Unit 10 Psych Questions Flashcards
A 36-year-old woman presents with symptoms of major depression that are unrelated to a general medical condition, bereavement, or substance abuse. She is not currently taking any prescription or over-the-counter medications. Drug treatment is to be initiated with paroxetine. In your information to the patient, you would tell her that
(A) It is preferable that she does not take the drug in the evening
(B) Muscle cramps and twitches can sometimes occur
(C) She should tell you if she anticipates using other prescription drugs
(D) The antidepressant effects of paroxetine may take 2 weeks or more to become effective
(E) All of the above
The answer is E
All the statements are appropriate regarding the initiation of treatment with fluoxetine or other SSRI in a depressed patient. The SSRIs have CNS-stimulating effects and may cause agitation, anxiety, “the jitters,” and insomnia, especially early in treatment . Consequently , the evening is not the best time to take SSRI drugs.
Concerning the proposed mechanisms of action of antidepressant drugs, which statement is accurate?
(A) Bupropion inhibits 5-HT reuptake into nerve endings in the CNS
(B) Chronic treatment with tricyclic antidepressants leads to upregulation of adrenoceptors in the CNS
(C) Decreased levels of NE and 5-HT in cerebrospinal fluid are characteristic of depressed patients before drug therapy
(D) Nefazodone blocks 5-HT receptors in the CNS
(E) Selegiline selectively decreases the metabolism of serotonin
The answer is D
The mechanism of action of bupropion is unknown, but the drug does not inhibit either NE or 5-HT transporters. Levels of NE and 5-HT metabolites in the cerebrospinal fluid of depressed patients before drug treatment are not higher than normal. Downregulation of adrenoceptors appears to be a common feature of chronic treatment of depression with tricyclic drugs such as amitriptyline. Selegiline is a selective inhibitor of MAO-B, the enzyme form that metabolizes dopamine (see Chapter 28 ). Nefazodone is a highly selective antagonist at the 5-HT 2 receptor subtype.
A 34-year-old male patient who was prescribed citalopram for depression has decided he wants to stop taking the drug. When questioned, he said that it was affecting his sexual performance. You ascertain that he is also trying to overcome his dependency on tobacco products. If you decide to reinstitute drug therapy in this patient, the best choice would be
(A) Bupropion (B) Fluoxetine (C) Imipramine (D) Paroxetine (E) Venlafaxine
The answer is A
The SSRIs and venlafaxine (an SNRI) can cause sexual dysfunction with decreased libido, erectile dysfunction, and anorgasmia. TCAs may also decrease libido or prevent ejaculation. Bupropion is the least likely antidepressant to affect sexual performance. The drug is also purportedly useful in withdrawal from nicotine dependence, which could be helpful in this patient.
A patient under treatment for a major depressive disorder is brought to the emergency department after ingesting 30 times the normal daily therapeutic dose of amitriptyline. In severe tricyclic antidepressant overdose, it would be of minimal value to
(A) Administer bicarbonate and potassium chloride (to correct acidosis and hypokalemia)
(B) Administer lidocaine (to control cardiac arrhythmias)
(C) Initiate hemodialysis (to hasten drug elimination)
(D) Maintain heart rhythm by electrical pacing
(E) Use intravenous diazepam to control seizures
The answer is C
TCA overdose is a medical emergency. The “3 Cs”— coma, convulsions, and cardiac problems— are the most common causes of death. Widening of the QRS complex on the ECG is a major diagnostic feature of cardiac toxicity. Arrhythmias resulting from cardiac toxicity require the use of drugs with the least effect on cardiac conductivity (eg, lidocaine ). Hemodialysis does not increase the rate of elimination of tricyclic antidepressants in overdose.
This drug, an antagonist at 5-HT 2 receptors, is widely used for the management of insomnia.
