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Antidepressant Flash Card Supplement

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WEEK 10 Quiz on Antidepressant Flash Card Supplement, created by Victoria Wright on 22/03/2017.
Victoria Wright
Quiz by Victoria Wright, updated more than 1 year ago
Victoria Wright
Created by Victoria Wright over 7 years ago
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Resource summary

Question 1

Question
Which of the following drugs are classified as SSRIs?
Answer
  • Venlafaxine
  • Imipramine
  • Paroxetine
  • Bupropion
  • Phenylzine
  • Fluoxetine
  • Sertraline
  • Desvenlafaxine
  • Citalopram
  • Escitalopram

Question 2

Question
Which of the following drugs are classified as SNRIs?
Answer
  • Imipramine
  • Duloxetine
  • Mirtazapine
  • Fluoxetine
  • Venlafaxine
  • Desvenlafaxine
  • Selegiline

Question 3

Question
Which of the following drugs are classified as TCAs?
Answer
  • Imipramine
  • Trazodone
  • Amitriptyline
  • Clomipramine
  • Paroxetine
  • Escitalopram
  • Duloxetine

Question 4

Question
Which of the following drugs are classified as MAO-Is?
Answer
  • Amitriptyline
  • Selegiline
  • Duloxetine
  • Phenylzine
  • Citalopram
  • Bupropion
  • Trazodone

Question 5

Question
Which of the following drugs are classified as Atypical?
Answer
  • Mirtazapine
  • Fluoxetine
  • Amitriptyline
  • Citalopram
  • Trazodone
  • Imipramine
  • Bupropion

Question 6

Question
[blank_start]Amine[blank_end] Hypothesis  Abnormally low levels of norepinephrine and/or [blank_start]serotonin[blank_end] underlie [blank_start]depression[blank_end] Evidence for this hypothesis includes:  Reserpine, an (old) antihypertensive drug depletes pre-synaptic stores of [blank_start]norepinephrine[blank_end] (NE) and is associated with depressive symptoms.  Autopsy studies of the brains of depressed suicide victims indicate a [blank_start]low[blank_end] level of NE and/or serotonin (5-HT) metabolism in most brain regions  Drugs found to be beneficial act to enhance NE or 5-HT levels. A major weakness to this hypothesis is the therapeutic lag – effects of drugs on NE or 5-HT levels are observed [blank_start]immediately[blank_end] yet therapeutic benefit takes a minimum of 1 to 4 [blank_start]weeks[blank_end] to occur
Answer
  • Amine
  • serotonin
  • depression
  • norepinephrine
  • low
  • immediately
  • weeks

Question 7

Question
[blank_start]Neuroendocrine[blank_end] Hypothesis  Depression is associated with elevated [blank_start]cortisol[blank_end] levels  [blank_start]HPA[blank_end] axis is dysregulated  Abnormal (low) [blank_start]thyroid[blank_end] function is common in depression
Answer
  • Neuroendocrine
  • cortisol
  • HPA
  • thyroid

Question 8

Question
[blank_start]Neurotrophin[blank_end] Hypothesis  Laboratory research indicates that antidepressants [blank_start]increase[blank_end] BDNF production in [blank_start]hippocampus[blank_end]  This requires [blank_start]long[blank_end] term (weeks) not [blank_start]short[blank_end] term (days) treatment  BDNF increases neurogenesis and [blank_start]synaptic[blank_end] connectivity  Stress, pain and depression can [blank_start]reduce[blank_end] BDNF  Imaging studies indicate reduced hippocampal volume (size) in [blank_start]depression[blank_end]
Answer
  • increase
  • hippocampus
  • long
  • short
  • synaptic
  • reduce
  • depression
  • Neurotrophin

Question 9

Question
Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for children?
Answer
  • Paroxetine
  • Citalopram
  • Escitalopram
  • Fluoxetine
  • Sertraline

Question 10

Question
Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for adolescents?
Answer
  • Fluoxetine
  • Paroxetine
  • Escitalopram
  • Citalopram
  • Sertraline

