Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Naplex
Depression
| Question | Answer |
|---|---|
| Q1. Drugs that Cause or Worsen Depression | • ADHD medications: Atomoxetine • Analgesics: Indomethacin • Antiretrovirals: NNRTIs incl efavirenz, rilpivirine • Beta-blockers • Hormonal contraceptives • Others: Benzodiazepines, steroids, varenicline |
| Q2. Strattera | • Atomoxetine: ADHD • Increasing NE / brain |
| Q3. Yaz | • Drospirenone and ethinyl estradiol |
| Q4. DSM-5 Criteria for Depression (M SIG E CAPS): 5 symptoms / 2-week period, incl mood & interest | • Mood • Sleep (up /down) • Interest/pleasure • Guilt • Energy • Concentration • Appetite (up / down) • Psychomotor agitation or retardation • Suicidal ideation |
| Q5. Natural products for MDD | • St. John's wort • SAMe |
| Q6. SAMe | • S-adenosyl methionine • Bleeding risk • Also for Osteoarthritis |
| Q7. St. John's wort and Oral contraception DDI | • Pregnancy risk • St. John's wort Photosensitivity • Decrease indinavir concentration |
| Q8. Valerian | • Sedation |
| Q9. Assessment MDD (for dose adjustment) | • Hamilton Depression Rating Scale (HDRS, or Ham-D) |
| Q10. 1st line MDD | • SSRI , SNRI • Bupropion, Remeron • Trial: 4-8 weeks |
| Q11. Preferred treatment for pregnancy women | • Psychotherapy preferred for mild depression • SSRIs, if medications are needed |
| Q12. SSRI Safety in Pregnancy | • Warning of persistent pulmonary hypertension of the newborn (PPHN) • NO paroxetine due to cardiac effects |
| Q13. "Baby blues" is Postpartum Depression | • NO • Hormone fluctuation • Goes away in a couple of weeks |
| Q14. Postpartum Depression treatment | • SSRIs or TCA (NO doxepin, a TCA) • Brexanolone (C-IV) |
| Q15. Brexanolone safety concerns | • Excessive sedation & sudden loss of consciousness • REM |
| Q16. BW of all antidepression | • Suicidal thought in pediatric and young adult patients • Risk once initiate treatment or dose change |
| Q16. Withdrawal Symptoms of antidepression | • Anxiety, agitation • Insomnia • Dizziness • Flu-like • Do not abruptly stop antidepressants • Taper gradually over several weeks • Exception: fluoxetine because of a long half-life |
| Q17. Antidepressant without withdrawal Symptoms | • Exception: fluoxetine |
| Q18. Dispense product information once dispense any antidepression | • NO • MedGuides: FDA-approved handout dispensed with a prescription: Specific issues such as mood changes w antidepressants |
| Q19. Antidepression - counselling | • Take daily • take 4-8 weeks to improve . Physical symptoms improve faster (1-2 weeks) |
| Q20. List of SSRIs | • Citalopram (Celexa) • Escitalopram (Lexapro) • Fluoxetine (Prozac) • Fluvoxamine (Luvox): 1A2 • Paroxetine (Paxil, Brisdelle) • Sertraline (Zoloft) |
| Q21. SSRI CI | • MAOi , linezolid, IV methylene blue or pimozide (Tourette's disorder) |
| Q22. SSRI warnings | • QT prolongation - Celexa: 40 mg QD or 20mg QD if > 60 yrs - Lexapro: Max 20 mg/day or 10 mg if > 60 • SIADH (syndrome of inappropriate antidiuretic hormone) / hyponatremia • Fall risk (Beers criteria) • Additive bleeding risk |
| Q23. Celexa, Lexapro metabolized by 2C19 | • 2C19 (major), 2D6, 3A4 • CYP2C19 inhibitors (e.g., Omeprazole, Esomeprazole, Fluconazole) can increase their levels. |
| Q24. SSRI SEs | • Low libido, ED • CNS effects: Somnolence / Insomnia, Dizziness, Headache, Weakness, Tremor, Nausea, dry mouth |
| Q25. What SSRI activating, take in morning | • Fluoxetine • Long half life, no need for taper off |
