Major Depressive Disorder Therapeutics Flashcards by Cynthia Navarro

Which of the following is the brand name of isocarboxazid?

A. Nardil

B. Parnate

C. Marplan

D. Zelapar

C. Marplan

Nardil= phenelzine

Parnate= tranylcypromine

Zelapar= selegiline

How well did you know this?

Not at all

Perfectly

What is the generic name of Parnate?

A. Phenelzine

B. Isocarboxazid

C. selegiline

D. none of the above

D. None of the above

the generic name is tranylcypromine

How well did you know this?

Not at all

Perfectly

Which of the following pairs is incorrect? Select all that apply

A. Marplan= Isocarboxazid

B. Phenelzine=Eldepryl

C. Tranylcypromine=Emsam

D. Selegiline=Zelapar

B, C

Eldepryl and Emsam are brand names for selegiline

How well did you know this?

Not at all

Perfectly

What is the brand name of phenelzine?

A. Quetiapine

B. Parnate

C. Sinequan

D. Nardil

Quetiapine is an antipsychotic

Parnate is tranylcypromine

Sinequan is doxepine ( a tertiary amine)

How well did you know this?

Not at all

Perfectly

Which of the following MAOIs is selective for MAO-B?

A. Eldepryl

B. Parnate

C. Nardil

D. Marplan

A. Eldepryl ( Selegiline)

Parnate= tranylcypromine

Phenelzine= Nardil

Isocarboxazid=marplan

How well did you know this?

Not at all

Perfectly

If a patient is on sertraline ( half-life is 24hours) and fails treatment the doctor wants to start an MAOI. How long shold the patient wait to initiate the MAOI?

A. Immediately

B. 1 week

C. 2-3 weeks

D. 5 weeks

How well did you know this?

Not at all

Perfectly

If a patient is on Marplan but didnt tolerate the medication so the doctor wants to switch her to sertraline. How long should the doctor wait before initiating the sertraline?

A. Immediately

B. 1 week

C. 2-3 weeks

D. 5 weeks

C. 2-3 weeks

How well did you know this?

Not at all

Perfectly

How does MAOI and tyramine cause hypertensive crisis?

MAO-A in the intestine breaks down tyramine
MAOI allows increase in tyramine absorption
Tyramine increases Norepinephrine displacement from storage vesicles
There is overstimulation of noradrenergic system
Incresase in blood pressure

How well did you know this?

Not at all

Perfectly

All of the following medications cause weight gain and constipation except:

A. Nardil

B. Parnate

C. Emsam

D. Marplan

C. Emsam ( selegiline)

How well did you know this?

Not at all

Perfectly

MAOI block the breakdown of NE and Serotonin. Which of the following side effects are caused by NE and which are caused by Serotoin?

A. Hypotension/Syncope

B. Dry Mouth

C. Headache

D. GI-discomfort

E. Sexyal dysfunction

F. Constipation

G. Weight Gain

H. Edema

Serotoinin: GI discomfort, Sexual dysfunction,

Norepinephrine:

Anti-Histaminic: weigh gain, constipation

How well did you know this?

Not at all

Perfectly

Which of the following medications is not a secondary amine?

A. Nortriptlyine

B. Protriptyline

C. Amitriptyline

D. Amoxipine

C. Amitriptyline

Remember secondary amines are better at increasing NE concentraitons and tertiary amines are better at increasing serotoinin

How well did you know this?

Not at all

Perfectly

Which of the following TCA has a metabolite of ioxapine that has antipsychotic properties?

A. Norpramin

B. Pamelor

C. Vivactil

D. Asendin

D. Asendin ( amoxapine)

Norpramin= Desipramine

Pamelor=Nortriptyline

Vivactil=protriptyline

How well did you know this?

Not at all

Perfectly

which of the following medication is FDA approved for insomnia treatment?

A. Amitriptlyine

B. Doxepin

C. Clomipramide

D. Imipramine

B. Doxepin

How well did you know this?

Not at all

Perfectly

Which of the following medications is FDA approved for OCD treatment?

A. amitriptyline

B. Doxepin

C. Clomipramine

D. Imipramine

C. Clomipramine

How well did you know this?

Not at all

Perfectly

True or False

In general, tertiary amines have higher chances of adverse side effects than the secondary amines

True

How well did you know this?

Not at all

Perfectly

Which of the following TCA has an active metabolite desipramine?

A. Imipramine

B. Clomipramine

C. Doxepin

D. Amitriptyline

A. Imipramine

How well did you know this?

Not at all

Perfectly

Which drug class you do you have to d/c at least 10 days prior to elective surgery?

A. SSRI

B. SNRI

C. TCA

D. MAOI

Anesthesia has effects on MAOI

Which of the following medications causes QTc prolongation?

A. Lexapro

B. Celexa

C. Prozac

D. Paxil

B. Celexa

Which of the following SSRI is well tolerated according to the studies?

