2
MH701 Exam 1 Big Set questions with accurate detailed || || || || || || || || ||
answers
These drugs are most likely to cause this discontinuation syndrome - ✔✔1-Paxil
|| || || || || || || || || || ||
2-Effexor
Goal of antidepressant therapy: - ✔✔Symptom remission and return to baseline functioning
|| || || || || || || || || || ||
Initial therapy with antidepressants - ✔✔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? - ✔✔-St. John's
|| || || || || || || || || || || || || ||
Wart (SAMe) || ||
-light therapy || ||
-exercise
Factors favoring treatment with an antidepressant: - ✔✔-Agitation
|| || || || || || ||
-Problems with sleep and/or appetite || || || ||
-hx of response to antidepressant
|| || || ||
-patient preference || ||
-moderate to severe symptoms. || || ||
,2
With antidepressant therapy, response can be expected in: - ✔✔50-75% of pts
|| || || || || || || || || || ||
Choice of Antidepressant - ✔✔-response history (if not initial episode)
|| || || || || || || || ||
-Comorbidities
-Depressive symptoms ||
-Safety/tolerability ||
-Drug interactions
||
-Pharmacokinetics
-Cost
-Patient preference ||
What are the most bothersome symptoms? - ✔✔Anxious, Energized, Vegetative, Altered
|| || || || || || || || || || ||
Sleep, Altered Sex Drive, Appetite Change, Fatigue, Hypersomnia
|| || || || || || ||
SSRIs from most energizing to most sedating: - ✔✔1-Fluoxetine (Prozac)
|| || || || || || || || ||
2-Sertraline (Zoloft) ||
3-Citalopram (Celexa) ||
4-Escitalopram (Lexapro) ||
5-Paroxetine (Paxil) ||
When treating depression w/ anxiety: - ✔✔-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
|| || || || ||
,2
most common clinical mistake leading to an unsuccessful trial of an antidepressant drug is:
|| || || || || || || || || || || || || ||
- ✔✔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? - ✔✔bupropion (welbutrin)
|| || || || || || ||
buspirone (buspar) ||
phosphodiesterase inhibitor (eg: viagra) || || ||
Sildenafil (Viagra) - ✔✔does reduce SSRI-induced sexual dysfunction in men
|| || || || || || || || ||
Tadalafil (Cialis) - ✔✔may reduce SSRI-induced sexual dysfunction in men
|| || || || || || || || ||
Phosphodiesterase Inhibitors - ✔✔milrinone (Primacor) || || || ||
most n/v - ✔✔prozac, effexor, cymbalta
|| || || || ||
most diarrhea - ✔✔zoloft
|| || ||
akathisia - ✔✔inner restlessness || || ||
Insomnia may be reduced through - ✔✔a.m. dosing, good sleep hygiene, CBT, melatonin or
|| || || || || || || || || || || || || ||
adding trazodone, a serotonin reuptake inhibitor/antagonist
|| || || || ||
most common SSRI to cause weight gain is - ✔✔paroxetine (Paxil)
|| || || || || || || || || ||
weight neutral/loss - ✔✔Bupropion (Wellbutrin) and fluoxetine (Prozac)
|| || || || || || ||
, 2
may cause weight loss - ✔✔Venlafaxine (Effexor)
|| || || || || ||
least likely to cause discontinuation syndrome - ✔✔prozac
|| || || || || || ||
TCAs can cause - ✔✔anticholinergic symptoms
|| || || || || ||
-mental status changes || ||
-urinary retention ||
-blurred vision. ||
TCA has the least anticholinergic side effects - ✔✔Desipramine
|| || || || || || || ||
TCA having the greatest anticholinergic side effects - ✔✔amitriptyline
|| || || || || || || ||
Citalopram (Celexa) is associated with - ✔✔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 - ✔✔a hypertensive crisis
|| || || || || || || || || || || || ||
may cause dose-dependent HTN - ✔✔Buproprion (Wellbutrin), venlafaxine (Effexor),
|| || || || || || || || ||
duloxetine and desvenlafaxine (Pristiq) || || ||
Serotonin Syndrome ||
More commonly seen with - ✔✔SSRI combined with:
|| || || || || || || ||
-triptan
-tramadol
-linezolid