Question 11

Question
Which of the following are uses for Serotonin Selective Reuptake Inhibitors (SSRIs)?
Answer
  • Depression
  • PTSD
  • Premature ejaculation
  • PMDD
  • Panic disorder
  • Bulimia
  • Menopausal “hot flashes”
  • Enuresis
  • OCD
  • GAD

Question 12

Question
Which of the following are true about SSRIs?
Answer
  • Rapid metabolism requires multiple doses per day
  • Risk of serotonin syndrome if switching to MAOI
  • Antagonist for 5-HT2A receptor
  • Mechanism of action: inhibition of serotonin transporter (SERT)
  • Some are potent inhibitors of CYP 2D6
  • Narrow therapeutic index
  • High selectivity for SERT (serotonin transporter)
  • Sedating - taken at bedtime
  • First line (with SNRIs) treatment for depression
  • High therapeutic index

Question 13

Question
Which seven of the following are the adverse effects of SSRIs?
Answer
  • Increased risk of bleeding by inhibiting SERT in platelets
  • Headaches, insomnia or hypersomnia
  • Significant weight gain in some patients
  • Increased sweating, urinary retention
  • Reduced sexual function; may improve over time on drug
  • Discontinuation syndrome (anxiety, irritability, confusion, crying)
  • Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
  • Nausea, GI upset, diarrhea; all improve after the first week
  • Lowers seizure threshold, problem in epilepsy, alcoholism, eating disorders
  • Paroxetine is Category D – risk of heart defects with first trimester exposure

Question 14

Question
Which of the following are uses of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?
Answer
  • Neuropathic pain
  • Vasomotor symptoms of menopause
  • Social anxiety
  • Panic disorder
  • OCD
  • GAD
  • Depression
  • PTSD
  • Sedation
  • Stress urinary incontinence

Question 15

Question
Which of the following are true about SNRIs?
Answer
  • Dominant class of antidepressants until ~ 1990s when SSRIs took over
  • Used for depression, neuropathic pain, GAD, stress urinary incontinence, vasomotor symptoms of menopause
  • Highly sedating and not associated with tolerance or dependence
  • Antagonist for 5-HT2A receptor
  • Drugs have high selectivity for SERT and NET (norepinephrine transporter)
  • Has CNS stimulating effects, inhibits NE and dopamine transporters; increases presynaptic release of NE and dopamine
  • Venlafaxine is metabolized to desvenlafaxine by CYP 2D6
  • Narrow therapeutic index and bothersome side effects explain reduced use
  • Discontinuation symptoms with venlafaxine and desvenlafaxine are common
  • Used for depression, GAD, PTSD, OCD, panic disorder, PMDD, bulimia

Question 16

Question
Which of the following are the adverse effects of SNRIs?
Answer
  • Significant weight gain in some patients
  • Sedation
  • Discontinuation symptoms with venlafaxine and desvenlafaxine are common
  • Nausea, GI upset, diarrhea; all improve after the first week
  • Increased risk of bleeding by inhibiting SERT in platelets
  • Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
  • Increased sweating, urinary retention
  • Reduced sexual function; may improve over time on drug
  • Headaches, insomnia or hypersomnia
  • Increased blood pressure and heart rate; not a problem in most patients

Question 17

Question
Which of the following are the uses for Tricyclic antidepressants (TCAs)?
Answer
  • GAD
  • Enuresis
  • Cardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
  • Vasomotor symptoms of menopause
  • Headaches, insomnia or hypersomnia
  • Neuropathic pain
  • Depression
  • Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
  • Stress urinary incontinence
  • Category D – risk of heart defects with first trimester exposure

