pyschopharm 1

Question 1

Depression: mood disorder -
Caused by decrease level of

Answer 1

of NA and serotonin -
in the CNS

Question 2

treatment of depression results in at least 50%*
.improvement in symptoms, it is called a

Answer 2

response

Question 3

results in removal of*
essentially all symptoms, it is called ———for the first
several months and then——— if it is sustained for longer
.than 12 months

Answer 3

remission
recovery

Question 4

depression returns before there is a full remission of*
symptoms or within the first several months following
.remission of symptoms, it is called a——–
When depression returns after a patient has recovered, it is*
.called ———-

Answer 4

relapse
a recurrence

Question 5

Selective Serotonin Reuptake

Inhibitors( SSRI’s)
overdose still safe higher therapeutic index

Answer 5

Fluoxetine*
Sertraline*
Paroxetine*
Citalopram*
Escitalopram*
Fluvoxamine*

Question 6

Thus, before shifting to non-SSRI antidepressants, it is most
Next step IN Tx

Answer 6

try other agents in the SSRI class for persons who did not respond
.to the first SSRI

Question 7

-paroxetine increases the risk of birth defects, particularly
heart defects, when women take it during the first 3 months
of pregnancy so Paroxetine should usually not be taken
so u give —-

Answer 7

during pregnancy .
- Concentrations of sertraline and escitalopram are
especially low in breast milk

Question 8

—————–has the most consistently demonstrated -

effectiveness in reducing symptoms of depressive disorder
in children and adolescent

Answer 8

Fluoxetine

Question 9

OCD Tx

Answer 9

Fluvoxamine , paroxtine , sertraline , and fluoxetine are indicated for-
treatment of OCD in persons older than the age of 18 yrs .

Fluvoxamine and sertraline have also been approved for treatment of
children with OCD (6 – 17 yrs

Question 10

1st line Tx in bulimia nervosa

Answer 10

ssri -fluoxetine
**SSRi has no role in TX of anorexia nervosa

Question 11

Benzodiazepine augmentation is useful in the
acute symptomatic state of which disease

Answer 11

Posttraumatic Stress Disorder.

Question 12

:Off-label Uses of SSRi
*

Answer 12

-Premature ejaculation: Fluoxetine and
sertraline have been shown to be
effective for this purpose.
- Paraphilias: SSRIs may reduce OCD in
people with paraphilias.
- Autism : Fluoxetine has been reported
to be effective for features of autism in
children, adolescents, and adults.

Question 13

Fluvoxamine may increase theophylline levels ————–
and warfarin levels ——————–.
fluvoxamine should not be used with
clozapine ; because it raises clozapine concentration,
increasing risk for —————-.
the duration of action and severity of
zolpidem-induced side effects including ———-
Concurrent administration of SSRIs with
,MAOIs,L-tryptophan,Tramadol,lithium.increase risk of ————

Answer 13

3 folds
2 folds
seizures
hallucination
serotonin syndrome

Question 14

serotonin syndrome Tx

Answer 14

cyproheptadine(serotonin antagonist )

Question 15

The most common chronic side effect of SSRIs
associated with long term treatment.
if pt don’t compline with medication

Answer 15

sexual dysfunction
but its reversible
{switch to mirtazapine}

Question 16

ANOTHER distrubant side effect of SSRi is ———– and mostly ————–so avoid in obese pts BMI > 30

Answer 16

One third of patients taking SSRIs will gain weight.
* Paroxitine is associated with more frequent ,rapid and
pronounced weight gain

Question 17

SSRi can effect cardiovascular system by ——-mostly ———-

Answer 17

lengthen the QT intervals
citalopram

Question 18

SSRi can cause headache mostly —————butttttttttttttt

Answer 18

Fluoxetine
All SSRIs are effective prophylaxis against both
migraine and tension type headaches.

Question 19

other 4 side effects of SSRi

Answer 19

sleep disturbance we give in morning
emotional blunting
seizures
sweating we give terazosin alpha antagonist

Question 20

hematologic effect of SSRi and on electrolyte balance

Answer 20

platlet aggregation +++hyponatremia

Question 21

emerge within 1-3 days.usually resolves
spontaneously in 3 weeks.characterized by both 1-psychological symptoms are anxiety, irritability and
crying spells.
2-physical symptoms are dizziness,
nausea and vomiting, fatigue, lethargy, flulike symptoms .ur Dx

Answer 21

discontinuation syndrome

Question 22

SNRIs have two and a half mechanisms:

Answer 22

🡪 boosting serotonin throughout the brain.
🡪 boosting norepinephrine throughout the brain.
🡪 boosting dopamine in prefrontal cortex

Question 23

Venlafaxine
is approved for treatment of four

Answer 23

MDD,GAD,PANIC DISORDER,SOCIAL anxiety disorder

Question 24

Higher-dose OF venlafaxine is associated with an increased risk of
sustained elevations of blood pressure\
most common reported adverse effect
contraindicated in

Answer 24

(monitoring of BP is
recommended. )
{nausea}
Contraindicated in patients taking
monoamine oxidase inhibitors (MAOIs) due
to the risk of pharmacodynamics interaction
( serotonin syndrome).
✔ MOAIs should not be started for at least 14
days after stopping venlafaxine.
* Overdose : HTN, arrhythmia

Question 25

part of SNRi
* It is formulated as a delayed release capsule to reduce the risk
of severe nausea associated with the drug.

Answer 25

Duloxetine

Question 26

Therapeutic indications: of duloxetine

Answer 26

✔ Depression
✔ Neuropathic pain associated with Diabetes and Stress Urinary
Incontinence.

Question 27

Antagonist of central presynaptic α2 adrenergic which increase levels of serotonin and norepinephrine
++++Blockade of postsynaptic serotonin 5-HT2 and 5-HT3
receptors+++++antagonist of
histamine H1{relieve insomnia at night, and improve anxiety
during the day, but could also cause drowsiness during the day.
(sedation)}
***always given before sleep

Answer 27

Mirtazapine

Question 28

which benefits of mirtazapine regarding its MOA
***always given before sleep

Answer 28

cause increase
.in appetite and weight gain
relieve insomnia at night,
Blocking receptors that mediates the nausea and vomiting which protect
against serotonin-induced gastrointestinal side effects

Question 29

mertazapine hematologic effect
cholestrol levels oncreased by 20%in 15 % of people

Answer 29

absolute neutrophil count dropped to
500/mm 3 or less within 2 months of the
onset of use in 0.3 percent of persons, some
of whom developed symptomatic infections.
(risk of agranulocytosis)