Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CMN 568 Module 5 > Depression - FITZ > Flashcards

Depression - FITZ Flashcards

1
Q 
44. Which patient presentation is most consistent with the diagnosis of depression?
A. recurrent diarrhea and cramping
B. difficulty initiating sleep
C. diminished cognitive ability
D. consistent early morning wakening
A

D. consistent early morning wakening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. According to DSM-5, a diagnosis of depression
    must include either depressed mood or which of
    the following?
    A. loss of interest or pleasure
    B. recurrent thoughts of death
    C. feelings of worthlessness
    D. weight change (either increase or decrease)
A

A. loss of interest or pleasure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

46 to 48. When considering depression and thoughts
about death, rank the following from most
common (1) to least common (3):

  1. thinking it would be “OK to just die”; passive
    without a plan to cause self-harm
A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

46 to 48. When considering depression and thoughts
about death, rank the following from most
common (1) to least common (3):

  1. having suicidal thoughts
A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

46 to 48. When considering depression and thoughts
about death, rank the following from most
common (1) to least common (3):

  1. making a plan to commit suicide
A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. Which of the following statements is false regarding patients with depression and hypochondriasis?
    A. About 30% of patients with depression also have
    hypochondriasis.
    B. A person with this condition is less likely to see
    a healthcare provider compared with those with
    depression alone.
    C. A person with this condition is unable to process
    objective information that he/she has no particular
    health problem.
    D. The person with hypochondriasis perceives that an
    existing health problem is far more serious than it is
    in reality.
A

B. A person with this condition is less likely to see
a healthcare provider compared with those with
depression alone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. Of the following individuals in need of an antidepressant, who is the best candidate for fluoxetine (Prozac®) therapy?
    A. an 80-year-old woman with hypertension, dyslipidemia, and osteoarthritis and with persistent depressed mood 1 year after the death of her husband
    B. a 45-year-old man with mild hepatic dysfunction
    C. a 28-year-old man who occasionally “skips a dose”
    of his prescribed medication
    D. a 44-year-old woman with decreased appetite
A

C. a 28-year-old man who occasionally “skips a dose”
of his prescribed medication

Missed doses less of a problem because of
protracted T1⁄2

Morning dosing recommended.

Protracted T1⁄2 can present problem in
elderly patients

Missed doses less of a problem because of
protracted T1⁄2

Weight loss of ~3–5 lb (1.4–2.3 kg) common in
early months of use, but usually not sustained

interaction with warfarin - increase effect of warfarin
long-term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  1. In caring for elderly patients, the NP considers that
    all of the following is true except:
    A. many older patients with dementia have a
    component of depression.
    B. dementia signs and symptoms usually evolve over
    months, but depression usually has a more rapid
    onset.
    C. with dementia, a patient is aware of difficulties
    with cognitive ability.
    D. treating concurrent depression can help improve
    symptoms of dementia.
A

C. with dementia, a patient is aware of difficulties

with cognitive ability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. Persistent depressive disorder (formerly known as
    dysthymia) is characterized by:
    A. suicidal thoughts.
    B. multiple incidents of harming oneself.
    C. social isolation.
    D. low level depression.
A

D. low level depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. Which of the following is most consistent with the
    diagnosis of persistent depressive disorder?
    A. a 23-year-old man with a 2-month episode of
    depressed mood after a job loss
    B. a 45-year-old woman with “jitteriness” and difficulty
    initiating sleep for the past 6 months
    C. a 38-year-old woman with fatigue and anhedonia
    for the past 2 years
    D. a 15-year-old boy with a school adjustment problem
    and weekend marijuana use for the past year
A

C. a 38-year-old woman with fatigue and anhedonia

for the past 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. Successful treatment of persistent depressive disorder typically involves:
    A. psychotherapy alone.
    B. a psychotropic agent alone.
    C. psychotherapy plus a psychotropic agent.
    D. electroconvulsive therapy (ECT).
A

