Podcast
Questions and Answers
What is the increased risk associated with all categories of antidepressants for certain age groups?
What is the increased risk associated with all categories of antidepressants for certain age groups?
- Increased risk of suicidal thoughts and behavior (correct)
- Increased anxiety levels
- Decreased effectiveness in treatment
- Increased risk of weight gain
Which of the following SSRIs is approved solely for treating OCD in the USA?
Which of the following SSRIs is approved solely for treating OCD in the USA?
- Fluvoxamine (correct)
- Escitalopram
- Citalopram
- Sertraline
What is the approximate time frame for the maximum benefit of SSRIs?
What is the approximate time frame for the maximum benefit of SSRIs?
- 1-2 weeks
- Up to 12 weeks (correct)
- 6-8 weeks
- 24 weeks
Which herb is known to interact with SSRIs and increase the risk of serotonin syndrome?
Which herb is known to interact with SSRIs and increase the risk of serotonin syndrome?
Which of the following is a common side effect of SNRIs?
Which of the following is a common side effect of SNRIs?
What are common side effects of mirtazapine?
What are common side effects of mirtazapine?
What is the mechanism of action for Desvenlafaxine, an SNRI?
What is the mechanism of action for Desvenlafaxine, an SNRI?
Which of the following medications is a tricyclic antidepressant?
Which of the following medications is a tricyclic antidepressant?
What should be closely monitored during the first 2-3 weeks after starting an SSRI?
What should be closely monitored during the first 2-3 weeks after starting an SSRI?
For what conditions are tricyclic antidepressants indicated?
For what conditions are tricyclic antidepressants indicated?
Which medication class is contraindicated for patients who have received monoamine oxidase inhibitors (MAOIs) in the previous two weeks?
Which medication class is contraindicated for patients who have received monoamine oxidase inhibitors (MAOIs) in the previous two weeks?
What is a recommended starting dose of amitriptyline for neuropathic pain?
What is a recommended starting dose of amitriptyline for neuropathic pain?
Which medication is best for sleep onset insomnia?
Which medication is best for sleep onset insomnia?
What is a common side effect of medications used to help patients sleep?
What is a common side effect of medications used to help patients sleep?
How should anxiolytics be dosed in elderly patients?
How should anxiolytics be dosed in elderly patients?
What is the mechanism of action of zolpidem?
What is the mechanism of action of zolpidem?
What is the primary goal of anti-Parkinson's medication treatment?
What is the primary goal of anti-Parkinson's medication treatment?
What is the role of carbidopa in Parkinson's treatment?
What is the role of carbidopa in Parkinson's treatment?
Which medication is a Monoamine oxidase type B inhibitor?
Which medication is a Monoamine oxidase type B inhibitor?
What are common side effects associated with tolcapone?
What are common side effects associated with tolcapone?
What is the effect of donepezil in Alzheimer's disease?
What is the effect of donepezil in Alzheimer's disease?
What side effect is associated with memantine?
What side effect is associated with memantine?
Which of the following melatonin receptor agonists is associated with abnormal dreams?
Which of the following melatonin receptor agonists is associated with abnormal dreams?
Which of the following statements regarding treatment goals in Alzheimer's disease is true?
Which of the following statements regarding treatment goals in Alzheimer's disease is true?
What is a common cause of neuropathic pain?
What is a common cause of neuropathic pain?
What is the primary action of gabapentin in treating neuropathic pain?
What is the primary action of gabapentin in treating neuropathic pain?
Which medication is considered first-line therapy for trigeminal neuralgia?
Which medication is considered first-line therapy for trigeminal neuralgia?
What is a common side effect of gabapentin/pregabalin?
What is a common side effect of gabapentin/pregabalin?
How long should a trial of gabapentin for neuropathic pain typically last?
How long should a trial of gabapentin for neuropathic pain typically last?
What is the mechanism of action of capsaicin cream?