MH701 Exam 1 Big Set questions with accurate detailed || || || || || || || || ||
answers
These drugs are most likely to cause this discontinuation syndrome - ✔✔1-Paxil
|| || || || || || || || || || ||
2-Effexor
Goal of antidepressant therapy: - ✔✔Symptom remission and return to baseline functioning
|| || || || || || || || || || ||
Initial therapy with antidepressants - ✔✔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? - ✔✔-St. John's
|| || || || || || || || || || || || || ||
Wart (SAMe) || ||
-light therapy || ||
-exercise
Factors favoring treatment with an antidepressant: - ✔✔-Agitation
|| || || || || || ||
-Problems with sleep and/or appetite || || || ||
-hx of response to antidepressant
|| || || ||
-patient preference || ||
-moderate to severe symptoms. || || ||
,2
With antidepressant therapy, response can be expected in: - ✔✔50-75% of pts
|| || || || || || || || || || ||
Choice of Antidepressant - ✔✔-response history (if not initial episode)
|| || || || || || || || ||
-Comorbidities
-Depressive symptoms ||
-Safety/tolerability ||
-Drug interactions
||
-Pharmacokinetics
-Cost
-Patient preference ||
What are the most bothersome symptoms? - ✔✔Anxious, Energized, Vegetative, Altered
|| || || || || || || || || || ||
Sleep, Altered Sex Drive, Appetite Change, Fatigue, Hypersomnia
|| || || || || || ||
SSRIs from most energizing to most sedating: - ✔✔1-Fluoxetine (Prozac)
|| || || || || || || || ||
2-Sertraline (Zoloft) ||
3-Citalopram (Celexa) ||
4-Escitalopram (Lexapro) ||
5-Paroxetine (Paxil) ||
When treating depression w/ anxiety: - ✔✔-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
|| || || || ||
,2
most common clinical mistake leading to an unsuccessful trial of an antidepressant drug is:
|| || || || || || || || || || || || || ||
- ✔✔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? - ✔✔bupropion (welbutrin)
|| || || || || || ||
buspirone (buspar) ||
phosphodiesterase inhibitor (eg: viagra) || || ||
Sildenafil (Viagra) - ✔✔does reduce SSRI-induced sexual dysfunction in men
|| || || || || || || || ||
Tadalafil (Cialis) - ✔✔may reduce SSRI-induced sexual dysfunction in men
|| || || || || || || || ||
Phosphodiesterase Inhibitors - ✔✔milrinone (Primacor) || || || ||
most n/v - ✔✔prozac, effexor, cymbalta
|| || || || ||
most diarrhea - ✔✔zoloft
|| || ||
akathisia - ✔✔inner restlessness || || ||
Insomnia may be reduced through - ✔✔a.m. dosing, good sleep hygiene, CBT, melatonin or
|| || || || || || || || || || || || || ||
adding trazodone, a serotonin reuptake inhibitor/antagonist
|| || || || ||
most common SSRI to cause weight gain is - ✔✔paroxetine (Paxil)
|| || || || || || || || || ||
weight neutral/loss - ✔✔Bupropion (Wellbutrin) and fluoxetine (Prozac)
|| || || || || || ||
, 2
may cause weight loss - ✔✔Venlafaxine (Effexor)
|| || || || || ||
least likely to cause discontinuation syndrome - ✔✔prozac
|| || || || || || ||
TCAs can cause - ✔✔anticholinergic symptoms
|| || || || || ||
-mental status changes || ||
-urinary retention ||
-blurred vision. ||
TCA has the least anticholinergic side effects - ✔✔Desipramine
|| || || || || || || ||
TCA having the greatest anticholinergic side effects - ✔✔amitriptyline
|| || || || || || || ||
Citalopram (Celexa) is associated with - ✔✔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 - ✔✔a hypertensive crisis
|| || || || || || || || || || || || ||
may cause dose-dependent HTN - ✔✔Buproprion (Wellbutrin), venlafaxine (Effexor),
|| || || || || || || || ||
duloxetine and desvenlafaxine (Pristiq) || || ||
Serotonin Syndrome ||
More commonly seen with - ✔✔SSRI combined with:
|| || || || || || || ||
-triptan
-tramadol
-linezolid