(A) Citalopram (B) Doxepin (C) Trazodone (D) Triazolam (E) Zolpidem
The answer is C
Triazolam and zolpidem are effective hypnotic drugs, but they do not act via antagonism of serotonin 5-HT 2 receptors. Trazodone is an antagonist at 5-HT 2 receptors and has wide use as a sleeping aid, especially in patients with symptoms of affective disorder.
A recently bereaved 73-year-old female patient was treated with a benzodiazepine for several weeks after the death of her husband, but she did not like the daytime sedation it caused even at low dosage. Living independently, she has no major medical problems but appears rather infirm for her age and has poor eyesight. Because her depressive symptoms are not abating, you decide on a trial of an antidepressant medication . Which of the following drugs would be the most appropriate choice for this patient?
(A) Amitriptyline (B) Mirtazapine (C) Phenelzine (D) Sertraline (E) Trazodone
The answer is D
Older patients are more likely to be sensitive to antidepressant drugs that cause sedation, atropine -like adverse effects , or postural hypotension. Tricyclics and MAO inhibitors cause many autonomic side effects; mirtazapine and trazodone are highly sedating. Sertraline (or another SSRI) is often the best choice in such patients.
SSRIs are much less effective than tricyclic antidepressants in the management of
(A) Bulimia (B) Chronic pain of neuropathic origin (C) Generalized anxiety disorder (D) Obsessive-compulsive disorder (E) Premenstrual dysphoric disorder
The answer is B
The SSRIs are not effective in chronic pain of neuropathic origin. All the other uses of SSRIs are approved indications with clinical effectiveness equivalent or superior to that of tricyclic drugs. In addition to treatment of chronic pain states and depression, the tricyclics are also used to treat enuresis and attention deficit hyperkinetic disorder.
Which of the following drugs is most likely to be of value in obsessive-compulsive disorders?
(A) Amitriptyline (B) Clomipramine (C) Doxepin (D) Nefazodone (E) Venlafaxine
The answer is B
Clomipramine, a tricyclic agent, is a more selective inhibitor of 5-HT reuptake than other drugs in its class. This activity appears to be important in the treatment of obsessive-compulsive disorder. However, the SSRIs have now become the drugs of choice for this disorder because they are safer in overdose than tricyclics.
Regarding the clinical use of antidepressant drugs, which statement is accurate?
(A) Chronic use of antidepressants increases the activity of hepatic drug metabolizing enzymes
(B) In the treatment of major depressive disorders, sertraline is usually more effective than fluoxetine
(C) Tricyclics are highly effective in depressions with attendant anxiety, phobic features, and hypochondriasis
(D) Weight gain often occurs during the first few months in patients taking SSRIs
(E) When selecting an appropriate drug for treatment of depression, the history of patient response to specific drugs is a valuable guide
The answer E.
No antidepressant has been shown to increase hepatic drug metabolism. MAO inhibitors (not TCAs), though now used infrequently, are the drugs most likely to be effective in depression with attendant anxiety, phobic features and hypochondriasis. SSRIs are usually associated with weight loss, at least during the first 6 months of treatment. There is no evidence that any SSRI is more effective than another, or more effective overall than a tricyclic drug, in treatment of major depressive disorder.
To be effective in breast cancer , tamoxifen must be converted to an active form by CYP2D6. Cases of inadequate treatment of breast cancer have occurred when tamoxifen was administered to patients who were being treated with
(A) Bupropion (B) Clomipramine (C) Fluoxetine (D) Imipramine (E) Phenelzine
The answer is C
Fluoxetine is an inhibitor of hepatic cytochromes P450 especially CYP2D6 , and to a lesser extent CYP3A4. Dosages of several drugs may need to be reduced if given concomitantly with fluoxetine. In the case of tamoxifen, however, its antineoplastic action is dependent on its conversion to an active metabolite by CYP2D6.
Trifluoperazine was prescribed for a young male patient diagnosed as suffering from schizophrenia. He complains about the side effects of his medication. Which of the following is not likely to be on his list?
