PAEA Psychiatry EOR Topics
acute AMS, seizures, coma, restlessness, diaphoresis, tremor, hyperthermia, N/V,
abdominal pain, mydriasis, and tachycardia are all signs of? which is caused by? -
✔️✔️serotonin syndrome
caused by SSRI + MAOI use or inadequate wash out time between switching meds
list the SNRIs - ✔️✔️venlafaxine/Effexor, desvenlafaxine/Pristiq, duloxetine/Cymbalta
which antidepressant can cause worsening of glaucoma? - ✔️✔️duloxetine/Cymbalta
amitriptyline, doxepin, cimipramine, imipramine, trimipramine, nortriptyline, amoxapine,
desipramine, protriptyline are what class of medications? - ✔️✔️TCAs for depression;
"-amine" & "-triptyline"
MDD diagnosis requires ___ or more symptoms every day for ___ weeks that is causing
impairment in social, occupational, or other important areas of funtioning - ✔️✔️≥5
symptoms
2 weeks
what are the symptoms of MDD? - ✔️✔️SIG E CAPS
-*S*leep (insomnia or hypersomnia)
-*I*nterest (decreased pleasure/interest in doing things)
-*G*uilt (or feelings of worthlessness)
-*E*nergy (loss or fatigue)
-*C*oncentration (loss or indecisiveness)
-*A*ppetite (loss or hyperphagia resulting in wt. loss or gain)
-*P*sychomotor (retardation or agitation)
-*S*uicidal Ideation
depression is thought to be caused by decreased levels of - ✔️✔️serotonin,
norepinephrine, and/or dopamine
how long does it take for most anti-depressants to start working enough that the patient
notices a difference? - ✔️✔️3 weeks with max effect at 3 mos
Dx? depressed mood for most of the day, more days than not for ≥2 years -
✔️✔️Persistent Depressive Disorder (Dysthymia)
,persistent depressive disorder (dysthymia) requires how many symptoms to be present
for at least 2 years? - ✔️✔️≥2 symptoms of depression (SIG E CAPS)
cyclothymic disorder is similar to persistent depressive disorder (dysthymia) in that
symptoms must be present for ____ years and not absent for more than ____ months at
a time - ✔️✔️2 years
2 months
what meds are considered 1st line in treating depressive disorders like MDD and PDD?
- ✔️✔️SSRI's (fluoxetine/Prozac, sertraline/Zoloft, paroxetine/Paxil, citalopram/Celexa,
escitalopram/Lexapro, fluvoxamine/Luvox)
what is another way treatment resistant depression can be treated? -
✔️✔️electroconvulsive therapy (ECT)- inducing a brief seizure causes the release of
NTs
all antidepressants carry a BBW for - ✔️✔️suicidal ideation (thoughts, not attempts) in
children, adolescents, and young adults; if this occurs, consider it a side effect of a med
instead of worsening depression & change meds
which antidepressants can lower the seizure threshold? which is the worst? - ✔️✔️ALL!
