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What are the risk factors associated with major depression?
- 1) family history
- 2) previous depressive episode
- 3) previous suicide attempt
- 4) comorbid medical or substance abuse
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What are some physical symptoms of major depression?
- 1) fatigue
- 2) pain
- 3) sleep disturbances
- 4) psychomotor retardation/agitation
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What are some emotional symptoms of major depression?
- 1) anhedonia
- 2) depressed mood
- 3) hopelessness/helplessness
- 4) inappropriate feelings of guilt and worthlessness
- 5) anxiety/worry
- 6) suicidal ideation
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What are some cognitive symptoms associated with major depression?
- 1) indecisiveness
- 2) decreased ability to concentrate
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What are some laboratory studies that are undergone to rule out any other causative factors?
- 1) CBC with differential
- 2) thyroid function tests
- 3) rapid plasma reagin (RPR) test for syphilis
- 4) urine drug screen
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What are some medical conditions that may contribute or worsen depression?
- 1) MI
- 2) CVA
- 3) Parkinson's Disease
- 4) MS
- 5) SLE
- 6) HIV
- 7) RA
- 8) thyroid abnormalities
- 9) DM
- 10) cancer
- 11) vitamin deficiencies
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What drugs may induce depression?
- 1) corticosteroids
- 2) oral contraceptives
- 3) propranolol
- 4) clonidine
- 5) methyldopa
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What are the risk factors for suicide attempt?
- 1) male
- 2) age > 50 years
- 3) recent loss of job/spouse
- 4) unemployment
- 5) social isolation
- 6) presence of weapon
- 7) comorbid substance abuse
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What are the DSM IV diagnostic criteria for major depression?
At least 5 symptoms ocurring everyday for 2 weeks, in which one of the five must be either anhedonia or depressed mood.
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How are TCAs dosed?
TCAs must be titrated over a period of 1-3 weeks.
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What is a major side effect of TCAs?
sedation
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What are the side effects of TCAs?
- 1) orthostatic hypotension
- 2) tachycardia
- 3) sedation
- 4) anticholinergic effects
- 5) prolong QT interval
- 6) weight gain
- 7) sexual dysfunction
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What are some contraindications of TCAs?
- 1) concomitant use of an MAOI within 14 days
- 2) pregnancy
- 3) lactation
- 4) narrow-angled glaucoma
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With what conditions would you want to exercise precaution when administering TCAs?
- 1) cardiac conductin defects
- 2) seizure disorders
- 3) hyperthyroidism
- 4) renal impairment
- 5) hepatic impairment
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What drugs are increased in the serum because of TCAs?
- 1) SSRIs
- 2) cimetidine
- 3) diltiazem
- 4) verapamil
- 5) labetolol
- 6) propoxyphene
- 7) quinidine
- 8) haloperidol
- 9) methylphenidate
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Which drugs are effected by decreased levels of TCAs?
- 1) CBZ
- 2) phenytoin
- 3) barbiturates
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What drugs, in combination with TCAs, will cause serotonin syndrome?
MAOIs
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What are some parameters that should be monitored while a patient is taking TCAs?
- 1) BP
- 2) pulse
- 3) ECG changes
- 4) mental status changes
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What pregnancy category are amitriptyline (Elavil)?
Pregnancy category D
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What are the indications for amitriptyline (Elavil)?
- 1) depression
- 2) chronic/neuropathic pain
- 3) migraine prophylaxis
- 4) peripheral neuropathy
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What is the initial dose of amitriptyline (Elavil)?
50-75 mg
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What is the dosage range for amitriptyline (Elavil)?
75-300 mg
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What pregnancy category is nortriptyline (Pamelor, Aventyl)?
Pregnancy category D
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What are the indications for nortriptyline (Pamelor, Aventyl)?
- 1) depression
- 2) chronic pain
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What is the initial dose of nortriptyline (Pamelor, Aventyl)?
25-50 mg
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What is the dose range for nortriptyline (Pamelor, Aventyl)?
40-200 mg
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What are the indications for imipramine (Tofranil)?