| Q26. Sarafem | • Fluoxetine • Premenstrual Dysphoric Disorder |
| Q27. Symbyax | • Fluoxetine + olanzapine • Treatment-resistant depression • Take at bedtime (sedation) |
| Q28. What SSRI cause Sedating | • Paroxetine (Paxil), take in the evening • CI: pregnancy |
| Q29. Brisdelle | • Paroxetine • Menopausal vasomotor symptoms |
| Q30. SSRI less bleeding risk | • Luvox • Celexa |
| Q31. Hyponatremia happens w | • SSRI • SNRI |
| Q32. SSRI w Anticholinergic effects | • Paroxetine |
| Q33. Serotonin syndrome once SSRI with | • Buspirone, TCAs, lithium, fentanyl, methadone, meperidine, tramadol, St John's wort, linezolid, dextromethorphan, • Triptans… |
| Q34. Lexapro formulation | • Tabs 5, 10, 20 mg scored • Sol: 5mg/5mL |
| Q35. Prozac Weekly | • ER 90mg capsules • Pts maintained on Prozac 20 mg/day, may be changed to Prozac Weekly 90 mg/week, starting 7 days after the last 20 mg/day dose. |
| Q36. SSRI has highest risk of weigth gain | • Paxil |
| Q37. Vortioxetine (Trintellix): SSRI + 5-HT1A agonist + 5-HT3 antagonist | • Substrate of CYP2D6 and 3A4 • CI: MAOi, linezolid, IV methylene blue |
| Q38. List SNRI | • Venlafaxine (Effexor) • Desvenlafaxine (Pristiq, Khedezla) • Duloxetine (Cymbalta) • Milnacipran (Savella) • Levomilnacipran (Fetzima) |
| Q39. SNRI dose adjust | • SNRIs need dose adjustment in renal / hepatic • S/E: Nausea (most common), constipation, dry mouth, dizziness, sweating. Increase BP. All drugs that inhibit serotonin uptake can cause sexual dysfunction and other serotonin S/E. |
| Q40. SNRI w foods | • Venlafaxine (Effexor) |
| Q41. Venlafaxine (Effexor) | • ER tab: ghost table in the stool • CrCI <30: Reduce total daily dose by 50% • Activating (higher dose) or Sedating |
| Q42. Desvenlafaxine succinate (Pristiq) | • CCI <30 to 50mg QOD |
| Q43. Duloxetine (Cymbalta, Irenka) | • Avoid in CrCI <30 mL/min & hepatic impairment • CYP2D6 substrate / inhibitor, CYP1A2 substrate |
| Q44. Milnacipran (Savella) indication | • Fibromyalgia. • ESRD: Use not recommended |
| Q45 Meds for • Fibromyalgia | • Lyrica (pregabalin) • Cymbalta (duloxetine) • Savella (Milnacipran) |
| Q46. Levemilnacipran (Fetzima) vs Milnacipran (Savella) | • Levemilnacipran: MDD, CYP3A4 substrate: max 80 mg QD • Milnacipran: fibromyalgia |
| Q47. Bupropion brand name | • Wellbutrin SR, Wellbutrin XL • Aplenzin (ER) • Zyban (MDD and smoke cessation) • No sexual dysfunction, weight loss • 2nd dose before 5 pm • Structural similarity to Amphetamine. |
| Q48. Trazodone | • Priapism: 4h ER (counselling) • Orthostatic hypotension • Indication: MDD, Sleep disorder (IR) • Sedative effect |
| Q49. Nefazodone | • MDD • Hepatotoxicity (D/c if 1 AST or ALT levels greater than 3 times the upper limit of normal. |
| Q50. Vilazodone (Viibryd): SSRI + 5-HT1A partial agonist | • CI: MAOi, linezolid, IV methylene blue • START: 10 mg QD w FOOD x 7d. Maintenance / Max: dose of 40 mg QD. • S/E: diarrhea, n/v, dizziness, dry mouth, insomnia/agitation, and sexual dysfunction. • NO weight gain • CYP3A4 substrate • MAOIs - 14 days |
| Q51 Serotonin modulators | • Trazodone • Nefazodone • Vilazodone (Viibryd): partial 5-HT1A Receptor Agonist |
| Q52. Mirtazapine (Remeron) | • S/E: Somnolence, appetite, weight gain, increase cholesterol, triglycerides, dizziness, anticholinergic effects (dry mouth, constipation); flu syndrome, abnormal dreams (taken at bedtime due to sedation), QT Prolongation • Has ODT, max 45mg |
