Depression Pharm

  1. How do you dx MDD?
    Need to have 5 or more of the following sx present during the same two week period with a concurrent sad mood:

    • Sleep, interest, guilt, energy, concentration, appetite, psychomotor retardation/agitation, suicide
  2. What medications can cause depression?
    anti-htn, interferon
  3. What does full remission mean?
    period <2 mo during which an improvement of sufficient magnitude is observed, that the pt is asx
  4. What is partial remission?
    Time period during which the pt has more than minimal sx but no longer meet the DSM-IV criteria for MDD
  5. What is recovery?
    Full remission of sx for greater than 2 mo
  6. What is relapse?
    return of depressive episode within two months of improvement
  7. What is recurrence?
    New episode of depression (occuring after recovery)
  8. How long can it take depression meds to work?
    4-6 weeks, but sleep improvement within 1-2 weeks
  9. What info do you need before starting SSRIs?
    medical hx, current meds, PE, thyroid function tests
  10. What patient education do you give pts on SSRIs?
    • They will not see an immediate response
    • Changes are gradual
    • They are NOT prn meds
    • Pts will maintain or decrease weight
  11. How do you start dosing the elderly on SSRIs?
    Half of starting dose
  12. Which SSRIs have a short half life?
    Celexa, Zoloft, Paxil, and Luvox
  13. Can SSRIs be prescibed in pregnant women?
    There's no answer, nursing not recommended
  14. How do SSRIs affect sexual function?
    decrease in libido and delayed/complete inorgasma
  15. What are sx of SSRI withdrawal syndrome?
    When does it start? How long does it last?
    How do you avoid?
    • N/V/Dizziness, vivid dreams, vertigo, malaise, HA
    • Occurs with rapid stopping of short 1/2 life drugs, lasts 2-3 weeks
    • Taper drugs over 1-2 weeks
  16. What info do you need before starting a pt on TCAs?
    H+P, thyroid function tests, EKG,
  17. Describe TCA use in the elderly
    • Not recommended due to profound hypotension, QT interval increase
    • If you need to use a TCA, start with nortriptline
  18. Can pregnant woman use TCAs?
    No, they are teratogenic (no nursing either)
  19. How do TCAs affect weight?
    They increase weight by 25 lbs
  20. What type of diet does a pt on a MAOI need to follow and why?
    Low tyramine 72h premedication, 10 days following in order to prevent a HTN crisis
  21. What are signs of a HTN crisis caused by MAOI? How do you tx?
    • HA, < sweating, dizziness, diplopia, HTN)
    • Tx with Procardia 10mg
  22. Describe elderly use of MAOI
    Don't use due to orthostatic hypotension
  23. Can pregnant woman use MAOI?
    use not established
  24. What are ADRs of bupropion?
    • Insomnia, HA, Nausea, Agitation
    • Above 450 mg = increased risk of seizures (lowers threshold)
    • NO sexual dysfunction
    • Do not give with SSRI, TCA, or MAOI
  25. What are ADRs of Effexor?
    What are its DIs?
    • Insomnia, HA, Nausea, Agitation, Sexual dysfunction
    • Very few DIs
  26. What are common ADRs of nefazodone?
    What are its DIs?
    • Dry mouth, HA, dizziness, orthostatic hypotension
    • Increases benzo levels (triazolam, alprazolam, diazepam)
    • MAOI, cisapride are contraindications
  27. What are common ADRs of trazodone?
    What are its DIs?
    dry mouth, HA, dizziness, orthostatic hypotension, sedation, mental dullness, priapism
  28. What are common ADRs of Remeron?
    What are its DIs?
    • Sedation, dry mouth, constipation, constipation
    • DIs=MAOIs
  29. What rx regimen do you follow if there is a partial response to MDD?
    Lithium: response within 48h, continue for 1 week if you get a response...if not, d/c immediately

    T3: response within one week, if not d/c

    Ritalin: response within 1 week, if no response, then D/C
  30. What are the three phases of depression management?
    • Acute (2-6 weeks to get pt into remission0
    • Continuation: (6-12 months to maintain remission)
    • Maintenance: (long term therapy for those at high risk for relapse)
  31. What is the Star D protocol?
    Level one: SSRI to remission. If HAM-D not at 7 or less, go to level 2

    Level two: switch SSRI to bupropion, sertraline, venlafaxine, or CBT OR augment SSRI with bupropion, buspirone, or CBT

    Level three: Switch to: mirtazepine or nortriptyline OR augment with lithium, T3, bupropion, sertraline, or venlafaxine
  32. What were the results of the Star-D study?
    Switching might be best if minimal or no response with drug intolerance

    Augmentation might be best if there was a partial response
  33. Olanzapine
    • Zyprexa
    • Atypical antipsychotic
    • Used in treatment-resistant depression
  34. TCAs should be avoided in what populations?
    Elderly, arrhythmia, syncope, orthostasis
  35. Bupropion should be avoided in what populations?
    seizure disorders
  36. Those with ADHD might receive benefit from what type of antidepressant?
  37. Those with chronic pain might benefit from what antidepressants?
    duloxetine, TCA
  38. In pts who are a suicide risk, what is the med class of choice? Which meds should be avoided?
    • SSRIS (safer if you OD)
    • MAOis are easy to OD
    • TCAs and MAOIs have a narrow therapeutic index
Card Set
Depression Pharm
Depression and pharm questions