- 1) depression
- 2) childhood enuresis
- 3) chronic/neuropathic pain
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What is the initial dose for imipramine (Tofranil)?
50-75 mg
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What is the dose range for imipramine (Tofranil)?
75-300 mg
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What is the pregnancy category for doxepin (Sinequan)?
Pregnancy category C
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What are the indications for doxepin (Sinequan)?
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What is the inital dose of doxepin (Sinequan)?
75 mg in divided doses BID or TID
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What is the dose range for doxepin (Sinequan)?
75-300 mg
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What pregnancy category is clomipramine (Anafranil)?
prengancy category C
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What are the indications for clomipramine (Anafranil)?
- 1) OCD
- 2) depression
- 3) chronic pain
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What is the initial dose for clomipramine (Anafranil)?
25-100 mg titrated up for 1-2 weeks
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What is the usual effective dose for clomipramine (Anafranil)?
200-250 mg/day
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What is the maximum dose of clomipramine (Anafranil)?
250 mg
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What pregnancy category is desipramine (Norpramin)?
Pregnancy category C
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What are the indications of desipramine (Norpramin)?
- 1) depression
- 2) chronic pain
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What is the initial dose for desipramine (Norpramin)?
50-75 mg
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What is the dose range for desipramine (Norpramin)?
75-300 mg
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What are the adverse effects of MAOIs?
- 1) weight gain
- 2) orthostatic hypotension
- 3) sexual dysfuntion
- 4) anticholinergic effects
- 5) hypertensive crisis
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What are the contraindications of MAOIs?
- 1) renal dysfunction
- 2) hepatic dysfunction
- 3) CVD
- 4) concomitant sympathomimetic therapy
- 5) use of SSRI within the last two weeks
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What foods should be avoided when using MAOIs?
Tyramine containing foods such as red wine and aged cheeses.
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What are some drug interactions of MAOIs?
- 1) TCAs
- 2) SSRIs
- 3) sympathomimetics
- 4) meperidine
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What are some MAOIs?
- 1) Penelzine (Nardil)
- 2) Tranylcypromine (Parnate)
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What should you do when wanting to d/c an SSRI?
You should taper down the dose of the SSRI.
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What are some side effects of SSRIs?
- 1) GI complaints
- 2) nervousness
- 3) insomnia
- 4) headache
- 5) fatigue
- 6) sexual dysfunction
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What are some side effects caused by abrupt withdrawal of SSRIs?
- 1) flu-like symptoms
- 2) dizziness
- 3) nausea
- 4) tremor
- 5) anxiety
- 6) palpitations
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What is the initial dose of citalopram (Celexa)?
10 mg
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What is the usual dose range of citalopram (Celexa)?
20-40 mg/day
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What is the maximum dose of citalopram (Celexa)?
60 mg/day
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What is the initial dose of escitalopram (Lexapro)?
10 mg
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What is the usual dose of escitalopram (Lexapro)?
10-20 mg/day
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What is the dose equivalence between citalopram (Celexa) and escitalopram (Lexapro)?
40 mg citalopram (Celexa) = 10 mg escitalopram (Lexapro)
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What is the initial dose of fluvoxamine (Luvox)?
50 mg
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What is the usual dose of fluvoxamine (Luvox)?
100-300 mg/day
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What is the initial dose of Paroxetine (Paxil)?
10-20 mg
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What is the usual dose of paroxetine (Paxil)?
10-40 mg
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What is the maximum dose of paroxetine (Paxil)?
50 mg/day
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What is the dosing equivalence between paroxetine (Paxil) and paroxetine Cr (Paxil Cr)?
10 mg paroxetine (Paxil) = 12.5 mg paroxetine Cr (Paxil Cr
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What is the initial dose of fluoxetine (Prozac)?
10-20 mg
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What is the usual dose of fluoxetine (Prozac)?
20-80 mg
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What is the initial dose of sertraline (Zoloft)?
25-50 mg
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What is the usual dose of sertraline (Zoloft)?
50-100 mg/day
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What is the maximum dose of sertraline (Zoloft)?
200 mg/day
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