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depression

  1. comorbidities that cause mental status changes
    • diabetes
    • AIDS
    • hypothyroidism
    • electrolyte disorders
    • SLE
    • neurologic disorders
    • malignant disease (cancer)
  2. lab work to rule out physical causes that may mimic depression
    • CBC with diff
    • thyroid function tests
    • electrolytes
    • basic metabolic panel
    • liver function tests
    • pregnancy test
  3. what are the increased risk of suicide
    • a detailed plan
    • living alone
    • having a physical illness
    • being unemployed
    • age 15-24 or > 65
    • history of drug/alcohol abuse
    • FH of suicide
  4. what are the personality changes with suicide risks
    • giving away possessions
    • making a will
    • purchasing a firearm
    • asking about the lethal dose of medications
  5. non pharmacologic options
    • -ECT 
    • -Psychotherapy (behavior therapy)
    • -transcranial magnetic stimulation
    • -light therapy 
  6. when is ECT used?
    • -pts with severe MDD refractory to psychotherapy  and pharmacotherapy
    • -patients in need of urgent response
  7. how many times is ECT used
    3 treatments per week
  8. when to not use ECT
    for patients on meds that lower seizure threshold (BZDs) or promote cognitive impairment
  9. side effects of ECT
    memory loss, muscle aches, headaches
  10. when is psychotherapy used
    • mild to moderate MDD
    • pregnant women
    • can be used in conjunction with PT
  11. what disease do light therapy treat
    seasonal affective disorder (SAD)
  12. minimum time until response is achieved
    4- 6 wks
  13. how is a response to treatment defined
    a >=50% drop in depression rating scores
  14. what is remission
    absence of symptoms (achieved in 35-40%)
  15. phases of therapy
    • acute (6-12 wks)
    • continuation (4-9 mths)
    • maintenance (12-36 mths) 
  16. which symptoms are the first to respond to in therapy
    neurogenerative
  17. Fluoxetine dosing
    • initial 20
    • usual 20-60
  18. when to avoid giving fluoxetine
    in pts with hepatic impairment
  19. Sertraline dosing
    • (zoloft)
    • initial 50
    • usual 50-200
  20. paroxetine dosing
    • (paxil)
    • initial 20
    • usual 20-60
  21. fluvoxamine dosing
    • luvox
    • initial 50
    • usual 50-300
  22. citalopram dosing
    • (celexa)
    • initial- 20
    • usual- 20-40
  23. citalopram monitoring paramater
    ECK for QTc prolongation
  24. what is first line for treatment of depression
    SSRI
  25. only SSRI associated with weight gain 
    paroxetine
  26. SSRI AE
    • GI upset
    • insomnia
    • headache
    • sex dysfunction
    • weight changes
    • somnolence
    • discontinuation syndrome
    • initial increase in anxiety
  27. CYP 1A2 SSRI interaction
    fluvoxamine (luvox)
  28. CYP 2C19 SSRI interaction
    • fluvoxamine (luvox)
    • fluoxetine (prozac)
  29. CYP 2D6 SSRI interaction
    • Paroxetine (paxil)
    • fluoxetine (prozac)
    • Escitalopram (lexapro)
    • Citalopram (celexa)
    • sertraline (zoloft)
  30. CYP 3A4 SSRI interaction
    norfluoxetine
  31. drugs that cause serotonin syndrome
    • antiemetics (metoclopramide, ondansetron)
    • DM
    • fentanyl
    • linezolid
    • meperidine
    • ritonavir
    • triptans
    • sibutramine
    • tramadol
    • valproic acid
  32. symptoms of serotonin syndrome
    • confusion
    • hypomania
    • restlessness
    • myoclonus
    • hyperreflexia
    • diaphoresis
    • shivering
    • tremor
    • diarrhea
    • incoordination
  33. duloxetine dosing
    • (cymbalta)
    • initial 30
    • usual 30-60
  34. avoid duloxetine when:
    • hepatic impairment:CrCl < 30ml/min
    • chronic alcohol use
  35. venlafaxine dosing
    • (effexor)
    • initial 37.5-75
    • usual 75-300
  36. desvenlafaxine
    • (pristiq)
    • initial 50
    • usual 50-400
  37. Buproprion dosing
    • (wellbutrin)
    • initial 150
    • usual 150-300
  38. higher doses of venlafaxine can cause 
    increase BP
  39. 3 dosage forms of wellbutrin
    • IR- 300-450
    • SR-150-400
    • ER-150-300
  40. wellbutrin contraindications
    • seizures (or pts with low threshold for seizures)
    • eating disorders
  41. TCAs that cause blue-green urine
    amitriptyline and desipramine
  42. Nortryptiline dosing
    • (Pamelor)
    • initial- 25
    • usual- 50-200
  43. TCAs are effective in pts for
    migraine prophylaxis and chronic pain
  44. MAOIs is the DOC for 
    atypical depression
  45. what to avoid when taking MAOIs
    foods high in tyramine
  46. AE of MAOIs
    • orthostatic hypotension
    • bradycardia
    • weight gain
    • sexual side effects
  47. MAOI drug interactions
    • decongestants
    • shouldnt combine with other antidepressants
    • 2 week washout period before initiating MAOI after other antidepressant
  48. mirtazpine dosing
    • (remeron)
    • initial 15
    • usual 15-45
  49. nefazodone
    • (serzone)
    • initial 100
    • usual 300-600
  50. trazadone
    • (desyrel)
    • initial 50
    • usual 150-300
  51. vilazodone
    • (viibryd)
    • initial 20
    • usual 20-40
  52. considerations of trazodone
    • given at night (causes sedation)
    • causes priapism
  53. vilazodone considerations
    must take with food
  54. antidepressant herbals
    • St johns wart (hypericum)
    • S-adenosyl methionine (SAMe)
  55. SSRI black box warning for 
    suicide ideations (increase energy to carry out suicide thought)
  56. serotonin withdrawal syndrome
    • electric shock sensations
    • headache
    • nausea
    • paresthesias 
    • sweating
    • tremulousness
    • vomiting
  57. FDA approved medication for pediatric patients
    Fluoxetine (prozac)
Author
alvo2234
ID
198025
Card Set
depression
Description
depression
Updated

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