C. psychotherapy plus a psychotropic agent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. John is a 47-year-old man who reports constant
    sadness following the death of his wife in a motor
    vehicle accident 3 weeks ago. He has not been able to function at work and avoids socializing with friends
    and family. You recommend:
    A. giving him time and support during this period
    of acute grief.
    B. weekly psychotherapy sessions.
    C. prescribing an anxiolytic to help with grief symptoms.
    D. psychotherapy plus a prescription for an
    antidepressant.
A

A. giving him time and support during this period

of acute grief.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q 
56. Successful treatment of a patient with reactive depression associated with a loss (e.g., death of a loved one) would expect all of the following results except:
A. elevated mood.
B. restored function.
C. improved decision-making ability.
D. elimination of sadness.
A

D. elimination of sadness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. Drug treatment options for a patient with bipolar
    disorder often include all of the following except:
    A. atomoxetine (Strattera®).
    B. lithium carbonate.
    C. risperidone (Risperdal®).
    D. valproic acid (Depakote®).
A

A. atomoxetine (Strattera®).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q 
58. Which of the following drugs is likely to be the most dangerous when taken in an intentional overdose equivalent to a standard adult therapeutic dose?
A. a 4-week supply of paroxetine
B. a 2-week supply of amitriptyline
C. a 3-week supply of duloxetine
D. a 5-day supply of alprazolam
A

B. a 2-week supply of amitriptyline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. One week into sertraline (Zoloft®) therapy, a patient complains of a new-onset recurrent dull frontal headache that is relieved promptly with acetaminophen. Which of
    the following is true in this situation?
    A. This is a common, transient side effect of selective
    serotonin reuptake inhibitor (SSRI) therapy.
    B. She should discontinue the medication.
    C. Fluoxetine should be substituted.
    D. Desipramine should be added
A

A. This is a common, transient side effect of selective

serotonin reuptake inhibitor (SSRI) therapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  1. A patient has been taking citalopram for 1 week and complains of mild nausea and diarrhea. You advise that:
    A. this is a common, long-lasting side effect of SSRI
    therapy.
    B. he should discontinue the medication.
    C. another antidepressant should be substituted.
    D. he should be taking the medication with food.
A

D. he should be taking the medication with food.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  1. Sally is a 34-year-old woman who is diagnosed with
    major depressive disorder. She feels that it is likely
    associated with stress resulting from her troubled
    marriage of the past 10 years. She is initiated on an
    SSRI and reports initial improvement in symptoms.
    However, over the following months, the medication
    appears to lose its effectiveness despite her insistence that she is being adherent with the dosing regimen.
    This is likely a result of:
    A. an inadequate dose of the medication.
    B. development of tolerance to the SSRI.
    C. continued or escalated stress from the troubled
    marriage.
    D. missed doses despite her insistence on compliance.
A

C. continued or escalated stress from the troubled

marriage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q 
62. Which of the following medications is most likely to cause sexual dysfunction?
A. vilazodone (Viibryd®)
B. paroxetine (Paxil®)
C. nortriptyline (Pamelor®)
D. bupropion (Wellbutrin®)
A

B. paroxetine (Paxil®)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  1. SSRI withdrawal syndrome is best characterized as:
    A. bothersome but not life-threatening.
    B. potentially life-threatening.
    C. most often seen with discontinuation of agents
    with a long half-life.
    D. associated with seizure risk.
A

A. bothersome but not life-threatening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q 
64. Which of the following SSRIs is most likely to
significantly interact with warfarin?
A. citalopram
B. escitalopram
C. fluoxetine
D. sertraline
A

C. fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q 
65. Which of the following SSRIs is associated with the
greatest anticholinergic effect?
A. fluvoxamine
B. sertraline
C. fluoxetine
D. paroxetine
A

D. paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  1. Which of the following statements is true regarding
    depression and relapse?
    A. Without maintenance therapy, the relapse rate
    is typically less than 50% in the first year.
    B. The risk of relapse is less for those who have
    experienced multiple episodes of major depressive
    disorder.
    C. The risk of relapse is greatest in the first 2 months
    after discontinuation of therapy.
    D. Relapse rarely occurs if there is an absence
    of symptoms after 9 months of treatment
    discontinuation.
A