| Q53. Tricyclic Antidepressants (TCA's) | • Amitriptyline (Elavil) • Clomipramine (Anafranil) - OCD • Doxepin / For Insomnia (Silenor) • Imipramine (Tofranil) • Trimipramine (Surmontil) |
| Q54. Tricyclic Antidepressants (TCA's) | Nortriptyline (Pamelor) ... |
| Q55. TCA safety concerns | • Alpha adrenergic receptors (orthostatic hypotension) • Histaminergic: (weight gain, sedation) • Anticholinergic receptors: side effects • Lower seizure threshold |
| Q56. MAOi | • Isocarboxazid (Marplan) • Phenelzine (Nardil) • Tranylcypromine (Parnate) • Selegiline (Emsam) - QD patch QD |
| Q57. MAOi DDI w Tyramine (or tryptophan which is metabolized to tyramine) | Tyramine (or tryptophan which is metabolized to tyramine) releases catecholamine (NE) from synaptic vesicles: Hypertensive crisis: |
| Q58. Selegiline (Emsam) - QD patch QD | PATCHES: 6, 9, 12mg/24 hours |
| Q59. Other MAO Inhibitors: | Linezolid; Tedizolid; Rasagiline; Procarbazine |
| Q60. Antipsychotics approved for MDD | • Aripiprazole (Abilify) • Olanzapine/fluoxetine (Symbyax): TRD, start with the lowest dose once (QHS) • Quetiapine (Seroquel XR) • Brexpiprazole (Rexulti): adjunt (Postpartum Depression), IV |
| Q61. Esketamine (Spravato) CIII | • Treatment-resistant depression |
| Q62. Prefer SSRI for cardiac risk | Sertraline |
| Q63. SSRI & SNRI warnings | • SIADH / hyponatremia • Fall risk (Beers criteria) • Additive bleeding risk |
| Q64. SNRI vs SSRI for SEs | • Same, plus Effects due to increased norepinephrine: • Increased BP (especially at higher doses), HR • Dilated pupils • Dry mouth • Excessive sweating • Constipation |
| Q65. Other venlafaxine indications: | • GAD • Panic disorder • SAD |
| Q66. Other duloxetine indications: | • GAD • Pain (eg, peripheral neuropathy, fibromyalgia, chronic musculoskeletal pain) |
| Q67. Additive risk of QT prolongation | • Citalopram or escitalopram, with venlafaxine |
| Q68. CYP450 2D6 inhibitors - duloxetine, fluoxetine, paroxetine | • Tamoxifen - prodrug requiring conversion through CYP2D6 (SEs: vasomotor symptoms such as hot flashes) • NO duloxetine, paroxetine for hot flashes, but Venlafaxine |
| Q69. TCA Anticholinergic SEs: | • Dry mouth • Blurry vision • Urinary retention • Constipation • Weight gain • Fall risk (Beers criteria) |
| Q70. TCA Cardiotoxicity: | • QT prolongation (and fatal arrhythmias) if overdosed (monitor for suicidal ideation) • Orthostasis |
| Q71. TCA Drug Interactions | • Serotonin syndrome or hypertensive crisis - 2-week washout from MAO inhibitors • QT prolongation - additive risk with other QT-prolonging drugs |
| Q72. Bupropion max dose | • 450 mg/day (IR and XL) • 400 mg/day (SR) for MDD • 300 mg/day (SR) for smoke cessation |
| Q73. Bupropion CI | • Seizure disorder • Eating disorder: anorexia, bulimia (chán ăn, cuồng ăn) • MAOi, linezolid, IV methylene blue |
| Q74. Bupropion SEs | • Dry mouth • CNS stimulation: insomnia, restlessness • Weight loss + naltrexone (Contrave): indicated for weight management |
| Q75. Bupropion DDI | Hypertensive crisis - use a 2-week washout from MAOi |
| Q76. MAOi list | • NON-selective: Isocarboxazid (Marplan), Phenelzine (Nardil), Tranylcypromine (Parnate) • Selective: Selegiline (Emsam) • HTN crisis and serotonin syndrome risk w other serotonergic drugs and tyramine-containing foods |
| Q77. Selegiline formulation | • Patch (Emsam): depression • ODT (Zelapar): Parkinson |
| Q78. MAOi DDI causes HTN crisis (elevated BP, HR, Agitation, Death) | Products increase epinephrine and norepinephrine Antidepressants (eg, SNRIs, TCAs, bupropion, remeron, ) • Amphetamines/stimulants • Linezolid • Methylene blue • Tyramine-rich foods |