What is the mechanism of action of capsaicin cream?
When using ketamine in patients on chronic opioids, how should baseline opioids be adjusted?
When using ketamine in patients on chronic opioids, how should baseline opioids be adjusted?
What is an adverse effect of tricyclic antidepressants (TCAs)?
What is an adverse effect of tricyclic antidepressants (TCAs)?
What serious side effect is associated with long-term opioid use?
What serious side effect is associated with long-term opioid use?
Which benefit is a key advantage of medicated patches?
Which benefit is a key advantage of medicated patches?
What is a potential adverse drug effect (ADE) of 5-alpha reductase inhibitors?
What is a potential adverse drug effect (ADE) of 5-alpha reductase inhibitors?
How do GnRH analogs affect the reproductive system?
How do GnRH analogs affect the reproductive system?
Which medication is known for preventing osteoporosis in postmenopausal women?
Which medication is known for preventing osteoporosis in postmenopausal women?
Which form of estrogen is best when taken orally due to first-pass metabolism?
Which form of estrogen is best when taken orally due to first-pass metabolism?
What is the primary function of mifepristone in pregnancy termination?
What is the primary function of mifepristone in pregnancy termination?
Which contraceptive method is safe for use while breastfeeding?
Which contraceptive method is safe for use while breastfeeding?
Which type of pain are opioids primarily used to treat?
Which type of pain are opioids primarily used to treat?
What is the mechanism of action of NSAIDs?
What is the mechanism of action of NSAIDs?
How does naloxone work to treat opioid overdose?
How does naloxone work to treat opioid overdose?
What characterizes nociceptive pain?
What characterizes nociceptive pain?
Which of the following statements about NSAIDs is correct?
Which of the following statements about NSAIDs is correct?
What is one key function of endogenous opioids released by the body?
What is one key function of endogenous opioids released by the body?
Which of these conditions is NOT typically associated with opioid use?
Which of these conditions is NOT typically associated with opioid use?
Which receptor is predominantly targeted by opioids for analgesia?
Which receptor is predominantly targeted by opioids for analgesia?
What is the primary reason for monitoring ethosuximide in patients with psychological disturbances?
What is the primary reason for monitoring ethosuximide in patients with psychological disturbances?
Which antiepileptic is known to interfere with the effectiveness of oral contraceptives?
Which antiepileptic is known to interfere with the effectiveness of oral contraceptives?
Among the following antiepileptics, which is considered the safest during pregnancy?
Among the following antiepileptics, which is considered the safest during pregnancy?
What are common side effects associated with phenytoin therapy?
What are common side effects associated with phenytoin therapy?
What is the primary mechanism of action of COX-1 inhibitors that leads to gastrointestinal (GI) bleeding?
What is the primary mechanism of action of COX-1 inhibitors that leads to gastrointestinal (GI) bleeding?
Which of the following statements regarding COX-2 inhibitors is true?
Which of the following statements regarding COX-2 inhibitors is true?
Which of the following is an indication for using tricyclic antidepressants?
Which of the following is an indication for using tricyclic antidepressants?
What is the optimal starting dose of amitriptyline for neuropathic pain?
What is the optimal starting dose of amitriptyline for neuropathic pain?
Which of these medications is best suited for patients with sleep maintenance insomnia?
Which of these medications is best suited for patients with sleep maintenance insomnia?
What is a potential side effect of medications used to help patients sleep?
What is a potential side effect of medications used to help patients sleep?
How should the dose of eszopiclone be adjusted in elderly patients?
How should the dose of eszopiclone be adjusted in elderly patients?
What is typically observed when using shorter-acting medications for sleep onset insomnia?
What is typically observed when using shorter-acting medications for sleep onset insomnia?
What type of pain are opioids particularly effective in treating?
What type of pain are opioids particularly effective in treating?
Which of the following statements accurately describes the mechanism of action of NSAIDs?
Which of the following statements accurately describes the mechanism of action of NSAIDs?