C. The risk of relapse is greatest in the first 2 months

after discontinuation of therapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
  1. All of the following are risk factors for relapse
    except:
    A. a current episode lasting more than 2 years.
    B. onset of depression occurring at younger than
    20 years of age.
    C. poor recovery between episodes.
    D. absence of persistent depressive disorder preceding the episode.
A

D. absence of persistent depressive disorder preceding the episode.

25
Q
  1. Which of the following is most consistent with the
    presentation of a patient with bipolar I disorder?
    A. increased need for sleep
    B. impulsive behavior
    C. fatigue
    D. anhedonia
A

B. impulsive behavior

26
Q
  1. In general, pharmacologic intervention for patients
    with depression should:
    A. be given for about 4 months on average.
    B. continue for a minimum of 6 months after
    remission is achieved.
    C. be continued indefinitely with a first episode
    of depression.
    D. be titrated to a lower dose after symptom relief is
    achieved
A

B. continue for a minimum of 6 months after

remission is achieved.

27
Q 
70. Depression often manifests with all of the following
except:
A. psychomotor retardation.
B. irritability.
C. palpitations.
D. increased feelings of guilt.
A

C. palpitations.

28
Q
  1. A 44-year-old man has been taking an SSRI for the
    past 4 months and complains of new onset of sexual
    dysfunction and difficulty achieving orgasm. You
    advise him that:
    A. this is a transient side effect often seen in the first
    weeks of therapy.
    B. switching to another SSRI would likely be
    helpful.
    C. this is a common adverse effect of SSRI therapy
    that is unlikely to resolve without adjustment in
    his therapy.
    D. he should see a urologist for further evaluation.
A

C. this is a common adverse effect of SSRI therapy
that is unlikely to resolve without adjustment in
his therapy.

29
Q
  1. The maximum recommended dose of citalopram
    for patients older than 60 years of age is:
    A. 10 mg/day.
    B. 20 mg/day.
    C. 30 mg/day.
    D. 40 mg/day.
A

B. 20 mg/day.

30
Q 
73. Which of the following agents has the longest T1⁄2?
A. fluoxetine
B. paroxetine
C. citalopram
D. sertraline
A

A. fluoxetine

31
Q
  1. Which of the following agents should be avoided
    in heavy alcohol users owing to a potential risk for
    hepatotoxicity?
    A. duloxetine
    B. desvenlafaxine
    C. escitalopram
    D. bupropion
A

A. duloxetine

32
Q 
75. Treatment with venlafaxine (Effexor®) can lead to
dose-dependent increases in:
A. heart rate.
B. serum glucose.
C. AST/ALT.
D. blood pressure.
A

D. blood pressure.

33
Q 
76. You see a 28-year-old man who has been diagnosed with moderate depression and has not responded well to SSRI therapy over the past 3 months. He was involved in a motor vehicle accident 2 years ago that resulted in head trauma and now occasionally experiences occasional tonic-clonic seizures. When considering alternative antidepressant therapy, which of the following should be avoided?
A. bupropion
B. trazodone
C. citalopram
D. duloxetine
A

A. bupropion

34
Q 
77. QT prolongation is a concern with higher doses of:
A. citalopram.
B. sertraline.
C. venlafaxine.
D. fluoxetine.
A

A. citalopram.

35
Q 
78. Priapism is a potential adverse effect of which of the following psychotropic medications?
A. bupropion
B. sertraline
C. trazodone
D. amitriptyline
A

C. trazodone

36
Q 
79. When using trazodone to aid sleep, the drug should be optimally taken \_\_\_\_\_ prior to sleep.
A. immediately
B. 15 minutes
C. 1 hour
D. 2 hours
A

C. 1 hour

37
Q 
80. Patient presentation possibly common to anxiety
and depression includes:
A. a feeling of worthlessness.
B. psychomotor agitation.
C. dry mouth.
D. appetite disturbance.
A

B. psychomotor agitation.

38
Q
  1. Which of the following describes prescriptions for
    antidepressant medications written by primary care
    providers?
    A. dose too high
    B. dose too low
    C. excessive length of therapy
    D. appropriate length of therapy
A

B. dose too low

39
Q

82 to 86. Match each serotonin receptor site with its
associated activity when stimulated.