Bupropion is worst
which antidepressants can cause QT prolongation? which is the worst? - ✔️✔️ALL
except for *combined SSRIs* (vilazodone/Viibryd, vortioxetine/Brintellex), *MAOIs*
(Isocaboxazid/Marplan, phenelzine/Nardil, tranylcypromine/Parnate, selegiline
transdermal patch), and *"fringe drugs"* (buproprion/Wellbutrin, mirtazapine/Remeron,
trazodone)
*citalopram*/Celexa (SSRI) has a BBW for QT prolongation
which SSRI is category D/X in pregnant patients for causing pulmonary HTN in
newborns? - ✔️✔️paroxetine/Paxil
1st, 2nd, and 3rd line medication treatment for depression - ✔️✔️1st- SSRIs
2nd- SNRIs, bupropion, mirtazapine
3rd- TCAs & MAOIs
all of these work best when combined with CBT
what are some common SEs of SSRIs? - ✔️✔️GI upset, sexual dysfxn, HA, changes in
energy level, anxiety, insomnia, wt changes, SIADH
, what are some reasons TCAs should generally be avoided in the elderly? - ✔️✔️-
cardiotoxicity (QT prolongation)
-anticholinergic SEs (can't pee, can't see, can't spit, can't shit)
-increases fall risk, confusion & sedation
what antidepressant is often used to overdose and can be detected on EKG of OD pts
as prolonged QT and wide complex tachycardia? - ✔️✔️TCAs "-amine" & "-triptyline"
list the MAOIs - ✔️✔️isocarboxazid/Marplan, phenelzine/Nardil,
tranylcypromine/Parnate, selegiline transderm patch
hypertensive crisis occurs with what class of antidepressants when tyramine containing
foods are ingested (fermented: beer, cheese, wine, etc.) - ✔️✔️MAOIs
what antidepressant works by inhibiting reuptake of dopamine and norepinephrine? -
✔️✔️bupropion/Wellbutrin
bupropion/Wellbutrin should NOT be given to what patients? - ✔️✔️-seizures
(significantly lowers threshold)
-bulimia/anorexia (electrolyte imbalances also lower seizure threshold)
-bipolar d/o (can cause mania)
what antidepressant has less GI upset and sexual dysfunction side effects than the
rest? - ✔️✔️bupropion/Wellbutrin
what antidepressant is also FDA approved to assist in treating smoking cessation? -
✔️✔️bupropion/Wellbutrin
what are the main SEs of mirtazapine/Remeron & trazodone? - ✔️✔️*sedation* -in fact
trazodone is predominately used for insomnia
what is the difference b/t diagnosing bipolar I vs II disorder? - ✔️✔️bipolar I: at least 1
*manic* episode +/- occasional depressive episodes (doesn't have to be MDE)
bipolar II: *hypomanic* episodes with at least 1 *MD episode*
mania is defined as abnml or persistently elevated, expanisve or irritable mood lasting
for at least ______ (or less if hospitalization is required) w/ marked impairment of
social/occupational fxn; hypomania is elevated/irritable mood w/o social/occupational
impairment or hospitalization for at least ____ amt of time - ✔️✔️mania: 1 week
hypomania: 4 days
what does the acronym DIGFAST (used in diagnosis of bipolar d/o) stand for? - ✔️✔️-
Distractibility
-Involvement in pleasurable activities
-Grandiosty
acute AMS, seizures, coma, restlessness, diaphoresis, tremor, hyperthermia, N/V,
abdominal pain, mydriasis, and tachycardia are all signs of? which is caused by? -
✔️✔️serotonin syndrome
caused by SSRI + MAOI use or inadequate wash out time between switching meds
list the SNRIs - ✔️✔️venlafaxine/Effexor, desvenlafaxine/Pristiq, duloxetine/Cymbalta
which antidepressant can cause worsening of glaucoma? - ✔️✔️duloxetine/Cymbalta
amitriptyline, doxepin, cimipramine, imipramine, trimipramine, nortriptyline, amoxapine,
desipramine, protriptyline are what class of medications? - ✔️✔️TCAs for depression;
"-amine" & "-triptyline"
MDD diagnosis requires ___ or more symptoms every day for ___ weeks that is causing
impairment in social, occupational, or other important areas of funtioning - ✔️✔️≥5
symptoms
2 weeks
what are the symptoms of MDD? - ✔️✔️SIG E CAPS
-*S*leep (insomnia or hypersomnia)
-*I*nterest (decreased pleasure/interest in doing things)
-*G*uilt (or feelings of worthlessness)
-*E*nergy (loss or fatigue)
-*C*oncentration (loss or indecisiveness)
-*A*ppetite (loss or hyperphagia resulting in wt. loss or gain)
-*P*sychomotor (retardation or agitation)
-*S*uicidal Ideation
depression is thought to be caused by decreased levels of - ✔️✔️serotonin,
norepinephrine, and/or dopamine
how long does it take for most anti-depressants to start working enough that the patient
notices a difference? - ✔️✔️3 weeks with max effect at 3 mos
Dx? depressed mood for most of the day, more days than not for ≥2 years -
✔️✔️Persistent Depressive Disorder (Dysthymia)
,persistent depressive disorder (dysthymia) requires how many symptoms to be present
for at least 2 years? - ✔️✔️≥2 symptoms of depression (SIG E CAPS)
cyclothymic disorder is similar to persistent depressive disorder (dysthymia) in that
symptoms must be present for ____ years and not absent for more than ____ months at
a time - ✔️✔️2 years
2 months
what meds are considered 1st line in treating depressive disorders like MDD and PDD?