A. Paroxetine

B. Fluoxetine

C. Escitalopram

D. Sertraline

Which of the following medications causes significant weight gain and is the worst offender of discontinuation syndrome?

A. Paroxetine

B. Fluoxetine

C. Escitalopram

D. Sertraline

A. Paroxetine

True or False

Paroxetine causes insomnia

False

What patients are at risk for developing SIADH while on an SSRI?

A. Age

B. Thiazide Diurects

C. Concomitant use of other antidepressants

D. methadone

At what strength does venlafaxine cause hypertension?

A. 100-200mg

B. 200-225mg

C. >300mg

D. None of the above, venlafaxine does not cause HTN

At what dose does venlafaxine start acting like an SSRI?

A. 100mg

B. 150mg

C. 200mg

D. 225mg

> 225mg

Which of the SNRI should not be used in patients at risk for hepatic dysfunction? A. Desvenlafaxine B. Venlafaxine C. Duloxetine D. A and B

C. Duloxetine

Select all that apply. What is duloxetine also approved for? A. Fibromyalgia B. Diabetic Neuropathy C. GAD D. Insomnia

A, B,C

Which SNRI doesnt not cause sexual dysfunction? A. venlafaxine B. Duloxentine C. Levomilnacipran D. Milnacipran

D. Milnacipan

Which drug class do you not give to patients with an eating disorder? A. SNRI B. SSRI C. NDRI D. TCA

C. NDRI Having an eating disorder increases risk of seizures due to electrolyte shifts

What components are consistent with MDD? Jessica is a 28 year-old married female. She has a very demanding, high stress job as a second year medical resident in a large hospital. Jessica has always been a high achiever. She graduated with top honors in both college and medical school. She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past. For the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her coworkers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping. At home, Jessica’s husband has noticed changes as well. She’s shown little interest in sex and has had difficulties falling asleep at night. Her insomnia has been keeping him awake as she tosses and turns for an hour or two after they go to bed. He’s overheard her having frequent tearful phone conversations with her closest friend, which have him worried. When he tries to get her to open up about what’s bothering her, she pushes him away with an abrupt “everything’s fine”. Although she hasn’t ever considered suicide, Jessica has found herself increasingly dissatisfied with her life. She’s been having frequent thoughts of wishing she was dead. She gets frustrated with herself because she feels like she has every reason to be happy, yet can’t seem to shake the sense of doom and gloom that has been clouding each day as of late

Jessica gets diagnosed with mild-moderate depression. What is the first line therapy to treat her depression?

Psychotherapy +/ - pharmacotherapy: SSRI SNRI Mirtazapine Bupropion

Upon reading Jessica's chart you find that she has had 2 MDD episodes. How long should the patient be treated? A. \> or equal to 6 months B. \> or equal to 1 year C. indefinite treatment

Jessica comes back in 2 weeks and you see no moderate improvement is observed. select all that apply the next steps the provider can do to. A. Maximize dose B. Change to another agent within the same class C. Change to an agent in another class D. Tell the provider that the patient will not see changes in 4-8 weeks

Jose is a 35 yo male who got diagosed with MDD, he comes to pick up his prescription for sertraline. When you counsel him you ask him what other medications he is on and he responds ibuprofen. What is the best approach that should be used when and SSRI and NSAIDs are taken together? A. combination must be avoided B. use this combination with caution and monitoring C.combination is associated with enhanced antidepressant effect D.non of the above

Rolando was diagnosed with MDD, he comes up to the pharmacy and states that the medications are not working. which of the following steps should be confirmed when prior to labeling them as nonresponders or failed therapy? A. adequate dose for adequate duration B. Adherence to prescribed regimen C. Proper monitoring response D. All of the above

Upon question Rolando, he said a nurse told him he should see full effects in 2 weeks. How should the nurse have educated the patient? (select all that apply) A. in 2 weeks he will see increased activity, sex drive, self-care, concentration, memory B. in 4-8 weeks he should see improved depressed mood, decreased/ remitted feelings of hopelessness C. in 4-8 weeks she will see increased activity,sex drive, self-care, concentration, memory D. In 2 weeks he should see improved depressed mood, decreased/ remitted feelings of hopelessness

A, B

What is the antidepressant of choice for an elderly patient who has narrow-angle glaucoma and MDD? A. Trazodone B. Mirtazapine C. Sertraline D. Amitriptyline

Which of the following antidepressant has the black box warning of pheochromocytoma? A. MAOI B. SSRI C. SNRI D. NDRI

Which antidepressants should not be taken with sympathomimetic or serotonergic agents? A. SSRI B. SNRI C. MAOI D. All of the antidepressents

Which of the following medications will not cause sexual dysfunction? A. Bupropion B. isocarboxazid C.Phenelzine D. Paroxetine

Which of the following is least likely to cause orthostatic hypotension? A. Desipiramide B. sertraline C. doxepin D. amitriptyline