X1 Flashcards
Which of the following SSRIs requires up to a 5-week washout period because of the
long half-life of its potent active metabolite?
A. Escitalopram
B. Fluvoxamine
C. Fluoxetine
D. Sertraline
C
Which of the following symptoms is most likely to improve within approximately 1 week
of starting treatment?
A. Depressed mood
B. Suicidal thoughts
C. Anhedonia
D. Sleep
D
Of the following combinations of medications, which one would you want to avoid?
A. Fluoxetine-lithium
B. Fluoxetine-phenelzine
C. Citalopram-valproic acid
D. Citalopram-aripiprazole
B
A 26-year-old man with a history of depression has been taking sertraline 200 mg/day
for 12 weeks with no response. The patient has no other complications. The physician
asks for your recommendation. The most reasonable recommendation would be to:
A. Increase sertraline
B. Add fluoxetine
C. Switch to amitriptyline
D. Change to venlafaxine
E. Decrease sertraline
D
Which of the following is a dangerous combination?
A. MAOI-lorazepam
B. MAOI-acetaminophen
C. MAOI-meperidine
D. MAOI-ziprasidone
C
A 23-year-old married white woman comes to the outpatient psychiatric clinic
complaining of decreased sleep, decreased appetite, decreased concentration,
depressed
mood, thoughts of death, and lack of interest in activities for 6 weeks’ duration. She has
no history of psychiatric illness and takes no medications except for Ortho-Tri Cyclen Lo
daily. Based upon the patients symptoms, choose the best medication to treat this
patient.
A. Nefazodone 100 mg po twice daily
B. Paroxetine 20 mg po daily
C. St. John’s wort 300 mg po three times daily
D. Amitriptyline 25 mg at bedtime
B
A 36-year-old man is admitted to the hospital for a severe methicillin-resistant
Staphylococcus aureus diabetic foot infection and is started on linezolid 600 mg IV
every 12 hours. His medication profile includes paroxetine 40 mg every morning,
trazodone 100 mg at bedtime as needed for sleep, and metformin 1000 mg po twice
daily. After 3
days on these medications, the patient becomes agitated, confused, and diaphoretic
and develops myoclonic jerks. Which of the following is the most likely diagnosis?
A. Overdose of metformin
B. Bacterial meningitis
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
D
A 46-year-old woman presents to the psychiatric outpatient clinic for follow-up treatment
of major depression. She is currently on paroxetine 10 mg at bedtime, which she started
taking 2 months ago when admitted to the psychiatric hospital for suicidal ideation.
During the interview, she says that she does not think the medication is working
because she is just as depressed as she was before taking the medication and has
recently started drinking eight to 10 beers daily to alleviate the depression. Before this
episode, she was
sober for 4 years. Which of the following treatment strategies would be the appropriate
choice for this patient?
A. Stop the paroxetine and start nefazodone 100 mg po twice daily
B. Increase the dose of paroxetine to 20 mg po at bedtime
C. Stop the paroxetine and start duloxetine 20 mg/day
D. Continue the paroxetine at them same dose for a longer period of time to evaluate
whether she will respond or not - CORRECT ANSWERS
B
Which of the following is a flaw in the monoamine hypothesis of depression?
A. Concentrations of neurotransmitters are reduced in the synaptic cleft
B. A switch to a different class of antidepressants does not improve response
C. Antidepressant response is associated with a therapeutic level of the medication
D. Antidepressant effects on neurotransmitters do not temporally correspond to
response. - CORRECT ANSWERS
D
A 26-year-old patient with a first episode of depression has been treated with duloxetine
60 mg twice daily for the past 4 months. The patient would like to discontinue treatment.
The patient should be told that they need at least _____full months of antidepressant
therapy after reaching full remission.
A. 3
B. 6
C. 9
D. 12
B
Which of the side effects of trazodone for the treatment of depression is most frequently
observed?
A. Hematuria
B. Delayed orgasm
C. Priapism
D. Orthostasis
D
An antidepressant that may be dangerous in overdose is
A. Mirtazapine
B. Amitriptyline
C. Fluoxetine
D. Escitalopram
B
A 28-year-old man with a history of depression has been taking sertraline 200 mg daily
for 12 weeks with no response. The patient has no other complaints. The physician
asks for your recommendation. The most reasonable recommendation would be to:
A. Increase sertraline
B. Add fluoxetine
C. Switch to amitriptyline
D. Change to venlafaxine
D
AS is an 18-year-old woman hospitalized for the fourth time for major depressive
disorder. On this occasion, AS was admitted for suicidal ideation. Her other symptoms
include loss of appetite, insomnia, decreased energy, increased agitation, and
anhedonia for the past 2 months. Although she did well her first semester of college, AS
“partied” a lot and broke up with a new boyfriend. Two months ago, AS refused to go
back to college after the winter holidays. She does not have any other medical
problems. AS’s mother and grandfather have a history of bipolar illness, and her father
has a history of
substance abuse. AS’s symptoms meet the criteria for major depressive disorder based
upon the fact that she has:
A. A history of mania
B. A history of substance abuse
C. Felt suicidal and had four target symptoms for more than 10 days
D. Had a loss of pleasure and four target symptoms for more than 2 weeks.
D
A 38-year-old male is diagnosed with major depressive disorder by his general
practitioner. His symptoms include depressed mood, insomnia, decreased appetite, and
poor concentration. He denies suicidal ideation. The patient remembers that his mother
and brother responded well to venlafaxine in the past, and he would like to try the same
medication. Which of the following monitoring parameters would be the most important
to follow on this medication?
A. Blood pressure
B. White blood cell count 7
C. Electrocardiogram
D. Potassium levels 8
A
