MH701 - EXAM 1 QUESTIONS & ANSWERS
These drugs are most likely to cause this discontinuation syndrome - Answer -1-Paxil
2-Effexor
Goal of antidepressant therapy: - Answer -Symptom remission and return to baseline
functioning
Initial therapy with antidepressants - Answer -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? - Answer --St.
John's Wart (SAMe)
-light therapy
-exercise
Factors favoring treatment with an antidepressant: - Answer --Agitation
-Problems with sleep and/or appetite
-hx of response to antidepressant
-patient preference
-moderate to severe symptoms.
What are the most bothersome symptoms? - Answer -Anxious, Energized, Vegetative,
Altered Sleep, Altered Sex Drive, Appetite Change, Fatigue, Hypersomnia
SSRIs from most energizing to most sedating: - Answer -1-Fluoxetine (Prozac)
2-Sertraline (Zoloft)
3-Citalopram (Celexa)
4-Escitalopram (Lexapro)
5-Paroxetine (Paxil)
With antidepressant therapy, response can be expected in: - Answer -50-75% of pts
Choice of Antidepressant - Answer --response history (if not initial episode)
-Comorbidities
-Depressive symptoms
-Safety/tolerability
-Drug interactions
-Pharmacokinetics
-Cost
-Patient preference
,When treating depression w/ anxiety: - Answer --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: - Answer -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? - Answer -bupropion (welbutrin)
buspirone (buspar)
phosphodiesterase inhibitor (eg: viagra)
Sildenafil (Viagra) - Answer -does reduce SSRI-induced sexual dysfunction in men
Tadalafil (Cialis) - Answer -may reduce SSRI-induced sexual dysfunction in men
Phosphodiesterase Inhibitors - Answer -milrinone (Primacor)
most n/v - Answer -prozac, effexor, cymbalta
most diarrhea - Answer -zoloft
akathisia - Answer -inner restlessness
Insomnia may be reduced through - Answer -a.m. dosing, good sleep hygiene, CBT,
melatonin or adding trazodone, a serotonin reuptake inhibitor/antagonist
most common SSRI to cause weight gain is - Answer -paroxetine (Paxil)
weight neutral/loss - Answer -Bupropion (Wellbutrin) and fluoxetine (Prozac)
may cause weight loss - Answer -Venlafaxine (Effexor)
least likely to cause discontinuation syndrome - Answer -prozac
TCAs can cause - Answer -anticholinergic symptoms
-mental status changes
-urinary retention
-blurred vision.
TCA has the least anticholinergic side effects - Answer -Desipramine
TCA having the greatest anticholinergic side effects - Answer -amitriptyline
,Citalopram (Celexa) is associated with - Answer -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 - Answer -a
hypertensive crisis
may cause dose-dependent HTN - Answer -Buproprion (Wellbutrin), venlafaxine
(Effexor), duloxetine and desvenlafaxine (Pristiq)
Serotonin Syndrome
More commonly seen with - Answer -SSRI combined with:
-triptan
-tramadol
-linezolid
*most severe when combined with a MAOI
CYP450 Drug Interactions
SSRIs with most significant enzyme inhibitors are - Answer -fluoxetine (Prozac),
fluvoxamine (Luvox) and paroxetine (Paxil)
greatest potential for inhibition of metabolism of other drugs among the SNRIs - Answer
-Duloxetine (Cymbalta)
response - Answer -at least a 50% improvement of symptoms.
remission - Answer -removal of almost all s/s for up to 6 months
recovery - Answer -s/s free more than 6 months
relapse - Answer -return of s/s before full remission or in first several months following
remission
recurrence - Answer -return of depression s/s after recovery
monoamine oxidase inhibitors (MAOIs) adverse effects - Answer -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. - Answer -combination of
medications and psychotherapy
APA recommendations: Initial therapy -- mild or moderate depression - Answer -options
include pharmacotherapy alone, psychotherapy alone or a combination.
, APA recommendations: For pts who request a CAM - Answer --St. John's Wart (SAMe)
-- efficacy is unclear.
-light therapy and exercise
Factors favoring treatment with an antidepressant: - Answer -(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 - Answer --
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 - Answer --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: - Answer --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 - Answer -in 1 to 2 weeks; maximum improvement ranges four to 12
weeks
If no response is seen in - Answer -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, - Answer -antidepressant therapy should
continue for at least four to nine months.
Individuals who have had three or more episodes of depression - Answer -most likely
will need continuous maintenance therapy.
