CNS 2- Test 1

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created 12 days ago by marleelayne
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1

Where does Fetzima act in the synapse?

  • SERT & NET

Why?... it is an SNRI

2

FETZIMA generic name?

Levomilnacipran

3

Where does EMSAM act in the synapse?

  • Monoamine Oxidase

Why?... it is a MAOI

4

EMSAM generic name?

Selegiline

5

Where does Lexapro act in this synapse?

  • SERT

Why?.... It is an SSRI

6

Inhibiting inositol formation and glycogen synthase kinase is associated with what drug?

Lithium

7

Target for Esketamine?

NMDA receptors

It will inhibit the NMDA receptors

8

Target for Zulresso?

GABAa receptors

Positive Allosteric Modulator

Only drug approved for postpartum depression

9

High Ki value=

LOW AFFINITY

10

Low Ki value=

HIGH AFFINITY

11

Orthostatic hypotension is due to which receptor?

Alpha-1 receptor

12

The higher the Ki value for a drug in regards to the alpha-1 receptor means....

The least likely it will cause orthostatic hypotension (as compared to a drug that has a lower Ki in regards to the alpha-1 receptor)

13

H1 receptor antagonism will cause?

Sleepiness and drowsiness

14

Antimuscarinic side effects?

  • blurry vision
  • confusion
  • constipation
  • dry mouth
15

What are the targets for TCAs?

  • NET
  • SERT
16

What class of drugs can be dangerous in overdose?

TCAs

(They will cause major cardiovascular issues)

17

Fluoxetine will inhibit which enzyme?

CYP2D6

(Since it inhibits this enzyme, it would decrease the metabolism of drugs that use the same enzyme)

18

St Johns Wort will...?

Induce the CYP450 enzymes, which would increase the metabolism of drugs that are also metabolized by those enzymes

This leads to decreased effectiveness of those medications

19

A patient has been identified as a slow acetylator, which statement is the most correct?

MAOI levels will be higher

Why?... because the MAOI would not be metabolized as quickly, so there are higher levels in the body. This could also increase a persons likelihood of causing Serotonin Syndrome

20

Grapefruit juice is?

A CYP3A4 inhibitor

21

Which one works faster, pharmacotherapy or psychotherapy?

Pharmacotherapy

22

Electro Convulsive therpay

  • very effective
  • very safe
  • rapid onset of effect
23

ECT has the ability to alter __________ term memory

short

24

What are the CAM therapy options for MDD?

  • St John's Wort
  • SAMe
  • Omega-3- fatty acids
25

What is the issue with ST Johns Wort?

The purity of the product since herbal supplements are not regulated by the FDA

26

St Johns Wort is...

an INDUCER of CYP450 enzymes

27

MAOIs

  • increase NE, DA, and Serotonin
  • Irreversible inhibition
  • takes 2 weeks for MAOI to get out of your body "wash out period"
  • HTN Crisis (too much NE)
  • Serotonin Syndrome (too much serotonin)
28

One major side effect of serotonin syndrome

Hyperthermia

29

Which SSRI has the longest half life and would be a good choice if patients tend to forget to take their medications?

Fluoxetine (Prozac)

30

Which SSRI tends to interact with a lot of other medication due to the PK parameters?

Fluvoxamine

31

What is the only NDRI?

Bupropion (Wellbutrin)

**** has no effect on Serotonin

32

What is the number one counseling point for Bupropion?

Seizures!!!!!

33

What is the max dose of Bupropion?

450 mg per day

34

What is the black box warning for Nefazodone?

Hepatotoxicity

35

Because trazodone is a WEAK SRI, at low doses it mostly produces?