Naloxone primarily functions as what type of medication?
Naloxone primarily functions as what type of medication?
What is the primary action of opioids when they bind to their receptors in the body?
What is the primary action of opioids when they bind to their receptors in the body?
Which pain condition is characterized by intense spikes of pain that occur despite ongoing pain management?
Which pain condition is characterized by intense spikes of pain that occur despite ongoing pain management?
What role do NSAIDs play when used in conjunction with opioids?
What role do NSAIDs play when used in conjunction with opioids?
Which of the following conditions is NOT typically associated with the use of opioids?
Which of the following conditions is NOT typically associated with the use of opioids?
PGE₂ sensitizes nerve endings in the context of pain. Which medication type inhibits its production?
PGE₂ sensitizes nerve endings in the context of pain. Which medication type inhibits its production?
What is the primary goal of anti-Parkinson's medications?
What is the primary goal of anti-Parkinson's medications?
Which medication is primarily responsible for inhibiting the metabolism of levodopa outside the CNS?
Which medication is primarily responsible for inhibiting the metabolism of levodopa outside the CNS?
What side effect is more specifically associated with tolcapone?
What side effect is more specifically associated with tolcapone?
Which of the following is a focus of treatment with donepezil in patients with Alzheimer's disease?
Which of the following is a focus of treatment with donepezil in patients with Alzheimer's disease?
What is the major side effect associated with memantine?
What is the major side effect associated with memantine?
Which of the following compounds is a Monoamine oxidase type B inhibitor?
Which of the following compounds is a Monoamine oxidase type B inhibitor?
What is a common side effect of melatonin receptor agonists like ramelteon and tasimelteon?
What is a common side effect of melatonin receptor agonists like ramelteon and tasimelteon?
Which condition does not improve with donepezil treatment in Alzheimer's patients?
Which condition does not improve with donepezil treatment in Alzheimer's patients?
What is the primary risk associated with all categories of antidepressants for young adults under 24 years of age?
What is the primary risk associated with all categories of antidepressants for young adults under 24 years of age?
Which side effect is not commonly associated with SNRIs?
Which side effect is not commonly associated with SNRIs?
What is the typical onset time for SSRIs to begin showing effects?
What is the typical onset time for SSRIs to begin showing effects?
What should be carefully monitored for the first 2-3 weeks after initiating SSRI treatment?
What should be carefully monitored for the first 2-3 weeks after initiating SSRI treatment?
Which of the following herbs is known to increase the risk of serotonin syndrome when taken with SSRIs?
Which of the following herbs is known to increase the risk of serotonin syndrome when taken with SSRIs?
For which of the following conditions are SNRIs indicated?
For which of the following conditions are SNRIs indicated?
What is a major contraindication for SNRIs?
What is a major contraindication for SNRIs?
What unique mechanism of action do SNRIs possess that aids in pain relief?
What unique mechanism of action do SNRIs possess that aids in pain relief?
What is the primary mechanism of action of gabapentin in epilepsy management?
What is the primary mechanism of action of gabapentin in epilepsy management?
Which side effect is commonly associated with levetiracetam?
Which side effect is commonly associated with levetiracetam?
Which condition is NOT a contraindication for the use of phenytoin?
Which condition is NOT a contraindication for the use of phenytoin?
What monitoring parameter is crucial for patients on carbamazepine?
What monitoring parameter is crucial for patients on carbamazepine?
Which of the following is a key concern when prescribing antiepileptics to women who are pregnant?
Which of the following is a key concern when prescribing antiepileptics to women who are pregnant?
What is the mechanism of action of lamotrigine in seizure management?
What is the mechanism of action of lamotrigine in seizure management?
What serious condition can arise from the use of valproic acid?
What serious condition can arise from the use of valproic acid?
Which of the following side effects is NOT associated with topiramate?
Which of the following side effects is NOT associated with topiramate?
