Therapeutics Exam 3 with 100 % correct
answered test guide
A patient diagnosed with MDD is treated with Prozac (fluoxetine). Stopped once felt better, on
no meds, sleeps 10-13 hrs per day, GAD s/s but no panic attacks or OCD s/s. Open to pharm &
psych tx. What baseline labs are needed? - ANS CBC
TSH
UDS
What is known as a partial response?
Response? - ANS 25-49%
>50%
70% of patients have a third relapse, what does this warrant? - ANS Lifelong treatment
Glutamate is a substrate for _____ & _____ receptors. ____ blockade activates AMPA
receptors. A downstreatm cascade leads to ____ ______. - ANS AMPA & NMDA
NMDA
Neural Plasticity
What is the treatment duration for each phase:
1) acute
2) continuation
3) maintenance - ANS 1) 6-12 weeks
2) 4-9 months but >6 months is recommended now
3) 12+ months
-recom for pts with 3+ MDD episodes
What are the FIRST line therapies for MDD? - ANS SSRIs / SNRIs
NaSSAs (Mirtazepine)
NDRIs (Bupropion)
Melatonin agonist
Serotonin modulator
What are the SECOND line therapies for MDD? - ANS TCAs
MAOIs
What are strategies that can be done while treating MDD besides combining pharm & psych
therapy or increasing the antidepressant dose? - ANS Augment antidepressant med with
lithium or antipsychotic med, or L-triiodothyronine
or
,Combine antidepressants
What 2 drugs are strong CYP2D6 inhibitors?
Moderate? - ANS Strong:
-Fluoxetine, Paroxetine
Moderate:
-Bupropion, Duloxetine, Sertraline
What 2 drugs are moderate CYP3A4 inhibitors? - ANS Fluvoxamine, Fluoxetine
What drug is a strong CYP1A2 inhibitor? - ANS Fluvoxamine
What drug is a strong CYP2C19 inhibitor?
Moderate? - ANS Strong:
-Fluvoxamine
Moderate:
-Fluoxetine
What 6 drugs are CYP2D6 substrates? - ANS Vortioxetine
Venlafaxine
Fluvoxamine
Fluoxetine
Mirtazapine
Paroxetine
What 2 drugs are CYP2C19 substrates? - ANS Citalopram
Escitalopram
What 2 drugs are CYP1A2 substrates? - ANS Duloxetine
Fluvoxamine
What drug is a CYP3A4 substrate? - ANS Mirtazepine
What drugs have the largest risk of causing serotonin syndrome and require monitoring when
COMBINED with antidepressants? - ANS Opioids
Dextromethorphan
Lithium
What is FIRST line for MDD that can be combined with or without psych?
What is a patient has severe depression? - ANS SSRI, SNRI, Bupropion, Mirtazapine,
Vortioxetine
,ECT with antidepressants + antipsychotic, or ECT
What is SECOND line for MDD? - ANS Alternative antidepresant, Augment with psych or
antidepressant from different class, Augment with FDA approved antipsychotic
What is SECOND line for MDD if the patient shows a partial response? - ANS Augment
antidepressant with antipsychotic (aripiprazole, quetiapine, or risperidone), CAM, Brexpiprazole
What is SECOND line for MDD if the patient shows non-response? - ANS Alternative
antidepressant (citalopram, escitalopram, mirtazapine, sertraline, venlafaxine), ECT, TMS
What can be used to treat MDD if a patient has mild/moderate depression? - ANS CAM
What is THIRD line to treat MDD? - ANS Alternative antidepressant in different class (SSRI,
SNRI, T3, Lithium, Mirtazapine, Bupropion, Brexpiprazole)
-DON'T combine SSRI + SNRI
+/- psychotherapy
Augment with antidepressant from differeent class or a TCA or augment with lithium or T3
Neurostimulation
What can be used to treat treatment resistant MDD? - ANS MAOI, ECT
Switch to TCA or MAOI
SSRI/SNRI + bupropion or mirtazapine
SSRI/SNRI + fda approved atypical antipsychotic
Augmentation after partial response with agent from different class (SSRI, SNRI, mirtazapine,
bupropion, TCA) or lamotrigine, TMS, VNS
What can be used to treat mixed features in MDD? - ANS Lurasidone
Ziprasidone
What can be used sleep disturbances in MDD? - ANS Miratzapine
What can be used to treat cognitive dysfunction? - ANS Vortioxetine, SSRIs, Duloxetine,
Bupropion
What can be used to treat anxious distress? - ANS Duloxetine, Bupropion, SSRIs
What can be used to treat Pain? - ANS Duloxetine, Venlafaxine, Desvenlafaxine
What can be used to treat smoking cessation? - ANS Bupropion
, What can be used to treat alcohol use disorder? - ANS Abstinence: sertraline
Mood: mirtazapine
What can be used for ADHD?