A. agitation, anxiety, panic
B. antimigraine effect
C. antidepressant effect
D. cerebral spinal fluid
production
E. nausea, diarrhea
  1. 55-HT1A
A

C. antidepressant effect

40
Q

82 to 86. Match each serotonin receptor site with its
associated activity when stimulated.

A. agitation, anxiety, panic
B. antimigraine effect
C. antidepressant effect
D. cerebral spinal fluid
production
E. nausea, diarrhea
  1. 5-HT1C, 5-HT2C
A

D. cerebral spinal fluid

production

41
Q

82 to 86. Match each serotonin receptor site with its
associated activity when stimulated.

A. agitation, anxiety, panic
B. antimigraine effect
C. antidepressant effect
D. cerebral spinal fluid
production
E. nausea, diarrhea
  1. 5-HT1D
A

B. antimigraine effect

42
Q

82 to 86. Match each serotonin receptor site with its
associated activity when stimulated.

A. agitation, anxiety, panic
B. antimigraine effect
C. antidepressant effect
D. cerebral spinal fluid
production
E. nausea, diarrhea
  1. 5-HT2
A

A. agitation, anxiety, panic

43
Q

82 to 86. Match each serotonin receptor site with its
associated activity when stimulated.

A. agitation, anxiety, panic
B. antimigraine effect
C. antidepressant effect
D. cerebral spinal fluid
production
E. nausea, diarrhea
  1. 5-HT3
A

E. nausea, diarrhea

44
Q

Paroxetine
(Paxil®)

SSRI

A

Half-life T1⁄2 21 hr

Sedating (HS dosing likely best)

Likely most anticholinergic effect of the SSRIs.

More constipation (13%) than diarrhea (11%)
Antihistamine-like,
anticholinergic activity can lead to increased
appetite.

Helpful in depression with anxiety

helpful in the treatment of depression in elderly
patients

45
Q

Fluvoxamine
(Luvox®)

SSRI

A

High rate of gastrointestinal upset and sleep disturbance compared with other SSRIs

Adverse effect profile can limit utility

46
Q

Sertraline
(Zoloft®)

SSRI

A

Equal numbers find medication sedating
and energizing Low rate of nervousness,
anorexia

Take with food to enhance
absorption

EZ on Heart - good for patients with heart disease

47
Q

Citalopram
(Celexa®)
Escitalopram
(Lexapro®)

SSRI

A

Equal numbers reporting somnolence and insomnia.
Favorable gastrointestinal profile
Low rates of agitation and anorexia

Because of risk of QT prolongation with
citalopram, for patients >60 years of age, the
maximum recommended dose is 20 mg/day,
maximum 40 mg/day in all others.

48
Q

Escitalopram (Lexapro)

SSRI

A

Escitalopram 10 mg is therapeutically equivalent
to citalopram 20–40 mg with a possibly superior
adverse effect profile

49
Q

Fluoxetine
(Prozac®)

SSRI

A

Energizing, anorexia common

Morning dosing recommended.

