PDA III - Exam III Quiz Questions + TA Review + Discussion Assignments

TCA exert some autonomic side effects by

A. Stimulating nicotinic receptors

B. Stimulating beta receptors

C. Antagonizing alpha receptors

D. Stimulating muscarinic receptors

C. Antagonizing alpha receptors

When an antidepressant is effective, symptoms disappear...

A. within 2-8 days

B. within 2-8 hours

C. within 2-8 weeks

D. within 2-8 min

C. within 2-8 weeks

Which of the following meds acts by selectively inhibiting the reuptake of serotonin?

A. levomilnacipran

B. duloxetine

C. citalopram

D. venlafaxine

C. citalopram

The MOA of TCAs is to...

A. antagonize alpha-2 and 5-HT-1D receptors

B. inhibit monoamine oxidase

C. block norepinephrine and serotonin reuptake

D. selectively block serotonin reuptake

C. block norepinephrine and serotonin reuptake

At a therapeutic dose, the MOA of fluoxetine is ...

A. inhibit 5-HT and NE reuptake equivalently

B. inhibit MAO

C. selectively inhibit 5-HT reuptake

D. selectively inhibit DA reuptake

C. selectively inhibit 5-HT reuptake

When considered as a drug category, the MOA of TCAs is..

A. selectively inhibit 5-HT reuptake

B. inhibit MAO

C. inhibit 5-HT and NE reuptake

D. selectively inhibit DA reuptake

C. inhibit 5-HT and NE reuptake

With which class of medications is the patient most likely to experience hypotension?

A. SSRI

B. SNRI

C. secondary amine TCA

D. tertiary amine TCA

D. tertiary amine TCA

Na+ depletion can lead to...

A. All of the above

B. Li+ toxicity

C. Loss of Li+ clinical efficacy

D. Decreased plasma concentration of Li+

B. Li+ toxicity

A thiazide diuretic...

A. increases Li+ excretion in the urine

B. increases Li+ reabsorption into the circulation from the proximal tubule

C. increases Li+ concentration in the lumen of the collecting duct

D. all of the above

B. increases Li+ reabsorption into the circulation from the proximal tubule

Presynaptic serotonin transporters...

A. inhibit presynaptic release of serotonin

B. perform reuptake of serotonin

C. metabolize serotonin

D. store serotonin in vesicles

B. perform reuptake of serotonin

Which drug listed below has an antidepressant metabolite?

A. clozapine

B. olanzapine

C. quetiapine

D. ziprasidone

C. quetiapine

Chronic treatment with a TCA results in...

A. down-regulation of presynaptic receptors only

B. down-regulation of postsynaptic receptors only

C. down-regulation of presynaptic transporters

D. down-regulation of both pre and postsynaptic receptors

A. down-regulation of presynaptic receptors only

Stimulation of presynaptic auto-receptors causes

A. inhibition of NT release

B. increased NT release

C. stimulation of NT reuptake

D. inhibition of NT reuptake

A. inhibition of NT release

Which is not a symptom of unipolar depression?

A. anhedonia

B. negative self-talk

C. dysphoria

D. mania

D. mania

Which of the following CYP450 isoforms contributes the most to antidepressant metabolism?

A. 2B6

B. 2C9

C. 2D6

D. 2E1

C. 2D6

True or False: major depression always involves decreased appetitie

False

The monoamine hypothesis of depression states that depression is due to ...

A. deficient monoamine levels in the brain

B. dysfunction of the HPA axis

C. excessive monoamine levels in the brain

D. high levels of monoamine metabolites in the brain

A. deficient monoamine levels in the brain

Which is not an effect of elevated cortisol on hippocampal neurons?

A. increased dendritic arborization

B. decreased dendritic arborization

C. decreased neurogenesis

D. loss of dendritic spines

A. increased dendritic arborization

Monoamines are thought to prevent depression by

A. antagonizing beta adrenergic receptors

B. antagonizing glucocorticoid receptors

C. inhibiting protein kinase A

D. stimulating transcription of the BDNF gene

D. stimulating transcription of the BDNF gene

What is amitriptyline metabolized to in humans?

A. desipramine

B. desvenlafaxine

C. nortriptyline

D. protriptyline

C. nortriptyline

Which of the following describes the monoamine hypothesis?

A. Strength of hypothesis: antidepressants increase monoamine function

B. The hypothesis arose after data suggested patients with depression have low monoamine levels

C. Shortcoming of the hypothesis: Antidepressants take weeks to see a clinical effect

D. All of the above

D. All of the above

Which of the following is the drug class of vortioxetine?

A. SSRI

B. SNRI

C. DA / NE reuptake inhibitor

D. DA partial agonist

A. SSRI

Which antidepressant would be the most sedating?

A. sertraline

B. venlafaxine

C. bupropion

D. trazodone

D. trazodone

Which of the following increase NE levels?

A. sertraline

B. venlafaxine

C. bupropion

D. trazodone

B and C

Which of the following is true regarding monoamine oxidase inhibitors?

A. Serotonin syndrome is a possible side effect

B. Headaches are a possible side effect

C. No washout period is required when switching medications

D. A + B are true

E. All of the above

D. A + B are true

2 week washout period is required here

Which is true regarding the ascending and descending pain pathways?

A. The ascending pain pathway originates in the brain

B. The descending pain pathway goes from the brain to the spinal cord

C. The descending pain pathway is turned on by default

D. Opioids inhibit only the ascending pain pathway

B. The descending pain pathway goes from the brain to the spinal cord

What is the order of the ascending pain pathway?

peripheral > spinal cord > brain

Which of the following pain pathway is turned off by default?