The sleepy effect

normally need at least 200 mg for it to be for depression

* low dose = sleep

* high dose = depression

36

Mirtazapine

  • INDIRECTLY increasing NE and Serotonin
  • blocks H-1 (antihistamine effects)
  • most common side effect is SLEEP
  • patient may have increased appetite
  • "can be used to help elderly with appetite"
  • low dose = for sleep
  • high dose = antidepressant (30 mg or HIGHER)
37

VIIBRYD

Vilazodone

38

TRINTILLEX

Vortioxetine

39

Viibryd

  • partial agonist at 5-HT1A
  • no activity at dirty receptors
  • "there can still be a possibility of sexual dysfunction"
40

Vortioxetine

  • faster onset
  • better tolerated
  • "will help with the cognitive effects of depression"- since people who are depressed can have memory impairment and difficulty concentration
  • "multi-modal MOA"
  • TACKLES COGNITIVE EFFECTS OF DEPRESSION
  • with CYP2D6:

- increase dose with inducers

- decrease dose with inhibitors

  • "still counsel a patient on sexual dysfunction"
41

What is euthymia?

"normal" or balanced mood

- depression is dysthymia

42

In an acute setting you prevent ____________ of MDD

relapse

43

Which black box warning for antidepressants should you ALWAYS counsel your patient?

an increased risk of suicidal ideation (worsening symptoms of depression)

44

What is the number 1 side effect of antidepressants that decrease compliance?

sexual dysfunction

45

Preferred first line treatment for MDD

  • SSRI
  • SNRI
  • Burpropion
  • Mirtazapine
46

Partial Response to first line

  • ADD MEDICATION ON (you dont want to lose the progress you made)
  • What is considered a partial response? --> 3 of their 5 presenting symptoms have gone away, but they still have 2 that are uncontrolled
47

No Response to first line

  • switch medications
  • this is when the patient just experiences side effects and nothing improved for the patient
48

If there is psychosis along with depression, you must add ____________ to therapy

antipsychotic

49

What is the "safe bet" due to few to no drug drug interactions?

Lexapro (SSRI)

50

How long does it take to see full antidepressant effect?

6-8 weeks

This is an "adequate trial"

51

How long does it take to see an improvement in sadness and loss of pleasure?

2-4 weeks

52

How long does it take the physical symptoms to improve (sleeping better, better sleep, eating better)?

1 week

53

Combo

two anti-depressants

54

Augmentation

Adding a medication that will enhance the existing anti-depressant

a drug in a different class that will work a different way

55

TWO FDA APPROVED MEDICATIONS FOR AUGMENTATION

  • Abilify
  • Seroquel

these are both antipsychotics

56

What other agent can be used for augmentation but is not FDA-approved?

Lithium

57

Should anti-depressants be taken PRN?

NOOOOO; must be taken consistently

58

Treatment Resistant Depression

failing two adequate trials

59

What are the two drugs that are approved for TRD?

  • Symbyax (olanzapine/Fluoxetine)
  • Spravato (Esketamine)

Spravato is a nasal spray; & it has a VERY rapid onset of action and supposedly you can feel better within days.

60

Spravato

  • nasal spray
  • non-competitive antagonist of the NMDA receptor (glutamate)
  • REMS program due to the risk of abuse
  • C-III
  • common side effects: increase BP (could be hurtful to pregnant women)
  • MONTHLY DOSE
61

________ depressed patients should receive both acute and continuation treatment

ALL!!!

62

Do all depressed patients need maintenance treatment?

No, just the people who are at the highest risk

63

How long should you tell a patient they will be on their medication?

1 2months

64

_______________ is least likely to cause antidepressant discontinuation syndrome

PROZAC

65

Is antidepressant discontinuation syndrome life threatening like BZDs?

No

But it will normally resolve after 2 weeks

"This can also happen when you switch medication classes"

66

BZD for anxiety

  • used for GAD, PD, and SAD
  • do not use these in PTSD
67

BZD dosing

  • higher dose for panic disorder
  • lower dose for anxiety
68

Buspirone (BUSPAR)

  • used for GAD ONLY!!!!
  • avoid in PD (ineffective)

it can also be used for augmentation

  • 5-HT1A partial agonist
  • "this drug is not well understood, but it is well tolerated"
  • normally 2 to 3 times a day (due to short half life)
  • maximum dose is 60 mg a day!!!! (they are in divided doses)
  • this could be a compliance issue due to how often it is dosed