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