What is the maximum duration for which adolescents and young adults should be monitored for suicidal ideation after starting antidepressant treatment?
What is the maximum duration for which adolescents and young adults should be monitored for suicidal ideation after starting antidepressant treatment?
Which of the following conditions can SSRIs be off-label used to treat?
Which of the following conditions can SSRIs be off-label used to treat?
What is a significant interaction concern when combining herbs with SSRIs?
What is a significant interaction concern when combining herbs with SSRIs?
Which SNRI medication requires dosage adjustment for hepatic and renal impairment?
Which SNRI medication requires dosage adjustment for hepatic and renal impairment?
What is the half-life range of SSRIs?
What is the half-life range of SSRIs?
Which common side effect is associated with higher dosages of SNRIs?
Which common side effect is associated with higher dosages of SNRIs?
Which of the following SSRIs was the first approved in the USA for depression treatment?
Which of the following SSRIs was the first approved in the USA for depression treatment?
What organ system primarily contributes to the glucuronidation excretion of Desvenlafaxine?
What organ system primarily contributes to the glucuronidation excretion of Desvenlafaxine?
Which of the following conditions is a known cause of neuropathic pain?
Which of the following conditions is a known cause of neuropathic pain?
What is a key mechanism of action for carbamazepine in treating trigeminal neuralgia?
What is a key mechanism of action for carbamazepine in treating trigeminal neuralgia?
Which adverse effect is commonly associated with the use of gabapentin or pregabalin?
Which adverse effect is commonly associated with the use of gabapentin or pregabalin?
What is the recommended duration for a trial of gabapentin when treating chronic neuropathic pain?
What is the recommended duration for a trial of gabapentin when treating chronic neuropathic pain?
Which of the following is a common side effect of tricyclic antidepressants (TCAs)?
Which of the following is a common side effect of tricyclic antidepressants (TCAs)?
What action does capsaicin cream have on substance P in neuropathic pain management?
What action does capsaicin cream have on substance P in neuropathic pain management?
When adjusting opioids for a patient also being treated with ketamine, how should the baseline opioids be modified?
When adjusting opioids for a patient also being treated with ketamine, how should the baseline opioids be modified?
Which medication is specifically indicated for painful diabetic neuropathy?
Which medication is specifically indicated for painful diabetic neuropathy?
What psychological issues can ethosuximide trigger, especially in younger patients?
What psychological issues can ethosuximide trigger, especially in younger patients?
Which antiepileptic medications are recognized as safer during pregnancy?
Which antiepileptic medications are recognized as safer during pregnancy?
What is the primary action of COX-1 in the body related to gastrointestinal health?
What is the primary action of COX-1 in the body related to gastrointestinal health?
Which antiepileptics are known to reduce the effectiveness of oral contraceptives?
Which antiepileptics are known to reduce the effectiveness of oral contraceptives?
Which of the following describes nociceptive pain?
Which of the following describes nociceptive pain?
What is a common side effect of phenytoin?
What is a common side effect of phenytoin?
What occurs when COX-1 is inhibited, particularly concerning gastrointestinal function?
What occurs when COX-1 is inhibited, particularly concerning gastrointestinal function?
Which condition is primarily treated with COX-2 inhibitors?
Which condition is primarily treated with COX-2 inhibitors?
Which type of pain are opioids primarily indicated for?
Which type of pain are opioids primarily indicated for?
What is the primary mechanism of action of NSAIDs?
What is the primary mechanism of action of NSAIDs?
What is the role of naloxone in the treatment of opioid overdose?
What is the role of naloxone in the treatment of opioid overdose?
Which of the following conditions is least likely to be treated effectively with opioid analgesics?
Which of the following conditions is least likely to be treated effectively with opioid analgesics?
What is the impact of combining NSAIDs with opioids?
What is the impact of combining NSAIDs with opioids?
Which receptor type is primarily targeted by opioids for their analgesic effects?
Which receptor type is primarily targeted by opioids for their analgesic effects?
Which of the following best describes the role of endogenous opioids in the body?
Which of the following best describes the role of endogenous opioids in the body?
What physiological effect occurs when opioids bind to mu receptors?
What physiological effect occurs when opioids bind to mu receptors?
What is the primary action of levodopa in the treatment of Parkinson's disease?
What is the primary action of levodopa in the treatment of Parkinson's disease?
Which side effect is specifically associated with tolcapone?
Which side effect is specifically associated with tolcapone?
Which of the following medications is considered a Monoamine oxidase type B inhibitor?
Which of the following medications is considered a Monoamine oxidase type B inhibitor?
What potential serious side effect can result from long-term opioid use?
What potential serious side effect can result from long-term opioid use?
Which benefit of medicated patches distinguishes them from oral medications?
Which benefit of medicated patches distinguishes them from oral medications?
What is the main goal of treatment with donepezil in Alzheimer's disease?
What is the main goal of treatment with donepezil in Alzheimer's disease?
What is a common adverse drug effect associated with 5-alpha reductase inhibitors like finasteride?
What is a common adverse drug effect associated with 5-alpha reductase inhibitors like finasteride?
What potential adverse effect might occur with the use of melatonin receptor agonists?
What potential adverse effect might occur with the use of melatonin receptor agonists?
What is the primary mechanism of action of GnRH analogs?
What is the primary mechanism of action of GnRH analogs?
What common side effect might be observed with memantine treatment?
What common side effect might be observed with memantine treatment?
Which statement about raloxifene's role in osteoporosis prevention is accurate?
Which statement about raloxifene's role in osteoporosis prevention is accurate?
What is the expected benefit of using carbidopa in conjunction with levodopa?
What is the expected benefit of using carbidopa in conjunction with levodopa?
Which statement about the goals of Parkinson's disease treatment is accurate?
Which statement about the goals of Parkinson's disease treatment is accurate?
What property differentiates estradiol from other forms of estrogen when taken orally?
What property differentiates estradiol from other forms of estrogen when taken orally?
What role does mifepristone (RU486) play in pregnancy management?
What role does mifepristone (RU486) play in pregnancy management?
Which contraceptive method is most recommended for breastfeeding women?
Which contraceptive method is most recommended for breastfeeding women?
Flashcards
Antidepressant Warning
Antidepressant Warning
All antidepressants carry an increased risk of suicidal thoughts and behaviors, especially in children, adolescents, and young adults (under 24) during the first couple months of treatment.
SSRI Medications
SSRI Medications
Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of antidepressants that increase serotonin levels in the brain.
SSRI Onset of Action
SSRI Onset of Action
SSRIs typically take a few weeks (2+) to show improvement, possibly up to 12 weeks for the full benefit.
SSRI Interactions
SSRI Interactions
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SNRI Mechanism
SNRI Mechanism
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SNRI Indications
SNRI Indications
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SNRI Side Effects
SNRI Side Effects
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Desvenlafaxine MOA
Desvenlafaxine MOA
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Mirtazapine side effects
Mirtazapine side effects
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Tricyclic antidepressants (TCAs)
Tricyclic antidepressants (TCAs)
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TCA use for neuropathic pain
TCA use for neuropathic pain
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Anxiolytic choice for sleep onset insomnia
Anxiolytic choice for sleep onset insomnia
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Anxiolytic choice for sleep maintenance insomnia
Anxiolytic choice for sleep maintenance insomnia
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Zolpidem Mechanism
Zolpidem Mechanism
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Anxiolytic dosing in the elderly
Anxiolytic dosing in the elderly
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Side effects of sleep medications
Side effects of sleep medications
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Melatonin receptor agonists side effects
Melatonin receptor agonists side effects
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Parkinson's treatment goal
Parkinson's treatment goal
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Carbidopa's role
Carbidopa's role
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Monoamine oxidase type B (MAO-B) inhibitors
Monoamine oxidase type B (MAO-B) inhibitors
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Tolcapone side effects
Tolcapone side effects
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Donepezil's goal in Alzheimer's
Donepezil's goal in Alzheimer's
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Memantine side effects
Memantine side effects
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Parkinson's treatment limitations
Parkinson's treatment limitations
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Neuropathic Pain Causes
Neuropathic Pain Causes
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Gabapentin/Pregabalin for Neuropathic Pain
Gabapentin/Pregabalin for Neuropathic Pain
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Gabapentin Trial Length
Gabapentin Trial Length
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Trigeminal Neuralgia Treatment
Trigeminal Neuralgia Treatment
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Capsaicin Cream Mechanism
Capsaicin Cream Mechanism
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Ketamine Dosing in Opioid Patients
Ketamine Dosing in Opioid Patients
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Topical Lidocaine Use
Topical Lidocaine Use
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Neuropathic pain
Neuropathic pain
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Nociceptive Pain Treatment
Nociceptive Pain Treatment
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When are Opioids Useful?
When are Opioids Useful?
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Naloxone's Action
Naloxone's Action
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Opioids' Pain Relief Mechanism
Opioids' Pain Relief Mechanism
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Opioid Risks
Opioid Risks
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Medicated Patches: Advantages
Medicated Patches: Advantages
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5-alpha Reductase Inhibitors: Side Effects
5-alpha Reductase Inhibitors: Side Effects
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GnRH Analogs: Mechanism
GnRH Analogs: Mechanism
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Raloxifene: Osteoporosis Prevention
Raloxifene: Osteoporosis Prevention
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Oral Estrogen: Best Choice
Oral Estrogen: Best Choice
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Mifepristone: Pregnancy Termination
Mifepristone: Pregnancy Termination
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Safe Contraception During Breastfeeding
Safe Contraception During Breastfeeding
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SSRI Warning
SSRI Warning
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SSRI Medication Examples
SSRI Medication Examples
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SSRI Herb Interactions
SSRI Herb Interactions
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Mirtazapine's Action
Mirtazapine's Action
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TCA Uses
TCA Uses
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Lowering TCA Dose
Lowering TCA Dose
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Sleep Onset Insomnia
Sleep Onset Insomnia
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Sleep Maintenance Insomnia
Sleep Maintenance Insomnia
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Zolpidem's Action
Zolpidem's Action
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Melatonin Agonists: Side Effects
Melatonin Agonists: Side Effects
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MAO-B Inhibitors: What are they?
MAO-B Inhibitors: What are they?
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Donepezil: Alzheimer's Treatment Goal
Donepezil: Alzheimer's Treatment Goal
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Gabapentin MOA in Epilepsy
Gabapentin MOA in Epilepsy
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Levetiracetam Side Effects
Levetiracetam Side Effects
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Phenytoin Contraindications
Phenytoin Contraindications
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Carbamazepine Monitoring
Carbamazepine Monitoring
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Valproic Acid in Pregnancy
Valproic Acid in Pregnancy
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Lamotrigine MOA
Lamotrigine MOA
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Valproic Acid Contraindications
Valproic Acid Contraindications
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Ethosuximide Monitoring
Ethosuximide Monitoring
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Ethosuximide and Pregnancy
Ethosuximide and Pregnancy
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Antiepileptics and Contraceptives
Antiepileptics and Contraceptives
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Safest Antiepileptics During Pregnancy
Safest Antiepileptics During Pregnancy
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Common Side Effects of Phenytoin
Common Side Effects of Phenytoin
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COX-1's Role in Gastrointestinal Protection
COX-1's Role in Gastrointestinal Protection
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Primary Indications for COX-2 Inhibitors
Primary Indications for COX-2 Inhibitors
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What is Nociceptive Pain?
What is Nociceptive Pain?
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NSAIDs MOA
NSAIDs MOA
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Opioids MOA for Pain
Opioids MOA for Pain
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Mechanism of Action of Naloxone
Mechanism of Action of Naloxone
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Opioids are useful in the treatment of which type of pain
Opioids are useful in the treatment of which type of pain
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Common SNRI Side Effects
Common SNRI Side Effects
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MAO-B Inhibitors
MAO-B Inhibitors
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Treatment Limitations for Parkinson's
Treatment Limitations for Parkinson's
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What causes neuropathic pain?
What causes neuropathic pain?
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Diabetes and neuropathic pain
Diabetes and neuropathic pain
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Trigeminal Neuralgia
Trigeminal Neuralgia
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Gabapentin's Role in Neuropathic Pain
Gabapentin's Role in Neuropathic Pain
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Carbamazepine for Trigeminal Neuralgia
Carbamazepine for Trigeminal Neuralgia
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Ketamine for Opioid-Tolerant Patients
Ketamine for Opioid-Tolerant Patients
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Ethosuximide Side Effects
Ethosuximide Side Effects
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Antiepileptics and Birth Control
Antiepileptics and Birth Control
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Safest Antiepileptics in Pregnancy
Safest Antiepileptics in Pregnancy
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Phenytoin: Common Side Effects?
Phenytoin: Common Side Effects?
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COX-1 and Stomach Protection
COX-1 and Stomach Protection
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COX-2 and Inflammation
COX-2 and Inflammation
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Nociceptive Pain: What is it?
Nociceptive Pain: What is it?
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Opioid Risk Discussion
Opioid Risk Discussion
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Medicated Patches: Benefits
Medicated Patches: Benefits
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Safe Contraception While Breastfeeding
Safe Contraception While Breastfeeding
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Estradiol: Oral Estrogen Therapy
Estradiol: Oral Estrogen Therapy
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Nociceptive Pain
Nociceptive Pain
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What's the main pharmacologic approach for Nociceptive pain?
What's the main pharmacologic approach for Nociceptive pain?
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What is Neuropathic Pain?
What is Neuropathic Pain?
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What's the main difference between Nociceptive and Neuropathic pain?
What's the main difference between Nociceptive and Neuropathic pain?
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Study Notes
FDA Warning on Antidepressants
- All antidepressants carry an increased risk of suicidal thoughts and behavior, especially in children, adolescents, and young adults (up to 24 years old) during the first two months of treatment.
- Depression and other psychiatric illnesses are risk factors.
SSRI Medications
- Citalopram
- Escitalopram
- Fluoxetine (First FDA-approved for depression, inhibits CYP450)
- Fluvoxamine (Only FDA-approved for OCD in the USA)
- Paroxetine (Inhibits CYP450)
- Sertraline
- Closely monitor patients for the first 2-3 weeks after starting any SSRI for suicidal thoughts.
Herbs that Interact with SSRIs
- Ginkgo Biloba
- St. John's Wort
- Garcinia cambogia (HCA)
- L-tryptophan (or 5-HTP)
- SAMe (S-adenosyl-methionine) supplements.
Onset and Mechanism of Action of SSRIs
- Onset of action is typically two weeks, and up to 12 weeks for maximum benefit.
- Half-life (T½) is 16-36 hours.
- SSRIs block the reuptake of serotonin, increasing its concentration in the synaptic cleft. This prevents serotonin from being reabsorbed by the presynaptic nerve, increasing serotonin availability at postsynaptic receptors.
Indications for SSRIs
- Depression
- Anxiety
- Panic disorder
- OCD
- Bulimia (off-label)
- Anorexia (off-label)
- Fluvoxamine is not indicated for depression.
Other Medications
- SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):
- Desvenlafaxine
- Duloxetine
- Levomilnacipran
- Milnacipran
- Venlafaxine
- Block reuptake of serotonin and norepinephrine.