Question 18

Question
Which of the following are true about TCAs?
Answer
  • Used in depression that is unresponsive to SSRIs and SNRIs
  • Narrow therapeutic index and bothersome side effects explain reduced use
  • Drug-drug interactions with CNS depressants, e.g. antihistamines, alcohol, benzodiazepines
  • Dominant class of antidepressants until ~ 1990s when SSRIs took over
  • Potentially lethal in overdose
  • Less selectivity than SSRIs, SNRIs
  • As a class, they inhibit NET and SERT but variable profiles of individual drugs
  • Sedating – taken at bedtime
  • Metabolized by CYP 2D6, serum levels are affected by inhibitors
  • Efficacy is similar to SSRIs, SNRIs

Question 19

Question
Which of the following are the adverse effects of TCAs?
Answer
  • Sexual side effects
  • Histamine H1 antagonism: weight gain, sedation
  • Cardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
  • Increased risk of bleeding by inhibiting SERT in platelets
  • Adrenergic α1 antagonism: orthostatic hypertension
  • Has been associated with priapism
  • Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
  • Discontinuation syndrome (flu-like symptoms)
  • Category D – risk of heart defects with first trimester exposure
  • Headaches, insomnia or hypersomnia

Question 20

Question
Which of the following are true about Trazodone?
Answer
  • Seldom used as monotherapy
  • Rapid metabolism requires multiple doses per day
  • Adjunct with SSRI for patients with insomnia
  • Has CNS stimulating effects, inhibits NE and dopamine transporters; increases presynaptic release of NE and dopamine
  • Drugs have high selectivity for SERT and NET (norepinephrine transporter)
  • Used for depression and anxiety
  • Appetite stimulating – may be useful in depression plus anorexia
  • Not associated with sexual side effects, bleeding or weight gain
  • Antagonist for 5-HT2A receptor
  • Is used as a hypnotic – highly sedating and not associated with tolerance or dependence

Question 21

Question
Which of the following are the adverse effects of Trazodone?
Answer
  • Sedation
  • Potentially lethal in overdose (autonomic, cardiac, seizures)
  • Has been associated with priapism
  • Insomnia, restlessness
  • α1-antagonism: orthostatic hypotension
  • GI
  • Lowers seizure threshold, problem in epilepsy, alcoholism, eating disorders
  • Orthostatic hypotension
  • Anticholinergic (muscarinic): dry mouth, constipation, urinary retention, blurred vision, confusion
  • Anorexia

Question 22

Question
Which of the following are true about Bupropion?
Answer
  • Has CNS stimulating effects, inhibits NE and dopamine transporters
  • Not sedating
  • Irreversible inhibition of MAO-A and MAO-B; long duration of effect
  • Antagonist at adrenergic α2 and 5-HT2 receptor
  • Drugs have high selectivity for SERT and NET (norepinephrine transporter)
  • Not used for anxiety
  • As effective as nicotine patches for smoking cessation
  • Not associated with sexual side effects, bleeding or weight gain
  • Increases presynaptic release of NE and dopamine
  • High selectivity for SERT

Question 23

Question
Which of the following are adverse effects of Bupropion?
Answer
  • Cardiac conduction delays; arrhythmogenic: Potentially lethal in overdose
  • Anorexia
  • Insomnia
  • Lowers seizure threshold
  • Increased risk of bleeding by inhibiting SERT in platelets
  • Agitation, anxiety, headache, nausea
  • Significant weight gain in some patients
  • Sexual side effects
  • Sedation
  • Problem in epilepsy, alcoholism, eating disorders

Question 24

Question
Which of the following are true about Mirtazapine?
Answer
  • Sedating – useful for depression with insomnias
  • Antagonist at adrenergic α2 and 5-HT2 receptor
  • Used for depression, neuropathic pain, GAD, stress urinary incontinence, vasomotor symptoms of menopause
  • High selectivity for SERT (serotonin transporter)
  • Drug-drug interactions with alcohol, benzodiazepines
  • Used in neuropathic pain, enuresis
  • H1 antagonist
  • Metabolized by CYP 2D6, serum levels are affected by inhibitors
  • Appetite stimulating – may be useful in depression plus anorexia
  • Not associated with sexual side effects