Heart Failure?
Acute Coronary Syndrome? - ANS Bupropion, Duloxetine
Sertraline
Escitalopram, Sertraline
What can be used for IBS (constipation & abdominal pain)?
Loss of libido in women?
Stress Incontinence? - ANS Paroxetine, Fluoxetine, Citalopram
Bupropion
Duloxetine
What can be used for Non-dialysis CKD?
Dialysis ESRD?
ESRD-associated pruritis? - ANS Sertraline
Sertraline
Sertraline, Mirtazapine
What can be used for chronic low back pain?
Osteoarthritis?
Diabetic peripheral neuropathy (PN)? - ANS Duloxetine
Venlafaxine, Duloxetine
Duloxetine, Venlafaxine, Desvenlafaxine
What can be used for fibromyalgia?
chemo-induced PN?
migraine prophylaxis? - ANS Mirtazapine, Duloxetine, SSRI, Venlafaxine
Duloxetine
Venlafaxine, Duloxetine
What is the most likely drug to cause headache?
Least likely? - ANS Bupropion, Escitalopram
answered test guide
A patient diagnosed with MDD is treated with Prozac (fluoxetine). Stopped once felt better, on
no meds, sleeps 10-13 hrs per day, GAD s/s but no panic attacks or OCD s/s. Open to pharm &
psych tx. What baseline labs are needed? - ANS CBC
TSH
UDS
What is known as a partial response?
Response? - ANS 25-49%
>50%
70% of patients have a third relapse, what does this warrant? - ANS Lifelong treatment
Glutamate is a substrate for _____ & _____ receptors. ____ blockade activates AMPA
receptors. A downstreatm cascade leads to ____ ______. - ANS AMPA & NMDA
NMDA
Neural Plasticity
What is the treatment duration for each phase:
1) acute
2) continuation
3) maintenance - ANS 1) 6-12 weeks
2) 4-9 months but >6 months is recommended now
3) 12+ months
-recom for pts with 3+ MDD episodes
What are the FIRST line therapies for MDD? - ANS SSRIs / SNRIs
NaSSAs (Mirtazepine)
NDRIs (Bupropion)
Melatonin agonist
Serotonin modulator
What are the SECOND line therapies for MDD? - ANS TCAs
MAOIs
What are strategies that can be done while treating MDD besides combining pharm & psych
therapy or increasing the antidepressant dose? - ANS Augment antidepressant med with
lithium or antipsychotic med, or L-triiodothyronine
or
,Combine antidepressants
What 2 drugs are strong CYP2D6 inhibitors?
Moderate? - ANS Strong:
-Fluoxetine, Paroxetine
Moderate:
-Bupropion, Duloxetine, Sertraline
What 2 drugs are moderate CYP3A4 inhibitors? - ANS Fluvoxamine, Fluoxetine
What drug is a strong CYP1A2 inhibitor? - ANS Fluvoxamine
What drug is a strong CYP2C19 inhibitor?
