Antipsychotics and Antidepressants Flashcards
A patient with major depressive disorder is most likely to develop antidepressant poop-out during maintenance treatment when she is taking which of the following antidepressants?
A. sertraline
B. venlafaxine
C. clomipramine
D. chlorpromazine
Answer A is correct. To identify the correct answer to this question, you need to know that the SSRIs are more likely than the SNRIs and TCAs to cause antidepressant poop-out (tachyphylaxis) and that, of the drugs listed in the answers, only sertraline is an SSRI. Answer D can be eliminated because this question is asking about antidepressants and chlorpromazine is an antipsychotic drug.
Which of the following antidepressants is least likely to have an adverse impact on sexual functioning?
A. fluoxetine
B. phenelzine
C. paroxetine
D. bupropion
Answer D is correct. An advantage of bupropion (an NDRI) is that it does not cause sexual dysfunction. In fact, it is sometimes used in conjunction with an SSRI to help relieve sexual dysfunction caused by fluoxetine, paroxetine, or other SSRI. (Phenelzine is an MAOI that can also cause sexual dysfunction.)
Bupropion (Wellbutrin) and other antidepressants that __________ have an energizing (stimulating) effect.
A. increase norepinephrine and dopamine levels
B. decrease norepinephrine and increase dopamine levels
C. increase norepinephrine and decrease dopamine levels
D. decrease norepinephrine and dopamine levels
Answer A is correct. Bupropion and other antidepressants that increase levels of norepinephrine and dopamine have an energizing effect, which means they are useful for patients with depression who have low energy and motivation.
A person who takes an SSRI concomitantly with an MAOI may develop serotonin syndrome, which is characterized by:
A. agitation, hyperthermia, and autonomic instability.
B. substantial weight gain, hypertension, and hyperglycemia.
C. throbbing headache, stiff neck, and light sensitivity.
D. parkinsonism, akathisia, and dystonia.
Answer A is correct. Combining an SSRI with an MAOI, lithium, or other serotonergic drug can cause serotonin syndrome, which is potentially fatal and involves restlessness and extreme agitation, confusion, autonomic instability, hyperthermia, tremor, seizures, and delirium.
Compared to first-generation antipsychotics, second-generation antipsychotics are:
A. less effective for reducing the positive symptoms of schizophrenia but more effective for reducing the negative symptoms.
B. more effective for reducing the positive symptoms of schizophrenia but less effective for reducing the negative symptoms.
C. as effective or more effective for reducing the positive symptoms of schizophrenia and more effective for reducing the negative symptoms.
D. more effective for reducing the positive symptoms of schizophrenia and equally effective for reducing the negative symptoms.
Answer C is correct. The research has not produced entirely consistent results, but the best conclusion is that the SGAs are as effective as or more effective than the FGAs for reducing the positive symptoms of schizophrenia and more effective for reducing the negative symptoms.
__________ may develop after long-term use of a first-generation antipsychotic and begins with involuntary movements of the tongue, face, and jaw.
A. Metabolic syndrome
B. Neuroleptic malignant syndrome
C. Dystonia
D. Tardive dyskinesia
Answer D is correct. Tardive dyskinesia is potentially life threatening and begins after long-term antipsychotic use. It starts with involuntary, rhythmic movements of the tongue, face, and jaw and, over time, may also affect the limbs and trunk. (Second-generation antipsychotics may produce tardive dyskinesia but do so less often than first-generation antipsychotics do.)
Clozapine and other second-generation antipsychotics are:
A. dopamine and serotonin agonists.
B. dopamine and serotonin antagonists.
C. dopamine agonists and serotonin antagonists.
D. dopamine antagonists and serotonin agonists.
Answer B is correct: Second-generation (atypical) antipsychotics alleviate the symptoms of schizophrenia by blocking dopamine and serotonin receptors, which means that they act as dopamine and serotonin antagonists. (Antagonists exert their therapeutic effects by blocking or reducing the effects of a neurotransmitter or agonist at receptor sites.)
Which of the following best describes the differences between secondary and tertiary amines?
A. Compared to tertiary amines, secondary amines cause greater blockage of serotonin reuptake and have more side effects.
B. Compared to tertiary amines, secondary amines cause greater blockage of norepinephrine reuptake and have fewer side effects.
C. Compared to secondary amines, tertiary amines cause greater blockage of serotonin reuptake and have fewer side effects.
D. Compared to secondary amines, tertiary amines cause greater blockage of norepinephrine reuptake and have more side effects.
Answer B is correct. Secondary and tertiary amines are two classes of tricyclic antidepressants. Secondary and tertiary amines inhibit both norepinephrine and serotonin reuptake, but secondary amines have a greater impact on norepinephrine reuptake while some tertiary amines have a greater impact on serotonin reuptake. In addition, secondary amines have fewer side effects than do tertiary amines (e.g., they’re less likely to cause sedation, orthostatic hypotension, and anticholinergic effects).
Which of the following is true about the SSRIs and TCAs?
A. The SSRIs are more cardiotoxic than the TCAs.
B. The SSRIs are less cardiotoxic than the TCAs.
C. The SSRIs and the TCAs are similar in terms of cardiotoxicity.
D. The SSRIs and the TCAs are not cardiotoxic.
Answer B is correct. Compared to the TCAs, the SSRIs have fewer side effects and are safer in overdose (e.g., are less cardiotoxic).