Question 25

Question
Which of the following are adverse effects of Mirtazapine?
Answer
  • Orthostatic hypotension
  • Headaches, insomnia or hypersomnia
  • Dry mouth
  • Increased risk of bleeding by inhibiting SERT in platelets
  • Constipation
  • Category D – risk of heart defects with first trimester exposure
  • Weight gain
  • Has been associated with priapism
  • Nausea, GI upset, diarrhea; all improve after the first week
  • Cardiac conduction delays; arrhythmogenic: Potentially lethal in overdose

Question 26

Question
Which of the following are true about Monoamine oxidase inhibitors (MAOIs)?
Answer
  • Potential for drug/food interactions
  • MAO-B: metabolizes dopamine
  • Antagonist at adrenergic α2 and 5-HT2 receptor
  • MAO-B: metabolizes NE, 5-HT and dopamine
  • MAO-A: metabolizes NE, 5-HT and dopamine
  • Inhibits NE and dopamine transporters and increases presynaptic release of NE and dopamine
  • Irreversible inhibition of MAO-A and MAO-B; long duration of effect
  • MAO-A: metabolizes dopamine
  • Used in treatment resistant depression
  • Is used as a hypnotic – highly sedating and not associated with tolerance or dependence

Question 27

Question
Which of the following are adverse effects of MOAIs?
Answer
  • Dry mouth
  • Insomnia, restlessness
  • Discontinuation syndrome
  • Anorexia
  • Orthostatic hypotension
  • Headaches, insomnia or hypersomnia
  • Potentially lethal in overdose (autonomic, cardiac, seizures)
  • Weight gain
  • Constipation
  • Increased sweating, urinary retention

Question 28

Question
[blank_start]Serotonin[blank_end] [blank_start]Syndrome[blank_end]  [blank_start]Cognitive[blank_end] (delirium), [blank_start]autonomic[blank_end] (hypertension, tachycardia, sweating) and [blank_start]somatic[blank_end] (tremor), also [blank_start]fever[blank_end], shivering  [blank_start]Discontinue[blank_end] serotonergic [blank_start]antidepressants[blank_end] at least [blank_start]2 weeks[blank_end] before starting MAOI; [blank_start]fluoxetine[blank_end] requires 5 weeks  Discontinue MAOI for 2 weeks [blank_start]before[blank_end] starting a serotonergic agent  Linezolid (antimicrobial), dextromethorphan, sumatriptan, tramadol, [blank_start]methadone[blank_end], St. John’s wart can cause serotonin syndrome in the presence of [blank_start]SSRI[blank_end] or MAOI
Answer
  • Serotonin
  • Syndrome
  • Cognitive
  • autonomic
  • somatic
  • fever
  • Discontinue
  • antidepressants
  • 2 weeks
  • 6 weeks
  • 4 weeks
  • before
  • after
  • SSRI
  • SNRI
  • methadone
  • fluoxetine
  • phenylzine
  • amitriptyline
  • Continue
  • sweating
  • nausea

Question 29

Question
Therapeutic use of antidepressants: [blank_start]Depression[blank_end] Requires [blank_start]1-2 months[blank_end] for benefit [blank_start]Trial period[blank_end] is [blank_start]4-12 weeks[blank_end], if inadequate response then switch or [blank_start]add[blank_end] another agent ~[blank_start]30%[blank_end] respond to [blank_start]initial[blank_end] agent ~[blank_start]70%[blank_end] respond if treatment is [blank_start]optimized[blank_end] e.g. SSRI + bupropion/atypical antipsychotic Many patients continue [blank_start]maintenance[blank_end] doses for year
Answer
  • Depression
  • 1-2 months
  • 2-4 months
  • Trial period
  • 4-12 weeks
  • add
  • 30%
  • 70%
  • initial
  • optimized
  • maintenance
  • paroxetine
  • bupropion
  • trazodone
  • 90%
  • 10%
  • 50%
  • Anxiety
  • Pain