(A) Constipation
(B) Disinterest in sexual activity
(C) Dizziness if he stands up too quickly
(D) Excessive salivation
(E) Small print in the newspaper is hard to see
Phenothiazines such as trifluoperazine cause sedation and are antagonists at muscarinic and α adrenoceptors. Postural hypotension, blurring of vision, and dry mouth are common autonomic adverse effects, as is constipation Effects on the male libido may result from increased prolactin or from increased peripheral conversion of androgens to estrogens.
The answer is D.
Which statement concerning the adverse effects of antipsychotic drugs is accurate?
(A) Acute dystonic reactions occur very infrequently with olanzapine
(B) Akathisias due to antipsychotic drugs are managed by increasing the drug dose
(C) Blurring of vision and urinary retention are common adverse effects of haloperidol
(D) Retinal pigmentation is a dose-dependent toxic effect of clozapine
(E) The late-occurring choreoathetoid movements caused by conventional antipsychotic drugs are alleviated by atropine.
Olanzapine has minimal dopamine receptor-blocking action and is unlikely to cause acute dystonias. Muscarinic blockers such as atropine exacerbate tardive dyskinesias. Akathisias (uncontrollable restlessness) resulting from antipsychotic drugs may be relieved by a reduction in dosage. Retinal pigmentation may occur with thioridazine, not clozapine.
The answer is A.
Which statement concerning the use of lithium in the treatment of bipolar affective disorder is accurate?
(A) Excessive intake of sodium chloride enhances the toxicity of lithium
(B) Lithium alleviates the manic phase of bipolar disorder within 12 h
(C) Lithium dosage may need to be decreased in patients taking thiazides
(D) Since lithium does not cross the placental barrier, it is quite safe in pregnancy
(E) The elimination rate of lithium is equivalent to that of creatinine
Clinical effects of lithium are slow in onset and may not be apparent before 1 or 2 weeks of daily treatment. High urinary levels of sodium inhibit renal tubular reabsorption of lithium, thus decreasing its plasma levels. Lithium clearance is decreased by distal tubule diuretics (eg, thiazides) because natriuresis stimulates a reflex increase in the proximal tubule reabsorption of both lithium and sodium. Any drug that can cross the blood-brain barrier can cross the placental barrier! Teratogenic risk is low, but use of lithium during pregnancy may contribute to low Apgar score in the neonate.
The answer is C.
A 30-year-old male patient is on drug therapy for a psychiatric problem . He complains that he feels “flat” and that he gets confused at times. He has been gaining weight and has lost his sex drive. As he moves his hands, you notice a slight tremor. He tells you that since he has been on medication he is always thirsty and frequently has to urinate. The drug he is most likely to be taking is
(A) Carbamazepine (B) Clozapine (C) Fluphenazine (D) Lithium (E) Valproic acid
Confusion, mood changes, decreased sexual interest, and weight gain are symptoms that may be unrelated to drug administration. On the other hand, psychiatric drugs are often responsible for such symptoms. Tremor and symptoms of nephrogenic diabetes insipidus are characteristic adverse effects of lithium that may occur at blood levels within the therapeutic range.
The answer is D.
A 30-year-old male patient is on drug therapy for a psychiatric problem . He complains that he feels “flat” and that he gets confused at times. He has been gaining weight and has lost his sex drive. As he moves his hands, you notice a slight tremor. He tells you that since he has been on medication he is always thirsty and frequently has to urinate. The drug he is most likely to be taking is
(A) Carbamazepine (B) Clozapine (C) Fluphenazine (D) Lithium (E) Valproic acid
Confusion, mood changes, decreased sexual interest, and weight gain are symptoms that may be unrelated to drug administration. On the other hand, psychiatric drugs are often responsible for such symptoms. Tremor and symptoms of nephrogenic diabetes insipidus are characteristic adverse effects of lithium that may occur at blood levels within the therapeutic range.
The answer is D.