Protracted T1⁄2 can present problem in elderly patients

Missed doses less of a problem because of
protracted T1⁄2

Weight loss of ~3–5 lb (1.4–2.3 kg) common in
early months of use, but usually not sustained
long-term

interacts with warfarin

50
Q 
Venlafaxine
(Effexor® and
Effexor XR®)
Desvenlafaxine
(Pristiq®)

SSNRI

A

Activating in larger amounts
Patients often need trazodone or other agent to help with sleep
Significant nausea with rapid onset of high dose
Dose-dependent increases in diastolic blood pressure
Average 5 mm Hg response

SSRI-like effect only in low doses, with norepinephrine
uptake blockade at medium to high doses, similar to TCA effect, but with fewer adverse effects. Withdrawal syndrome similar to SSRIs

51
Q

Duloxetine
(Cymbalta®)

SSNRI

A

Rare liver toxicity risk, most often noted in presence of
other hepatic risk factors. Few anticholinergic adverse effects

Indicated for treatment of mood disorders
and neuropathic pain

52
Q

Duloxetine
(Cymbalta®)

SSNRI

A

Rare liver toxicity risk, most
often noted in presence of
other hepatic risk factors. Few
anticholinergic adverse effects

Indicated for treatment of mood disorders
and neuropathic pain

53
Q

Levomilnacipran
(Fetzima®)

SSNRI

A 
Nausea, constipation, hyperhidrosis,
tachycardia, erectile
dysfunction; can increase risk of
activation of mania/hypomania
(screen for bipolar disorder)

Indicated for treatment of major depressive
disorder (MDD)

54
Q 
Bupropion
(Wellbutrin®)
[selective
dopamine
reuptake
inhibitor]
A 
Few anticholinergic effects
Energizing
Possible increased libido,
agitation (25%)
Avoid with significant manifestation
of anxiety, agitation,
insomnia.

Avoid use in presence of eating disorder or if
anorexia is a major component of depression.
Weight loss often seen (28% >5 lb
[2.3 kg]) after initiation of therapy
Do not give if history of or risk for seizure,
closed head injury history, history of
quiescent epilepsy
Seizure risk worsens if dose increased rapidly

55
Q 
Tricyclic
antidepressants;
includes
nortriptyline
([Pamelor®,
active metabolite
of amitriptyline],
desipramine
[Norpramin®],
active metabolic
of imipramine)
A 
Weight gain
Anticholinergic activity (blurred
vision, dry mouth, memory loss,
sweating, anxiety, postural hypotension,
dizziness, and tachycardia)
Constipation a problem,
but infrequent nausea. Little
sexual dysfunction

Inexpensive, more effective than SSRI in more
severe depression, likely owing to its norepinephrine
and serotonin activity
More bothersome adverse effect profile leads
to high dropout rate
Primary care providers seldom prescribe
sufficient doses to relieve depression
Taper off over 2–4 wk to avoid TCA
withdrawal symptoms; sleep disturbance,
nightmares, gastrointestinal upset, malaise,
irritability

56
Q

Trazodone
(Desyrel®,
Oleptro®)
[triazolopyridine]

A 
Highly sedating, dizziness, favorable
gastrointestinal adverse
effect profile. Priapism risk found
in 1 in 6000 men using drug.
Patient should be informed to
go to emergency department
promptly for painful erection
lasting >30 min
Anxiolytic and antidepressant activity
5-HT2 antagonist
Clinical use limited by marked sedation
Effective hypnotic with little morning drowsiness
at doses 25–100 mg taken 1 hr before
sleep
Can use in low, frequent doses as benzodiazepine
alternative for generalized anxiety
57
Q

tricyclic antidepressant (TCA) - Amitriptyline

A

A 2-week supply of a tricyclic antidepressant (TCA) - Amitriptyline - in full therapeutic dose would likely be lethal, with significantly smaller amounts capable of causing seizures and dysrhythmias.

58
Q

SSRIs, selective dopamine reuptake inhibitors (SDRIs),
and serotonin and norepinephrine reuptake inhibitors
(SNRIs)

A

have a significantly better safety profile when taken

in overdose; usually more than a 2-month supply of a full therapeutic dose is needed to cause life-threatening effects

59
Q

Benzodiazepine

A

Benzodiazepine taken as a solo product in overdose is seldom fatal. However, when taken in conjunction with other sedating substances such as opioids, alcohol, and barbiturates, the risk of a fatal outcome with benzodiazepine overdose is significant

CMN 568 Module 5 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions