risk of orthostasis?
alpha 1 antagonists ("zosins")
How log do patients need to take antidepressants before noticeable effects are seen?
2-4 wks
What is the acute phase of antidepressant therapy?
first 6-12 wks
reduction in symptoms to baseline
What is the continuation phase of antidepressant therapy?
4-9 months following remission
What is the minimal amount of time required for antidepressant therapy?
2 month acute phase
+
4-9 months continuation phase
Peak effects of antidepressants are seen when?
8 wks
What is the worst SSRI option in a pregnant female?
paroxetine
What SSRIs are probably the safest choices in pregnant females with severe depression?
sertraline
citalopram
What SSRIs have the highest risk of suicidal thoughts/behaviors?
venlafaxine
paroxetine
What monitoring should be used if antidepressants are given to an adolescent?
careful monitoring for first 3 months
(weekly visits for first 4 wks, then every other week for next 8 wks)
What is the best therapy for treatment resistant depression?
monotherapy with agents from differing classes/ neurotransmitter effects
What is the treatment algorithm for antidepressant therapy?
meet after 2 wks to assess tolerability
meet at 4 wks to assess efficacy
met at 6 wks to measure max response
meet every month for next 4-9 months during continuation phase