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RxPrep
MDD/Anxiety
| Question | Answer |
|---|---|
| First line for anxiety? | SSRIs and SNRIs |
| First line for MDD? | SSRIs and SNRIs |
| When are benzodiazepines generally used in anxiety treatment? | Short-term only |
| When is buspirone used in anxiety treatment? | Second-line or as add-on to antidepressants |
| Which drug is first-line for panic disorder according to the antidepressant selection section? | SSRIs |
| Which drug is preferred for depression with cardiac risk? | Sertraline |
| Which drugs are suggested as first-line options for depression in pregnancy? | SSRIs |
| Which drugs are first-line options for postpartum depression? | Escitalopram and sertraline |
| When is hydroxyzine used in anxiety treatment? | For anxiolytic effect, but it does not treat the underlying disorder |
| When is gabapentin used in anxiety treatment? | Not FDA-approved for anxiety, but may provide immediate anxiolytic effects similar to benzodiazepines |
| When is propranolol used in anxiety treatment? | Performance/social anxiety with tremor or tachycardia |
| Which drugs are used for treatment-resistant depression as adjuncts? | Aripiprazole, olanzapine/fluoxetine, quetiapine XR, brexpiprazole, cariprazine |
| What is Symbyax | Fluoxetine/olanzapine |
| Dosing for Symbyax? | Start 6mg/25mg QHS |
| What is Rexulti? | Brexpiprazole, used for agitation in dementia) |
| What important bleeding interaction applies to SSRIs? | SSRIs increase bleeding risk with NSAIDs, antiplatelets, anticoagulants, and some natural products |
| What washout period is needed when switching from fluoxetine to an MAOI? | 5 weeks |
| What washout period is usually needed when switching from most other SSRIs to an MAOI? | 14 days |
| Which drugs should be always be avoided with SSRIs? | Linezolid, MAOIs, IV methylene blue |
| Which SSRIs most consistently carry QT prolongation risk? | Citalopram and escitalopram |
| Which SSRIs interact with 2D6? | Fluoxetine and paroxetine |
| Which SSRI should be avoided in pregnancy/postpartum because of neonatal adverse effects? | Paroxetine |
| Which SSRI is the only one in the book approved only for OCD? | Fluvoxamine IR/ER |
| Which SSRI has a very long half-life? | Fluoxetine |
| What is Fetzima? | Levomilnacipram, an SNRI |
| Which SNRI is noted to increase blood pressure and requires caution? | Effexor |
| Which SNRI is noted to cause withdrawal if stopped abruptly? | Venlafaxine |
| Which SNRI has a moderate CYP2D6 inhibition effect and is converted to active metabolite by CYP2D6? | Duloxetine |
| Which SNRI can leave a ghost tablet in stool? | Desvenlafaxine (Pristiq) |
| Which SNRIs should be avoided in CKD stage 4 or beyond? | Duloxetine (avoid when CrCl < 30) Levomilnacipran (CrCl < 15) |
| Which drugs need to be avoided with linezolid or IV methylene blue? | Bupropion, SNRIs, SSRIs, TCAs, basically all MDD medications |
| What CYP interaction is most important for buspirone? | Buspirone is a major CYP3A4 substrate |
| How do moderate/strong CYP3A4 inhibitors affect buspirone? | Decrease busperone dose |
| Which MDD/anxiety med requires avoidance of grapefruit juice? | Buspirone |
| How long does it take for buspirone to fully work? | 2-4 weeks |
| Benzo patients require tapering before d/c if they have been taking them for __________. | 10 days or more |
| What major contraindication applies to benzodiazepines? | Acute narrow-angle glaucoma, pregnancy, sleep apnea, severe respiratory insufficiency |
| Can benzos be used in pregnancy? | No, can be teratogenic and cause withdrawel in infants |
| What age-related safety concern applies to benzodiazepines in older adults? | Increased risk of cognitive impairment, delirium, falls, and paradoxical reactions |
| Which benzo has the highest abuse potential? | Xanax, due to rapid onset. |
| Which benzo has a longer half-life and is preferred if benzos are needed? | Clonazepam |
| Which benzos have a 3A4 interactions? | Only alprazolam, contraindicated with strong 3A4 inhibitors and caution with moderate inhibitors |
| Which drugs are MAO inhibitors listed in the book? | Isocarboxazid, phenelzine, tranylcypromine, selegiline transdermal |
| What is the brand name for isocarboxazid? | Marplan |
| What is the brand name for phenelzine? | Nardil |
| What is the brand name for tranylcypromine? | Parnate |
| Brand name of selegine transdermal? | Emsam |
| What class warning applies to MAO inhibitors? | Serotonin syndrome and hypertensive crisis |
| What drugs are contraindicated with MAO inhibitors? | SSRIs, SNRIs, TCAs, linezolid, methylene blue, bupropion, buspirone, stimulants, dextromethorphan, opioids, herbal weight-loss products |
| What common adverse effects do MAO inhibitors cause? | Orthostasis, headache, insomnia, sexual dysfunction, weight gain; anticholinergic effects with some agents |
| Which MAO inhibitor patch allows avoiding some dietary tyramine restrictions at low dose | Selegiline transdermal |
| Which drugs are tertiary amine TCAs? | Amitriptyline, clomipramine, imipramine, trimipramine, doxepin |
| Which drugs are secondary amine TCAs? | Nortriptyline, amoxapine, desipramine, protriptyline |
| What common class adverse effects do TCAs cause? | Anticholinergic effects, orthostasis, QT prolongation, sedation |
| Which antidepressants can be fatal in overdose? | TCAs |
| What CYP issue applies to TCAs? | Many are metabolized by CYP2D6; check for interactions |
| What is the first step in treatment-resistant depression if the antidepressant is tolerated but incomplete response occurs? | Increase the antidepressant dose |
| 2nd steps in treatment-resistant depression after inadequate response? | Switch to a different antidepressant or Add a medication with a different mechanism |
| Which adjunctive antipsychotic for treatment-resistant depression has a boxed warning for dementia-related psychosis and can cause akathisia/insomnia? | Aripiprazole |
| Which adjunctive therapy for treatment-resistant depression combines an antidepressant and an antipsychotic in one product? | Olanzapine/fluoxetine (Symbyax) |
| Which adjunctive therapy for treatment-resistant depression can cause dyslipidemia and weight gain? | Brexpiprazole |
| Which adjunctive therapy for treatment-resistant depression can cause insomnia, EPS, and dystonia? | Cariprazine |
| Which antidepressants are preferred if sexual side effects are a concern? | Bupropion and mirtazapine |
| Which antidepressants should be taken in the morning because they may be activating? | Fluoxetine and bupropion |
| What is the preferred non-drug treatment that should be combined with or considered alongside medication for anxiety disorders? | Cognitive behavioral therapy (CBT) |
Created by:
cdaughtry