Exam #02 - Antidepressants

Question 1

What is the 1st line Tx for major depressive disorder?

Answer 1

SSRI + cognitive behavioral therapy

Question 2

How long is the minimum amount of recommended treatment duration for acute treatment phase? Continuation phase? Maintenance phase?

Answer 2

Acute: 6-12 wks
Continuation: 4-9 months
Maintenance greater than or equal to 1 year

Question 3

All of the following are true about depression except:

A. depression is heterogenous
B. low rate of relapse
C. drugs have delayed onset of action
D. monoamine hypothesis involves a deficiency of serotonin, NE, and/or DA
E. Decreasing tryptophan concentration will cause depressive relapse

Answer 3

(B) there is a HIGH rate of relapse in treatment of depression

Since tryptophan is involved in the production of serotonin, it is implicated in having an effect on the concentration of serotonin

Question 4

True or False - reserpine produces depressive symptoms?

Answer 4

True - it depletes stores of NT’s and low [NT’s] (specifically DA, NE, and serotonin) is what causes depression

Question 5

How long might antidepressant drugs take before a therapeutic effect is seen in the patient?

Answer 5

1 - 6 weeks

Question 6

Which of the following statements about depression is false?

A. Antidepressant treatment increases BDNF expression
B. depression is caused by up regulation of neurotransmitter receptors
C. antidepressant effects is related to down regulation of receptors
D. Glucocorticoid hypothesis is related to chronic cortisol in the hippocampus
E. none of above

Answer 6

(E) all of them are correct

Antidepressant treatment increases BDNF (brain derived neutrotrophic factor) expression which increases neurogenesis activity

Question 7

All of the following are SSRIs used in the Tx of depression except:

A. Fuoxetine
B. Sertraline
C. Fluvoxamine
D. Venlafaxine
E. Citalopram

Answer 7

(D) venlafaxine is a SNRI

Question 8

What is the basic MOA of buproprion (wellbutrin ®)?

Answer 8

DNRI

Question 9

What are the most common SE of SSRIs?

Answer 9

1. nausea
2. loss of appetite
3. insomnia
4. HA
5. sexual dysfunction

Question 10

Which SSRI is considered the best tolerated drug for depression b/c it has the fewest CYP450 interactions?

Answer 10

Escitalopram (Lexapro ®)

Question 11

True or False - it is not necessary to be tapered off SSRIs?

Answer 11

False - when D/C SSRIs patient should be tapered off and should NOT stop abruptly

Question 12

True or False - SNRIs are used for patients who only have a partial response with initial SSRI Tx?

Answer 12

True

SNRIs
Venlafaxine (Effexor ®)
Desvenlafaxine (Pristiq ®)
Duloxetine (Cymbalta ®)
Milnacipran (Ixel ®, Toledomin ®)

Question 13

What SE might you see with Venlafaxine or other SNRIs based on their MOA?

Answer 13

increased HR and BP

Question 14

Which antidepressant drug is also prescribed for smoking cessation?

Answer 14

bupropion (Wellbutrin ®)

Question 15

Which of the following statements is false?

A. Neurotrophic hypothesis of major depression states that chronic stress results in decrease BDNF and therefore decreased neurogenesis
B. Fluoxetine and sertraline have active metabolites
C. sexual dysfunction is a common AE of SSRIs
D. Trazadone is an atypical antidepressant
E. Long term effect of SSRIs is 5HT receptor upregulation

Answer 15

(E) Long term effect of SSRIs is 5HT receptor DOWNREGULATION

Depression is CAUSED by up regulation of NT receptors

Question 16

All of the following are SNRIs except:

A. Venlafaxine (Effexor ®)
B. Duloxetine (Cymbalta ®)
C. Bupropion (Wellbutrin ®)
D. Milnacipran
E. all are SNRIs

Answer 16

(C) Bupropion is a DNRI not an SNRI

Question 17

Which antidepressant was the first drug approved for seasonal affective disorder?

Answer 17

Bupropion

Question 18

Which antidepressant produces fewer sexual SE than other antidepressants?

Answer 18

Bupropion

Question 19

Which antidepressant was approved by the FDA for neuropathic pain and fibromyalgia pain?

Answer 19

Duloxetine (Cymbalta ®)