- MOA of Desvenlafaxine
- Blocks reuptake of serotonin and norepinephrine.
- Degree of block is dose-dependent.
- Dosage adjustment may be needed for hepatic or renal impairment.
- Side Effects of Venlafaxine and Duloxetine:
- Common: CNS effects, nausea, constipation, dry mouth, sexual dysfunction (higher dosages).
- Higher Dosages: hypertension.
- Side Effects of Milnacipran: Similar to Venlafaxine (such as palpitation), ADE Levomilnacipran similar to others, urinary hesitation.
Tricyclic Antidepressants (TCAs) and Other Medications
- Imipramine
- Trimipramine
- Nortriptyline
- Doxepin
- Desipramine
- Amitriptyline
- Clomipramine
- Protriptyline
- Amoxapine
- Dosage for Neuropathic Pain: Amitriptyline and duloxetine are commonly used at low doses to control neuropathic pain
- Anxiolytics for Sleep Patterns:
- Zaleplon, zolpidem, triazolam, and ramelteon, temazepam, Eszopiclone (short-acting)
- Zolpidem extended release, eszopiclone, temazepam, lorazepam, eszopiclone, low-dose doxepin, and suvorexant (longer-acting)
- Longer-acting medications can increase the risk of morning drowsiness
- Side Effects of Mirtazapine:
- Sedation, increased appetite, weight gain.
- Gabapentin/Pregabalin: used for neuropathic pain and binds to calcium channels
- Chronic use may need a trial of 2 months or more.
Ketamine
- Used for chronic opioid pain, but at a lower dosage than for anesthesia.
- Use with caution in patients with epilepsy or schizophrenia
- Requires concomitant reduction in baseline opioid dose by 25% to 50%.
Lidocaine (Topical)
- Used to treat localized neuropathic pain.
- Blocks nerve impulse conduction.
Gabapentin
- Mechanism involves increased GABAergic impulses.
- Used for managing epilepsy.
Antiepileptic Drugs
- Levetiracetam - Side effects include CNS depression, suicidal ideation, blood dyscrasias, Steven-Johnson Syndrome, nausea, and weight gain/loss.
- Phenytoin - Contraindicated with pregnancy, liver problems, sinus bradycardia, and hypersensitivity.
- Carbamazepine - Monitor patients for bone marrow complications like leukopenia, thrombocytopenia, and agranulocytosis (agranulocytosis can cause death if not caught)
- Valproic Acid - Can interact with other antiepileptics (e.g., carbamazepine and lamotrigine)
- Lamotrigine - Risk of adverse effects is increased with valproic acid.
- Topiramate- Side effects include numbness, tingling, weight loss/decreased appetite, nausea, diarrhea, blurred vision, mental slowing, anxiety, and metallic taste.
- Contraindications to valproic acid include liver disease, urea cycle disorders, and genetic mitochondrial disorders (especially in children under 2).
Other Indications and Contraindications
- COX-1 Inhibitors: Gastric cytoprotection.
- Opioids: Used for moderate to severe pain (post-surgical, cancer-related, trauma, chronic pain)
- NSAIDs: Used for mild to moderate pain (strains, sprains).
- Monoamine Oxidase Inhibitors (MAOIs) are contraindicated with SSRIs/SNRIs.
- Ethosuximide Therapeutic drug monitoring is necessary.
- Pregnancy Risks: Some anti-epileptic drugs (AEDs) have pregnancy risks, eg., valproic acid.
- Anti-epileptics interference with Hormones: Certain AEDs induce the enzymes that break down other medications or interfere with hormone levels, requiring dose adjustments.
- Hormonal Contraceptives: AEDs might reduce the effectiveness of oral contraceptives, requiring adjustments if necessary.
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Description
This quiz covers key information about antidepressants, particularly SSRI medications, their associated risks such as increased suicidal thoughts, and interactions with herbal supplements. Additionally, it discusses the onset and mechanism of action of these medications.