| Q79. Tyramine-rich foods that increase norepinephrine | Aged, fermented, pickled, or smoked foods • Aged cheese • Cured, smoked, or processed meats • Pickled or fermented foods • Soy sauce • Beer |
| Q80. MAOi DDI w Products that increase serotonin: Serotonin Syndrome (elevated HR, Seizures, Death) | • Antidepressants (eg, SSRIs, SNRIs, TCAs, mirtazapine,, razodone) • Linezolid • Lithium • Opioids • St. John's wort •Tramadol |
| Q81. Mirtazapine (Remeron, Remeron SolTab) | • CI: MAOi, linezolid. IV methylene blue • SEs: Increased appetite, weight gain, sedation |
| Q82. Trazodone: QHS | • CI: MAOi, linezolid, IV methylene blue • Side Effects Sedation, priapism |
| Q83 Remeron MoA | • TCA • presynaptic alpha-2 adrenergic effects: norepinephrine and serotonin |
| Q84. Antidepression for cardiac / QT risk | • Sertraline |
| Q85. MDD Augment treatment: | • Buspirone • Atypical antipsychotic • Lithium • Esketamine • Electroconvulsive therapy (ECT) |
| Q86. Atypical antipsychotics BW | • Elderly w dementia-related psychosis is at increased risk of death |
| Q87. Aripiprazole Side Effects | • Anxiety • Insomnia • Akathisia |
| Q88. Olanzapine/fluoxetine (Symbyax) Side Effects | • Sedation • Weight gain • Increased lipids • Increased glucose |
| Q89. Quetiapine Side Effects | • Sedation • Orthostasis • Weight gain • Increased lipids • Increased glucose |
| Q90. Brexpiprazole Side Effects | • Weight gain • Akathisia (agitation) |
| Q91. Esketamine (Spravato): CIll, Nasal spray | • Under supervision of a healthcare provider • BW: Sedation and dissociative or perceptual changes, risk of abuse and misuse, REMS |
| Q92. Conditions that cause or worsen depression | • Metabolic: DM, Hypercalcemia, Hypothyroidism, Vit D deficiency • Neurologic: Dementia, Multiple sclerosis, Parkinson, Stroke, Traumatic brain injury • Other: Chronic pain, HIV/AIDS, Overactive bladder |
| Q93. Safety concerns for all antidepressants | • Withdrawal symptoms • Serotonin syndrome • Activation of mania: racing thoughts, pressured speech, impulsivity (Screen for bipolar disorder) |
| Q94. Antidepressant dosing for Premenstrual dysphoric disorder (PMDD) | • Daily, OR • Day -14 to start of menses (Day of symptom onset) • SSRI, if not effective then SNRI |
| Q95. Antidepressant if bleeding risk | • Bupropion • Mirtazapine |
| Q96. Antidepressant if Fatigue | • Bupropion • Fluoxetine |
| Q96. Antidepressant if Insomnia | • Mirtazapine • Paroxetine • Trazodone • ТСА |
| Q97. Antidepressant if Peripheral neuropathy or pain | • Duloxetine • ТСА |
| Q98. Antidepressant if Sexual dysfunction | • Bupropion • Mirtazapine • Vortioxetine • Vilazodone |
| Q99. Antidepressant if Weight gain desired | • Mirtazapine • Paroxetine |
| Q100. Antidepressant if Weight loss desired | • Bupropion |
| Q101. Forfivo XL | Bupropion |
| Q102. Natural products: 5-HTP | • Depression • Serotonin syndrome* |
| Q103. Natural products: Kava | • Anxiety • Insomnia • Hepatotoxicity |
| Q104. Natural products: Melatonin | • ADHD • Insomnia • Dependency for sleep with chronic use |
| Q105. Natural products: Passionflower | • Anxiety • QT prolongation |
| Q106. Natural products: SAMe | • Depression • Serotonin syndrome* • Activation of mania (avoid in patients with bipolar disorder) |
| Q107. Natural products: St. John's wort | • Anxiety • Depression • Drug interactions (CYP450 enzyme inducer) • Serotonin syndrome* • Photosensitivity |