Question 30

Question
Therapeutic uses of [blank_start]antidepressants[blank_end]:  Depression  [blank_start]Anxiety[blank_end] - SSRIs and SNRIs are approved for PTSD, OCD, social anxiety, GAD and panic disorder - Slower onset of benefit than [blank_start]benzodiazepines[blank_end]  [blank_start]Pain[blank_end] - Effects on pain are [blank_start]independent[blank_end] of antidepressant effects - [blank_start]TCAs[blank_end], SNRIs are more effective than others  [blank_start]Premenstrual Dysphoric Disorder[blank_end] - [blank_start]Fluoxetine[blank_end] and sertraline are approved therapies  [blank_start]Smoking Cessation[blank_end] - [blank_start]Bupropion[blank_end] - As effective as nicotine patches  [blank_start]Eating Disorders[blank_end] - More success with [blank_start]bulimia[blank_end] than [blank_start]anorexia[blank_end] - [blank_start]Mirtazapine[blank_end] stimulates appetite and used in anorexia  [blank_start]Premature ejaculation[blank_end] - [blank_start]SSRIs[blank_end] - Most antidepressants (except bupropion, [blank_start]mirtazapine[blank_end]) have sexual side effects  [blank_start]Menopausal “hot flashes”[blank_end] - SSRIs and SNRIs show benefit
Answer
  • antidepressants
  • Anxiety
  • Pain
  • Premenstrual Dysphoric Disorder
  • Smoking Cessation
  • Eating Disorders
  • Premature ejaculation
  • Menopausal “hot flashes”
  • benzodiazepines
  • independent
  • TCAs
  • Fluoxetine
  • Bupropion
  • bulimia
  • anorexia
  • Mirtazapine
  • SSRIs
  • SNRIs
  • MOAIs
  • mirtazapine

Question 31

Question
Choosing an antidepressant  At the population level, [blank_start]efficacy[blank_end] is [blank_start]similar[blank_end] for all drugs  SSRIs and [blank_start]SNRIs[blank_end] are first line therapies  choice is often based on [blank_start]adverse effects[blank_end], potential drug interactions, patient [blank_start]history[blank_end]  [blank_start]Bupropion[blank_end]
Answer
  • efficacy
  • similar
  • different
  • SNRIs
  • TCAs
  • SSRIs
  • MAOIs
  • adverse effects
  • history
  • Bupropion

Question 32

Question
Antidepressants: Mechanisms of action  [blank_start]SERT inhibition[blank_end] (SSRIs)  NET and SERT inhibition ([blank_start]venlafaxine[blank_end], TCAs)  5-HT2C agonist ([blank_start]trazodone[blank_end])  α2 antagonist ([blank_start]mirtazapine[blank_end])  [blank_start]5-HT2A, 2C, 3 antagonist[blank_end] (mirtazapine)  MAO inhibition ([blank_start]MAOIs[blank_end])  [blank_start]NE and DA potentiating[blank_end] ([blank_start]bupropion[blank_end])
Answer
  • venlafaxine
  • trazodone
  • mirtazapine
  • SERT inhibition
  • 5-HT2A, 2C, 3 antagonist
  • NE and DA potentiating
  • MAOIs
  • bupropion

Question 33

Question
Adverse effects  Mirtazapine has [blank_start]high[blank_end] affinity for [blank_start]H1[blank_end]  Antagonism of M, H1 and α1 is characteristic of [blank_start]TCAs[blank_end] - Dry mouth, sedation, [blank_start]orthostatic hypotension[blank_end] - Cardiotoxicity  [blank_start]SSRIs[blank_end] - Weight gain, sexual dysfunction, drug interactions (plasma protein binding, drug metabolism), nausea, [blank_start]insomnia[blank_end]
Answer
  • H1
  • M
  • α1
  • TCAs
  • orthostatic hypotension
  • SSRIs
  • MOAIs
  • anorexia
  • sedation
  • insomnia
  • high
  • low
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