NU553 Unit 3 Major Depressive Disorder and Bipolar Disorders Advanced Pharmacology and Pharmacotherapeutics Exam 2

DSM-5 criteria for major depressive episode duration?

Two consecutive weeks

Cardinal symptoms of major depressive disorder?

Depressed mood or anhedonia

Anhedonia definition?

Inability to gain pleasure

Neurotransmitters decreased in depression?

Norepinephrine serotonin dopamine

Permissive hypothesis?

Low serotonin allows mood disorder expression

Beta adrenergic hypothesis cause?

Increased receptor sensitivity

Absolute vs functional deficiency?

Production absent vs signaling impaired

Chronic mild depression diagnosis?

Persistent depressive disorder

Postpartum depression onset?

Within 6 weeks

Therapy that modifies dysfunctional thoughts?

Cognitive behavioral therapy

Therapy focused on social triggers?

Interpersonal therapy

Electroconvulsive therapy effectiveness?

Up to 80 percent

Response definition in depression?

50 percent reduction

Remission HAM-D score?

7 or below

Why aim for remission?

Residual symptoms increase relapse risk

Acute phase duration?

6 to 12 weeks

Continuation phase duration?

4 to 9 months

Maintenance therapy indication?

Three or more episodes

Maintenance duration?

3 to 5 years or longer

Early SSRI improvement symptoms?

Sleep appetite cognition

Serotonin syndrome symptoms?

Fever tachycardia collapse

How to stop antidepressants?

Gradual taper

SSRI mechanism?

Block serotonin reuptake

Why SSRIs first-line?

Better tolerated safer in overdose

SSRI with most sexual side effects?

Paroxetine

How to manage SSRI sexual dysfunction?

Add bupropion

SSRIs morning dosing why?

Avoid insomnia and anxiety

Sedating SSRI choice?

Paroxetine

Fluoxetine interaction enzyme?

CYP2D6

SSRI black box warning?

Suicidal thoughts under 25

SNRI mechanism?

Serotonin and norepinephrine reuptake inhibition

Venlafaxine major risk?

Hypertension

Duloxetine adverse effects?

Nausea dry mouth

TCA mechanism?

Block norepinephrine serotonin reuptake

Why TCAs second-line?

Anticholinergic effects overdose risk

TCA anticholinergic effects?

Dry mouth blurred vision urinary retention

TCA cardiac risk?

QT prolongation arrhythmia

Preferred TCAs elderly?

Nortriptyline desipramine

MAOI mechanism?

Block monoamine oxidase

MAOI diet restriction?

Tyramine

MAOI risk with tyramine?

Hypertensive crisis

MAOI washout period?

14 days

Bupropion mechanism?

Norepinephrine dopamine reuptake inhibition

Bupropion contraindication?

Seizure disorder

Mirtazapine use?

Insomnia and weight loss

Trazodone main use?

Sleep

Trazodone serious risk?

Priapism

Nefazodone warning?

Liver toxicity

Vilazodone mechanism?

SSRI plus 5HT1A partial agonist

Vortioxetine receptor targets?

Multiple serotonin receptors

Esketamine route?

Intranasal

Esketamine mechanism?

NMDA antagonist

Esketamine monitoring time?

2 hours

SSRI approved in children?

Fluoxetine

Why lower dose elderly?

Increased sensitivity

Poor metabolizers cause?

CYP polymorphisms

Bipolar I requirement?

Mania

Bipolar II requirement?

Hypomania and depression

Mania definition?

Elevated mood at least 1 week

Hypomania difference?

No severe impairment

Lithium acute range?

0.8 to 1.2 mEq per L

Lithium maintenance range?

0.6 to 1.0 mEq per L

Lithium adverse effects?

Thyroid kidney calcium

Lithium contraindication?

Cardiac renal disease

Carbamazepine required test?

HLA B1502

Why test HLA B1502?

Prevent Stevens Johnson syndrome

Lamotrigine danger?

Stevens Johnson syndrome

Valproate risks?

Liver pancreas teratogenic

Valproate therapeutic range?

50 to 125 micrograms per milliliter

Atypical antipsychotic risk?

Metabolic syndrome

Ziprasidone monitoring?

Electrocardiogram QT

St Johns wort interaction?

CYP3A4 induction

St Johns wort plus SSRI risk?

Serotonin syndrome

Antidepressant monotherapy bipolar?

Avoid triggers mania

Lithium monitoring?

Level kidney thyroid

Lamotrigine counseling?

Report rash

Valproate pregnancy risk?

Neural tube defects

First-line MDD drugs?

SSRIs

SSRI major risk?

Suicidality

SNRI example risk?

Hypertension

MAOI plus tyramine result?

Hypertensive crisis

Bupropion best use?

Avoid sexual side effects

Mirtazapine best use?

Insomnia weight loss

Lithium toxicity signs?

Tremor confusion

ECT use?

Severe refractory depression