- ✔️✔️SSRI's (fluoxetine/Prozac, sertraline/Zoloft, paroxetine/Paxil, citalopram/Celexa,
escitalopram/Lexapro, fluvoxamine/Luvox)
what is another way treatment resistant depression can be treated? -
✔️✔️electroconvulsive therapy (ECT)- inducing a brief seizure causes the release of
NTs
all antidepressants carry a BBW for - ✔️✔️suicidal ideation (thoughts, not attempts) in
children, adolescents, and young adults; if this occurs, consider it a side effect of a med
instead of worsening depression & change meds
which antidepressants can lower the seizure threshold? which is the worst? - ✔️✔️ALL!
Bupropion is worst
which antidepressants can cause QT prolongation? which is the worst? - ✔️✔️ALL
except for *combined SSRIs* (vilazodone/Viibryd, vortioxetine/Brintellex), *MAOIs*
(Isocaboxazid/Marplan, phenelzine/Nardil, tranylcypromine/Parnate, selegiline
transdermal patch), and *"fringe drugs"* (buproprion/Wellbutrin, mirtazapine/Remeron,
trazodone)
*citalopram*/Celexa (SSRI) has a BBW for QT prolongation
which SSRI is category D/X in pregnant patients for causing pulmonary HTN in
newborns? - ✔️✔️paroxetine/Paxil
1st, 2nd, and 3rd line medication treatment for depression - ✔️✔️1st- SSRIs
2nd- SNRIs, bupropion, mirtazapine
3rd- TCAs & MAOIs
all of these work best when combined with CBT
what are some common SEs of SSRIs? - ✔️✔️GI upset, sexual dysfxn, HA, changes in
energy level, anxiety, insomnia, wt changes, SIADH
, what are some reasons TCAs should generally be avoided in the elderly? - ✔️✔️-
cardiotoxicity (QT prolongation)
-anticholinergic SEs (can't pee, can't see, can't spit, can't shit)
-increases fall risk, confusion & sedation
what antidepressant is often used to overdose and can be detected on EKG of OD pts
as prolonged QT and wide complex tachycardia? - ✔️✔️TCAs "-amine" & "-triptyline"
list the MAOIs - ✔️✔️isocarboxazid/Marplan, phenelzine/Nardil,
tranylcypromine/Parnate, selegiline transderm patch
hypertensive crisis occurs with what class of antidepressants when tyramine containing
foods are ingested (fermented: beer, cheese, wine, etc.) - ✔️✔️MAOIs
what antidepressant works by inhibiting reuptake of dopamine and norepinephrine? -
✔️✔️bupropion/Wellbutrin
bupropion/Wellbutrin should NOT be given to what patients? - ✔️✔️-seizures
(significantly lowers threshold)
-bulimia/anorexia (electrolyte imbalances also lower seizure threshold)
-bipolar d/o (can cause mania)
what antidepressant has less GI upset and sexual dysfunction side effects than the
rest? - ✔️✔️bupropion/Wellbutrin
what antidepressant is also FDA approved to assist in treating smoking cessation? -
✔️✔️bupropion/Wellbutrin
what are the main SEs of mirtazapine/Remeron & trazodone? - ✔️✔️*sedation* -in fact
trazodone is predominately used for insomnia
what is the difference b/t diagnosing bipolar I vs II disorder? - ✔️✔️bipolar I: at least 1
*manic* episode +/- occasional depressive episodes (doesn't have to be MDE)
bipolar II: *hypomanic* episodes with at least 1 *MD episode*
mania is defined as abnml or persistently elevated, expanisve or irritable mood lasting
for at least ______ (or less if hospitalization is required) w/ marked impairment of
social/occupational fxn; hypomania is elevated/irritable mood w/o social/occupational
impairment or hospitalization for at least ____ amt of time - ✔️✔️mania: 1 week
hypomania: 4 days
what does the acronym DIGFAST (used in diagnosis of bipolar d/o) stand for? - ✔️✔️-
Distractibility
-Involvement in pleasurable activities
-Grandiosty
