MH701 - Exam 1 - Big Set. 71 pages of questions with Accurate answers. 99% Examinable.

MH701 - Exam 1 - Big Set. 71 pages of questions with Accurate answers. 99% Examinable. Document Content and Description Below These drugs are most likely to cause this discontinuation syndrome - Ans-1-Paxil 2-Effexor Goal of antidepressant therapy: - Ans-Symptom remission and return to baseline functioning Initial the rapy with antidepressants - Ans-severe: combo of meds and therapy mild-mod: options: meds alone therapy alone combo What would you recommend to patients who request a CAM therapies? - Ans--St. John's Wart (SAMe) -light therapy -exercise Factors favoring treatment with an antidepressant: - Ans--Agitation -Problems with sleep and/or appetite -hx of response to antidepressant -patient preference -moderate to severe symptoms. With antidepressant therapy, response can be expected in: - Ans-50-75% of pts Choice of Antidepressant - Ans--response history (if not initial episode) -Comorbidities -Depressive symptoms -Safety/tolerability -Drug interactions -Pharmacokinetics -Cost -Patient preference What are the most bothersome symptoms? - Ans-Anxious, Energized, Vegetative, Altered Sleep, Altered Sex Drive, Appetite Change, Fatigue, Hypersomnia SSRIs from most energizing to most sedating: - Ans-1-Fluoxetine (Prozac) 2-Sertraline (Zoloft) 3-Citalopram (Celexa) 4-Escitalopram (Lexapro) 5-Paroxetine (Paxil) When treating depression w/ anxiety: - Ans--less energizing SSRI, Venlafaxine or Duloxetine -Viibryd if others fail -if fluoxetine w/ anxiety be sure to start low and titrate slowly to avoid activation of anxiety -Avoid Wellbutrin too activating; increased anxiety most common clinical mistake leading to an unsuccessful trial of an antidepressant drug is: - Ans-too low a dosage for too short a time If the pt is having sexual side effects but you do not want to change the antidepressant, what can you add on? - Ans-bupropion (welbutrin) buspirone (buspar) phosphodiesterase inhibitor (eg: viagra) Sildenafil (Viagra) - Ans-does reduce SSRI-induced sexual dysfunction in men Tadalafil (Cialis) - Ans-may reduce SSRI-induced sexual dysfunction in men Phosphodiesterase Inhibitors - Ans-milrinone (Primacor) most n/v - Ans-prozac, effexor, cymbalta most diarrhea - Ans-zoloft akathisia - Ans-inner restlessness Insomnia may be reduced through - Ans-a.m. dosing, good sleep hygiene, CBT, melatonin or adding trazodone, a serotonin reuptake inhibitor/antagonist most common SSRI to cause weight gain is - Ans-paroxetine (Paxil) weight neutral/loss - Ans-Bupropion (Wellbutrin) and fluoxetine (Prozac) may cause weight loss - Ans-Venlafaxine (Effexor) least likely to cause discontinuation syndrome - Ans-prozac TCAs can cause - Ans-anticholinergic symptoms -mental status changes -urinary retention -blurred vision. TCA has the least anticholinergic side effects - Ans-Desipramine TCA having the greatest anticholinergic side effects - Ans-amitriptyline Citalopram (Celexa) is associated with - Ans-QT interval prolongation and torsade de pointe --FDA recommends against using doses 40 mg/day MAOs when combined with SSRIs, SNRIs and TCAs can cause - Ans-a hypertensive crisis may cause dose-dependent HTN - Ans-Buproprion (Wellbutrin), venlafaxine (Effexor), duloxetine and desvenlafaxine (Pristiq) Serotonin Syndrome More commonly seen with - Ans-SSRI combined with: -triptan -tramadol -linezolid *most severe when combined with a MAOI CYP450 Drug Interactions SSRIs with most significant enzyme inhibitors are - Ans-fluoxetine (Prozac), fluvoxamine (Luvox) and paroxetine (Paxil) greatest potential for inhibition of metabolism of other drugs among the SNRIs - Ans-Duloxetine (Cymbalta) response - Ans-at least a 50% improvement of symptoms. remission - Ans-removal of almost all s/s for up to 6 months recovery - Ans-s/s free more than 6 months relapse - Ans-return of s/s before full remission or in first several months following remission recurrence - Ans-return of depression s/s after recovery monoamine oxidase inhibitors (MAOIs) adverse effects - Ans-hypertensive crisis, orthostatic hypertension, serotonin syndrome APA recommednations: Initial therapy -- severe depression For patients who request a CAM St. John's Wart (SAMe) may be tried but efficacy is unclear. Other CAM includes light therapy and exercise. - Ans-combination of medications and psychotherapy APA recommendations: Initial therapy -- mild or moderate depression - Ans-options include pharmacotherapy alone, psychotherapy alone or a combination. APA recommendations: For pts who request a CAM - Ans--St. John's Wart (SAMe) -- efficacy is unclear. -light therapy and exercise Factors favoring treatment with an antidepressant: - Ans-(response expected in 50-75% of pts.) -Agitation -Problems w/ sleep and/or appetite -hx response to antidepressant, patient preference and moderate to severe symptoms. Choice of antidepressant is largely based on the following factors - Ans--Antidepressant response history (if not initial episode) -Comorbidities -Depressive symptoms -Safety/tolerability (MAOIs and TCA's are not appropriate first-line) -Drug interactions -Pharmacokinetics -Cost -Patient preference how to choose antidepressant - Ans--What are the most bothersome symptoms? (Anxious, Energized, Vegetative, Altered Sleep, Altered Sex Drive, Appetite Change, Fatigue, Hypersomnia) -Take advantage of the side effects When treating depression w/ anxiety: - Ans--Use less energizing SSRI, Venlafaxine or Duloxetine. Consider Viibryd if others fail. -If using Fluoxetine -- start low and titrate slowly to avoid activation of anxiety -Avoid Wellbutrin as this is too activating; can cause increased anxiety Initial improvement - Ans-in 1 to 2 weeks; maximum improvement ranges four to 12 weeks If no response is seen in - Ans-4 to 8 weeks with maximally tolerated dose then: -switch to a different med in the same or different class. After complete remission of symptoms, - Ans-antidepressant therapy should continue for at least four to nine months. Individuals who have had three or more episodes of depression - Ans-most likely will need continuous maintenance therapy. MDD s/s - Ans-5 of 9 -sleep (too much/too little) -decrease interest -guilt/worthlessness -energy (decreased) -concentration problems -appetite (too much/too little) -psychomotor agitation/retardation -suicidality how long must s/s of depression be present - Ans-more than 2 weeks priaprism - Ans-Painful erection lasting longer than 3 hours Serotonin syndrome symptoms - Ans-hypertension, tachycardia; myoclonic jerking, tremors; nausea, diarrhea, sweating, hyperthermia; agitation, confusion lability of mood disorientation ataxia SSRI's - Ans-Citalopram celexa Escitalopram lexapro Fluoxetine prozac Fluvoxamine luvox Paroxetine paxil Sertraline zoloft Bupropion (Wellbutrin) Contraindications - Ans-seizures, HTN, bulimia, insomnia / agitation Agonist = Full Agnist - Ans-Binds to receptor with full effect, like that of a neurotransmitter SSRI Most likely to have drug interaction - Ans-Fluoxetine, fluvoxamine and paroxetine Dopamine - Ans-A neurotransmitter associated with movement, attention and learning and the brain's pleasure and reward system. to much dopamine - Ans-schizophrenia To little dopamine causes - Ans-depression and parkinson Depression neurotransmitters - Ans-decreased dopamine, serotonin and norepinephrine increased acetylcholine GABA most