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Questions and Answers
Which SSRI is contraindicated in pregnancy but can be prescribed to a client with insomnia and social anxiety?
Which SSRI is contraindicated in pregnancy but can be prescribed to a client with insomnia and social anxiety?
Which SSRI is recommended for a client with hypersomnolence and social anxiety?
Which SSRI is recommended for a client with hypersomnolence and social anxiety?
Which SSRI should used to treat anxiety & depression should be increased in dosage for a client who smokes?
Which SSRI should used to treat anxiety & depression should be increased in dosage for a client who smokes?
Which SSRI is known to improve speed of processing and cognitive function?
Which SSRI is known to improve speed of processing and cognitive function?
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Which SSRI is best tolerated with the fewest CYP interactions?
Which SSRI is best tolerated with the fewest CYP interactions?
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What dosing consideration is recommended for Escitalopram?
What dosing consideration is recommended for Escitalopram?
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Which SSRI should be avoided for a patient with a history of falls or fractures?
Which SSRI should be avoided for a patient with a history of falls or fractures?
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What is the role of L-Methylfolate in depression treatment?
What is the role of L-Methylfolate in depression treatment?
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What is the method of action of L-Methylfolate?
What is the method of action of L-Methylfolate?
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Why is L-Methylfolate recommended as an adjunct?
Why is L-Methylfolate recommended as an adjunct?
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How do SNRIs work?
How do SNRIs work?
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Which neurotransmitters are affected in SNRIs?
Which neurotransmitters are affected in SNRIs?
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What are side effects of SNRIs?
What are side effects of SNRIs?
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Why should SNRIs not be stopped abruptly?
Why should SNRIs not be stopped abruptly?
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Is SNRI use safe during breastfeeding?
Is SNRI use safe during breastfeeding?
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Which medication has the potential for activation and to increase panic attacks?
Which medication has the potential for activation and to increase panic attacks?
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What is the pharmacological similarity between an SRRI and buspirone? It is used to treat both depression and anxiety.
What is the pharmacological similarity between an SRRI and buspirone? It is used to treat both depression and anxiety.
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Which medication is effective for somatic symptoms of depression and atypical pain (fibromyalgia & diabetic neuropathy) at higher doses?
Which medication is effective for somatic symptoms of depression and atypical pain (fibromyalgia & diabetic neuropathy) at higher doses?
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Why should SSRIs be avoided when the client has anxiety?
Why should SSRIs be avoided when the client has anxiety?
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Which patient population is more at risk when prescribed an SSRI due to a less robust response and risk of suicide?
Which patient population is more at risk when prescribed an SSRI due to a less robust response and risk of suicide?
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What lab tests should be completed before prescribing Desvenlafaxine (Pristiq) to a patient?
What lab tests should be completed before prescribing Desvenlafaxine (Pristiq) to a patient?
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What symptoms can Desvenlafaxine (Pristiq) be prescribed for in perimenopausal patients?
What symptoms can Desvenlafaxine (Pristiq) be prescribed for in perimenopausal patients?
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Which specific type of symptoms indicate the prescription of Desvenlafaxine (Pristiq) in perimenopausal patients?
Which specific type of symptoms indicate the prescription of Desvenlafaxine (Pristiq) in perimenopausal patients?
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What is the recommended course of action before initiating SSRIs for a patient?
What is the recommended course of action before initiating SSRIs for a patient?
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What SMRI medication can be prescribed if the patient suffers from perimenopausal vasomotor symptoms (sweating, flushing)?
What SMRI medication can be prescribed if the patient suffers from perimenopausal vasomotor symptoms (sweating, flushing)?
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What is a common side effect of NDRI medications?
What is a common side effect of NDRI medications?
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Which neurotransmitters are affected by NDRI medications?
Which neurotransmitters are affected by NDRI medications?
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All of the following are important to prescribing pearls regarding bupropion (Wellbutrin) except?
All of the following are important to prescribing pearls regarding bupropion (Wellbutrin) except?
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When should NDRI medications be taken?
When should NDRI medications be taken?
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Why should carbamazepine be avoided in the elderly?
Why should carbamazepine be avoided in the elderly?
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What is the primary mechanism of action of Trazadone a serotonin antagonist reuptake inhibitor (SARI)?
What is the primary mechanism of action of Trazadone a serotonin antagonist reuptake inhibitor (SARI)?
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Which side effect is NOT commonly associated with Trazadone use?
Which side effect is NOT commonly associated with Trazadone use?
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In what patient population is Trazadone commonly used for adjunctive treatment?
In what patient population is Trazadone commonly used for adjunctive treatment?
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Tricyclic antidepressants (TCAs) posses both SRI & NRI properties and blocks which receptors?
Tricyclic antidepressants (TCAs) posses both SRI & NRI properties and blocks which receptors?
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What is the primary reason TCAs are not used as first-line treatment?
What is the primary reason TCAs are not used as first-line treatment?
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What side effect should patients be warned about when taking Trazadone?
What side effect should patients be warned about when taking Trazadone?
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What are common side effects of Tricyclic antidepressants (TCAs)?
What are common side effects of Tricyclic antidepressants (TCAs)?
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When should Tricyclic antidepressants (TCAs) be avoided?
When should Tricyclic antidepressants (TCAs) be avoided?
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Which medication should be given in a supervised setting due to sedation & dissociation?
Which medication should be given in a supervised setting due to sedation & dissociation?
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Which side effect is NOT commonly associated with Tricyclic antidepressants (TCAs)?
