Question 1

1. In regards to selective serotonin reuptake inhibitors (SSRIs) all of the following statements are true EXCEPT?
3. Onset of antidepressant action of SSRIs is slow (2-12 weeks)
5. Common side effects of SSRIs are GI disturbances & sexual dysfunction
7. SSRIs inhibit serotonin (5HT) and norepinephrine (NE) reuptake equally
9. Rapid withdrawl of SSRIs can cause flu–like fatigue, headache etc.
11. Anxiety is a side effect seen in the first few days of therapy with Fluoxetine (Prozac)

10 points 

Question 2

1. Which one of the following antidepressants has an active metabolite with a half-life of 10 days?
3. Venlafaxine (Effexor)
5. Sertraline (Zoloft)
7. Fluoxetine (Prozac)
9. Imipramine (Tofranil)
11. Paroxetine (Paxil)

10 points 

Question 3

1.  A 40 yr old man is brought to the ER by his sister who reported that he had dropped by her apartment acting “drunk” & agitated. Further examination reveals symptoms consistent with serotonin syndrome (fever, hypertension, hyperreflexia, rigidity, and tremor). He had been diagnosed with severe depression one month ago & treated with Phenelzine initially. He was switched to fluvoxamine (Luvox) a week ago. What is the most likely cause for the hyperserotenergic state in this patient?
3. The dose of the SSRI was too high
5. The patient is hypersensitive to the SSRI
7. The patient consumed cheese prior to taking Luvox causing food interaction
9. Inhibition of monoamine oxidases continues for 2-3 weeks after phenelzine has been stopped
11. The patient consumed alcohol prior to taking Luvox

10 points 

Question 4

1. Which one of the following is NOT a viable option to address sexual dysfunction caused by SSRIs?
3. Counsel the patient that these effects are only temporary
5. Add Sildenafil (Viagra) to antidepressant therapy
7. Reduce the dose of his current SSRI and add on an atypical antidepressant
9. Replace SSRI with Trazadone or nefazadone
11. Switching to Venlafaxine

10 points 

Question 5

1. Which one of the following drugs is approved for treatment of nicotine addiction?
3. Fluoxetine (Prozac)
5. Paroxetine (Paxil)
7. Citalopram (Celexa)
9. Bupropion (Wellbutrin)
11. Fluvoxamine (Luvox)

10 points 

Question 6

1. A 38 yr old woman is prescribed amitriptyline (Elavil) for her depression. Soon after she begins taking this medication, she reports to her physician that she is having fainting episodes. What peripheral system affected by amitriptyline is most likely responsible for the postural hypotension?
3. Blockade of x1 adrenergic receptors
5. Blockade of histamine receptors
7. Blockade of muscarinic receptors
9. Inhibition of norepinephrine reuptake
11. Inhibition of serotonin reuptake

10 points 

Question 7

1. Which one of the following is a metabolite of Amitriptyline (Elavil)?
3. Desipramine (Norpramine)
5. Nortriptyline (Pamelor)
7. Clomipramine (Anfranil)
9. Trazadone (Desyrel)
11. Norfluoxetine

10 points 

Question 8

1. Which one of the following side effects of tricyclic antidepressants (TCAs) is due to blockade of central histamine H1 receptors?
3. Dry mouth
5. Constipation
7. Sedation
9. Ejaculatory dysfunction
11. Blurred vision

10 points 

Question 9

1. Which one of the following is the mechanism of action of Lithium in bipolar disorder?
3. Enhances synthesis of phosphoinositol phosphate2 (PIP2)
5. Activates phospholipase to resynthesize PIP2
7. Activates protein kinase C
9. Enhances formation of Diacylglycerol (DAG)
11. Interferes with the formation of Inositol and resynthesis of PIP2

10 points 

Question 10

1. What is the most common early sign of acute lithium toxicity?
3. Cardiac arrhythmias
5. Diarrhea
7. Hallucinations
9. Renal shutdown
11. Change in personality

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