Moderate? - ANS Strong:
-Fluvoxamine
Moderate:
-Fluoxetine
What 6 drugs are CYP2D6 substrates? - ANS Vortioxetine
Venlafaxine
Fluvoxamine
Fluoxetine
Mirtazapine
Paroxetine
What 2 drugs are CYP2C19 substrates? - ANS Citalopram
Escitalopram
What 2 drugs are CYP1A2 substrates? - ANS Duloxetine
Fluvoxamine
What drug is a CYP3A4 substrate? - ANS Mirtazepine
What drugs have the largest risk of causing serotonin syndrome and require monitoring when
COMBINED with antidepressants? - ANS Opioids
Dextromethorphan
Lithium
What is FIRST line for MDD that can be combined with or without psych?
What is a patient has severe depression? - ANS SSRI, SNRI, Bupropion, Mirtazapine,
Vortioxetine
,ECT with antidepressants + antipsychotic, or ECT
What is SECOND line for MDD? - ANS Alternative antidepresant, Augment with psych or
antidepressant from different class, Augment with FDA approved antipsychotic
What is SECOND line for MDD if the patient shows a partial response? - ANS Augment
antidepressant with antipsychotic (aripiprazole, quetiapine, or risperidone), CAM, Brexpiprazole
What is SECOND line for MDD if the patient shows non-response? - ANS Alternative
antidepressant (citalopram, escitalopram, mirtazapine, sertraline, venlafaxine), ECT, TMS
What can be used to treat MDD if a patient has mild/moderate depression? - ANS CAM
What is THIRD line to treat MDD? - ANS Alternative antidepressant in different class (SSRI,
SNRI, T3, Lithium, Mirtazapine, Bupropion, Brexpiprazole)
-DON'T combine SSRI + SNRI
+/- psychotherapy
Augment with antidepressant from differeent class or a TCA or augment with lithium or T3
Neurostimulation
What can be used to treat treatment resistant MDD? - ANS MAOI, ECT
Switch to TCA or MAOI
SSRI/SNRI + bupropion or mirtazapine
SSRI/SNRI + fda approved atypical antipsychotic
Augmentation after partial response with agent from different class (SSRI, SNRI, mirtazapine,
bupropion, TCA) or lamotrigine, TMS, VNS
What can be used to treat mixed features in MDD? - ANS Lurasidone
Ziprasidone
What can be used sleep disturbances in MDD? - ANS Miratzapine
What can be used to treat cognitive dysfunction? - ANS Vortioxetine, SSRIs, Duloxetine,
Bupropion
What can be used to treat anxious distress? - ANS Duloxetine, Bupropion, SSRIs
What can be used to treat Pain? - ANS Duloxetine, Venlafaxine, Desvenlafaxine
What can be used to treat smoking cessation? - ANS Bupropion
, What can be used to treat alcohol use disorder? - ANS Abstinence: sertraline
Mood: mirtazapine
What can be used for ADHD?
Heart Failure?
Acute Coronary Syndrome? - ANS Bupropion, Duloxetine
Sertraline
Escitalopram, Sertraline
What can be used for IBS (constipation & abdominal pain)?
Loss of libido in women?
Stress Incontinence? - ANS Paroxetine, Fluoxetine, Citalopram
Bupropion
Duloxetine
What can be used for Non-dialysis CKD?
Dialysis ESRD?
ESRD-associated pruritis? - ANS Sertraline
Sertraline
Sertraline, Mirtazapine
What can be used for chronic low back pain?
Osteoarthritis?
Diabetic peripheral neuropathy (PN)? - ANS Duloxetine
Venlafaxine, Duloxetine
Duloxetine, Venlafaxine, Desvenlafaxine
What can be used for fibromyalgia?
chemo-induced PN?
migraine prophylaxis? - ANS Mirtazapine, Duloxetine, SSRI, Venlafaxine
Duloxetine
Venlafaxine, Duloxetine
What is the most likely drug to cause headache?
Least likely? - ANS Bupropion, Escitalopram