Which side effect is NOT commonly associated with Tricyclic antidepressants (TCAs)?
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What is a potential consequence of taking Tricyclic antidepressants (TCAs) along with other central nervous system depressants?
What is a potential consequence of taking Tricyclic antidepressants (TCAs) along with other central nervous system depressants?
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What is the primary reason MAOIs are considered the last choice medication class for depression?
What is the primary reason MAOIs are considered the last choice medication class for depression?
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Which enzyme encoded by the MAOA gene is targeted by MAOIs for treating depression and anxiety?
Which enzyme encoded by the MAOA gene is targeted by MAOIs for treating depression and anxiety?
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Foods containing what supplement increase the risk for hypertensive crisis because it is broken down by MAOIs?
Foods containing what supplement increase the risk for hypertensive crisis because it is broken down by MAOIs?
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Why should serotonergic agents be avoided when taking MAOIs?
Why should serotonergic agents be avoided when taking MAOIs?
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What 2 medications increase appetite & promote weight gain?
What 2 medications increase appetite & promote weight gain?
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All of the following are common side effects of MAOIs EXCEPT?
All of the following are common side effects of MAOIs EXCEPT?
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What is the primary mechanism by which MAOIs can lead to confusion, dizziness, and other side effects?
What is the primary mechanism by which MAOIs can lead to confusion, dizziness, and other side effects?
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What is the recommended waiting period before starting MAOI after discontinuing a serotonergic medication?
What is the recommended waiting period before starting MAOI after discontinuing a serotonergic medication?
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Which type of MAOI is typically used to treat Parkinson's disease?
Which type of MAOI is typically used to treat Parkinson's disease?
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Which condition is MAOI-B commonly used to treat?
Which condition is MAOI-B commonly used to treat?
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What is the primary use of MAOI-A?
What is the primary use of MAOI-A?
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Which atypical antipsychotic is best for female trying to concieve?
Which atypical antipsychotic is best for female trying to concieve?
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What is a potentially life-threatening condition associated with the use of serotonergic antidepressants?
What is a potentially life-threatening condition associated with the use of serotonergic antidepressants?
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Which age group has an increased risk of death by suicide when taking antidepressants?
Which age group has an increased risk of death by suicide when taking antidepressants?
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Where are 90% of the 5HT receptors located in the body?
Where are 90% of the 5HT receptors located in the body?
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Mental status changes, autonomic instability, neuromuscular effects & seizures are common side effects of what condition?
Mental status changes, autonomic instability, neuromuscular effects & seizures are common side effects of what condition?
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What is the timeframe for achieving symptom relief with antidepressant medication?
What is the timeframe for achieving symptom relief with antidepressant medication?
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What condition should be monitored for when using serotonergic drugs (e.g., triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, & St. John's wart)concomitantly?
What condition should be monitored for when using serotonergic drugs (e.g., triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, & St. John's wart)concomitantly?
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Study Notes
Antidepressant Therapy
- The goal of antidepressant therapy is complete remission of symptoms.
- Antidepressants increase the risk of death by suicide in children and adults under 25 years of age.
- Antidepressants take 4-6 weeks to achieve symptom relief.
Serotonergic Antidepressants
- Serotonergic antidepressants can cause serotonin syndrome, a potentially life-threatening condition, especially when used concomitantly with other serotonergic drugs.
- Symptoms of serotonin syndrome include GI side effects, mental status changes, autonomic instability, neuromuscular effects, and seizures.
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Paroxetine (Paxil) is prescribed for clients who also suffer from insomnia and social anxiety, but is contraindicated in pregnancy.
- Sertraline (Zoloft) is prescribed for clients who suffer from hypersomnolence and social anxiety.
- Fluvoxamine (Luvox) requires increased dosing if the client actively smokes.
- Vortioxetine (Brintellix) improves the speed of processing and cognitive function.
- Escitalopram has fewest CYP interactions and should start at ½ the dose due to QT prolongation.
Monoamine Oxidase Inhibitors (MAOIs)
- MAOI-A is used as an antidepressant and anxiolytic.
- MAOI-B is used to treat Parkinson's disease.
- Wait 5 half-lives after discontinuing a serotonergic medication before starting an MAOI.
- Foods that contain tyramine (e.g., red wine, sauerkraut, aged cheese) should be avoided when taking MAOIs to prevent a hypertensive crisis.
Other Medications
- Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs) work by inhibiting dopamine and norepinephrine reuptake.
- Bupropion (Wellbutrin) is prescribed to improve alertness, energy, and motivation.
- Trazadone is a Serotonin Antagonist Reuptake Inhibitor (SARI) that blocks 5-HT and 5-HT2C receptors.
- Tricyclic Antidepressants (TCAs) work by blocking α-adrenergic, histamine-1, and muscarinic cholinergic receptors.
Important Considerations
- CBC, CMP, and thyroid stimulating hormone levels should be completed prior to prescribing SSRIs.
- Patients aged 65 and older are more at risk when prescribed an SSRI because they do not respond as robustly as younger people or children/adults younger than 25 due to the risk of death by suicide.
- Antipsychotics are used as adjuncts to SSRIs.
- Fluoxetine has the potential for activation and can increase panic attacks.
- SSRIs should be avoided when the client has anxiety because they can exacerbate anxiety.
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Description
Test your knowledge on which SSRI should be prescribed for specific mental health conditions and considerations. Questions cover SSRI medications for insomnia, social anxiety, hypersomnolence, cognitive function, and smoking habits.