| Q108. Natural products: Valerian | • Anxiety • Insomnia • Sedation |
| Q109. Tamoxifen is considered a prodrug | • ProDrug • Substrate |
| Q110. TCA MoA (6) Incl: amitriptyline, nortriptyline & doxepin | • Serotonin reuptake inhibition • Norepinephrine reuptake inhibition • Muscarinic blockade • Histamine blockade • Alpha-1 adrenergic blockade • Cardiac sodium channel blockade |
| Q111. TCA safety concerns 2/2: Serotonin reuptake inhibition | • Sexual dysfunction, diaphoresis, serotonin syndrome |
| Q112. TCA safety concerns 2/2: Norepinephrine reuptake inhibition | • Anxiety, tremor, hypertensive crisis |
| Q113. TCA safety concerns 2/2: Muscarinic blockade | Anticholinergic effects: • Dry mouth, constipation, urinary retention • Blurred vision, confusion |
| Q114. TCA safety concerns 2/2: Histamine blockade | • Sedation, increase appetite (weight gain) |
| Q115. TCA safety concerns 2/2: Alpha-1 adrenergic blockade | • Orthostasis • Reflex tachycardia |
| Q116. TCA safety concerns 2/2: Cardiac sodium channel blockade | • QT prolongation • Overdose can cause fatal arrhythmias (monitor for suicide risk) |
| Q117. Serotonin syndrome | • Mild: nausea, headache, and diarrhea • Severe Agitation, tachycardia, hallucinations, and muscle rigidity |
| Q118. Duloxetine for Pain conditions? | • Peripheral neuropathy • Fibromyalgia • Chronic musculoskeletal pain |
| Q119. SSRI / SNRI for Migraine prevention | • Venlafaxine (Effexor, Effexor XR) |
| Q120. SSRI / SNRI for Menopause-related vasomotor symptoms | • Venlafaxine (Effexor, Effexor XR) |
| Q121. Antipressant w low risk of sexual dysfunction | • Bupropion, Mirtazapine • Vortioxetine: Trintellix®, Serotonin modulator • Vilazodone: Viibryd®, Serotonin Partial Agonist/Reuptake Inhibitor |
| Q122. Antidepressant discontinuation syndrome (FINISH) | • Flu-like • Insomnia (vivid dreams) • N/V • Imbalance (dizziness, lightheadedness) • Sensory disturbances (electrical shock sensation/"brain zaps," paresthesia) • Hyperarousal (agitation, anxiety, mood swings) |
| Q123. Antidepression for Premenstrual dysphoric disorder | • Sertraline • Fluoxetine • Paroxetine CR |
| Q124. Conditions that cause/worsen depression | • Hematologic/oncologic: Anemia, Malignancy • Metabolic • Neurologic • Other: Chronic pain, HIV, Overactive bladder |
| Q125. Metabolic Conditions that cause/worsen depression | • Diabetes mellitus • Hypercalcemia • Hypothyroidism • Vitamin D deficiency |
| Q126. Neurologic Conditions that cause/worsen depression | • Dementia • Multiple sclerosis • Parkinson disease • Stroke • Traumatic brain injury |
| Q127. Is Bupropion indicated for treatment of vasomotor symptoms (hot flashes and night sweats) | • NO role • 2D6 inhibitor |
| Q128. Contraindication Bupropion if Concurrent Dilaudid use | • NO • Abrupt d/c alcohol or sedatives (benzodiazepines) • W MAOi, linezolid, IV methylene blue • Multiple forms of bupropion |
| Q129. Max bupropion daily dose | • Smoke: 300mg • MMD: 450mg • Higher dose: Seizure risk |
| Q130. Diaphoresis is a SE of | • SSRI, SNRI • GI effects: nausea, dry mouth • Neurologic effects Insomnia, drowsiness, HA, weakness, dizziness, tremors |
| Q131. Adjunctive treatments w SSRI / SNRI | Augmentation agent SGA, buspirone, lithium, esketamine |
| Q132. Other Amitriptyline indications | • Neuropathic pain or insomnia |
| Q133. Other Fluvoxamine indication | • OCD |
| Q134. Marplan | Isocarboxazid, MAOi |
Created by:
dao.vo11017