MDD s/s - Answer -5 of 9
-sleep (too much/too little)
-decrease interest
These drugs are most likely to cause this discontinuation syndrome - Answer -1-Paxil
2-Effexor
Goal of antidepressant therapy: - Answer -Symptom remission and return to baseline
functioning
Initial therapy with antidepressants - Answer -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? - Answer --St.
John's Wart (SAMe)
-light therapy
-exercise
Factors favoring treatment with an antidepressant: - Answer --Agitation
-Problems with sleep and/or appetite
-hx of response to antidepressant
-patient preference
-moderate to severe symptoms.
What are the most bothersome symptoms? - Answer -Anxious, Energized, Vegetative,
Altered Sleep, Altered Sex Drive, Appetite Change, Fatigue, Hypersomnia
SSRIs from most energizing to most sedating: - Answer -1-Fluoxetine (Prozac)
2-Sertraline (Zoloft)
3-Citalopram (Celexa)
4-Escitalopram (Lexapro)
5-Paroxetine (Paxil)
With antidepressant therapy, response can be expected in: - Answer -50-75% of pts
Choice of Antidepressant - Answer --response history (if not initial episode)
-Comorbidities
-Depressive symptoms
-Safety/tolerability
-Drug interactions
-Pharmacokinetics
-Cost
-Patient preference
,When treating depression w/ anxiety: - Answer --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: - Answer -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? - Answer -bupropion (welbutrin)
buspirone (buspar)
phosphodiesterase inhibitor (eg: viagra)
Sildenafil (Viagra) - Answer -does reduce SSRI-induced sexual dysfunction in men
Tadalafil (Cialis) - Answer -may reduce SSRI-induced sexual dysfunction in men
Phosphodiesterase Inhibitors - Answer -milrinone (Primacor)
most n/v - Answer -prozac, effexor, cymbalta
most diarrhea - Answer -zoloft
akathisia - Answer -inner restlessness
Insomnia may be reduced through - Answer -a.m. dosing, good sleep hygiene, CBT,
melatonin or adding trazodone, a serotonin reuptake inhibitor/antagonist
most common SSRI to cause weight gain is - Answer -paroxetine (Paxil)
weight neutral/loss - Answer -Bupropion (Wellbutrin) and fluoxetine (Prozac)
may cause weight loss - Answer -Venlafaxine (Effexor)
least likely to cause discontinuation syndrome - Answer -prozac
TCAs can cause - Answer -anticholinergic symptoms
-mental status changes
-urinary retention
-blurred vision.
TCA has the least anticholinergic side effects - Answer -Desipramine
TCA having the greatest anticholinergic side effects - Answer -amitriptyline
,Citalopram (Celexa) is associated with - Answer -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 - Answer -a
hypertensive crisis
may cause dose-dependent HTN - Answer -Buproprion (Wellbutrin), venlafaxine
(Effexor), duloxetine and desvenlafaxine (Pristiq)
Serotonin Syndrome
More commonly seen with - Answer -SSRI combined with:
-triptan
-tramadol
-linezolid
*most severe when combined with a MAOI
CYP450 Drug Interactions
SSRIs with most significant enzyme inhibitors are - Answer -fluoxetine (Prozac),
fluvoxamine (Luvox) and paroxetine (Paxil)
greatest potential for inhibition of metabolism of other drugs among the SNRIs - Answer
-Duloxetine (Cymbalta)
response - Answer -at least a 50% improvement of symptoms.
remission - Answer -removal of almost all s/s for up to 6 months
recovery - Answer -s/s free more than 6 months
relapse - Answer -return of s/s before full remission or in first several months following
remission
recurrence - Answer -return of depression s/s after recovery
monoamine oxidase inhibitors (MAOIs) adverse effects - Answer -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. - Answer -combination of
medications and psychotherapy
APA recommendations: Initial therapy -- mild or moderate depression - Answer -options
include pharmacotherapy alone, psychotherapy alone or a combination.
, APA recommendations: For pts who request a CAM - Answer --St. John's Wart (SAMe)
-- efficacy is unclear.
-light therapy and exercise
Factors favoring treatment with an antidepressant: - Answer -(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 - Answer --
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 - Answer --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: - Answer --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 - Answer -in 1 to 2 weeks; maximum improvement ranges four to 12
weeks
If no response is seen in - Answer -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, - Answer -antidepressant therapy should
continue for at least four to nine months.
Individuals who have had three or more episodes of depression - Answer -most likely
will need continuous maintenance therapy.
MDD s/s - Answer -5 of 9
-sleep (too much/too little)
-decrease interest