A. ascending

B. descending

B

What is the mechanism of action of morphine?

A. Inhibits reuptake of both serotonin and norepinephrine

B. Antagonist at the mu opioid receptor

C. Activates the descending pain pathway

D. B + C are correct

C. Activates the descending pain pathway

Explanation: B is wrong because it's an AGONIST

What is the result of activating the descending pain pathway?

less sensation of pain

True or False: morphine is an agonist at the mu opioid receptor in both the ascending and descending pathways

True

What adverse renal effect is associated with lithium therapy?

A) Hypernatremia

B) Nephrogenic diabetes insipidus

C) Neurogenic diabetes insipidus

D) Acute kidney injury

B) Nephrogenic diabetes insipidus

In the thirst test, what is a normal increase in urine osmolality?

A) 1.5-fold

B) 2-4-fold

C) 5-6-fold

D) No change

B) 2-4-fold

What does an 8% increase in urine osmolality after desmopressin indicate?

A) Normal response

B) Neurogenic diabetes insipidus

C) Nephrogenic diabetes insipidus

D) Diabetes mellitus

C) Nephrogenic diabetes insipidus

What physiological action does lithium block?

A) Sodium reabsorption

B) Glucose reabsorption

C) ADH/vasopressin action in the collecting duct

D) ADH secretion from the pituitary

C) ADH/vasopressin action in the collecting duct

What is a pharmacologic treatment for lithium-induced polyuria?

A) Furosemide

B) Thiazide diuretic

C) ACE inhibitor

D) Loop diuretic

B) Thiazide diuretic

What side effect may thiazide diuretics cause when combined with lithium?

A) Hypokalemia

B) Lithium toxicity

C) Dehydration

D) Hyperglycemia

B) Lithium toxicity

Why is lithium toxicity a concern with thiazide diuretics?

A) They increase Li+ secretion

B) They promote Li+ reabsorption due to Na+ loss

C) They increase GFR

D) They stimulate lithium metabolism

B) They promote Li+ reabsorption due to Na+ loss

What symptoms suggest lithium toxicity in DF (from discussion)?

A) Rash and fever

B) Shaky hands, nausea, diarrhea

C) Insomnia and headache

D) Weight gain and confusion

B) Shaky hands, nausea, diarrhea

What precaution should CG take during RAGBRAI training?

A) Increase protein intake

B) Avoid water

C) Prevent dehydration

D) Take more lithium

C) Prevent dehydration

Dehydration in lithium-treated patients may lead to:

A) Reduced lithium levels

B) Increased lithium levels

C) No effect

D) Increased sodium levels

B) Increased lithium levels

What electrolyte imbalance increases lithium reabsorption?

A) Hyperkalemia

B) Hyponatremia

C) Hypernatremia

D) Hypocalcemia

B) Hyponatremia

MR's case demonstrates a shift from depression to:

A) Bipolar 2 disorder

B) General anxiety disorder

C) Bipolar 1 disorder

D) Cyclothymia

A) Bipolar 2 disorder

What is a common starting medication for bipolar disorder?

A) Fluoxetine

B) Lithium

C) Sertraline

D) Valproic acid

B) Lithium

What is a therapeutic lithium range?

A) 0.1-0.5 mEq/L

B) 0.6-1.3 mEq/L

C) 1.5-2.5 mEq/L

D) 2.5-3.5 mEq/L

B) 0.6-1.3 mEq/L

What triggered GS's depressive symptoms (from discussion)?

A) Job loss

B) Migraine medications

C) Death of a friend

D) Marital issues

C) Death of a friend

What antidepressant did GS start with?

A) Fluoxetine

B) Duloxetine

C) Mirtazapine

D) Bupropion

C) Mirtazapine

Why was bupropion not selected?

A) It causes sedation

B) It causes weight gain

C) It can worsen insomnia and weight loss

D) It interacts with levothyroxine

C) It can worsen insomnia and weight loss

Mirtazapine's sedating effect is useful because GS has:

A) Anxiety

B) Insomnia

C) High blood pressure

D) Mania

B) Insomnia

Mirtazapine's mechanism of action includes antagonizing:

A) Dopamine receptors

B) Alpha-1 receptors

C) Alpha-2 autoreceptors and heteroreceptors

D) MAO

C) Alpha-2 autoreceptors and heteroreceptors

What neurotransmitters are increased by mirtazapine?

A) Dopamine and serotonin

B) GABA and glutamate

C) Norepinephrine and serotonin

D) Acetylcholine and dopamine

C) Norepinephrine and serotonin

How does mirtazapine differ from SSRIs?

A) Inhibits serotonin reuptake

B) Increases dopamine

C) Antagonizes 5HT autoreceptors

D) Inhibits MAO

C) Antagonizes 5HT autoreceptors

Why is weight gain a likely side effect of mirtazapine?

A) Increased metabolism

B) H1 and 5HT2C receptor antagonism

C) Serotonin agonism

D) Appetite suppression

B) H1 and 5HT2C receptor antagonism

After two months, what side effect did GS experience from mirtazapine?

A) Sedation

B) Agitation

C) Weight gain

D) Headaches

C) Weight gain

What side effect of mirtazapine may help GS's insomnia?

A) Serotonin agonism

B) Histamine receptor antagonism

C) Dopamine inhibition

D) Melatonin production

B) Histamine receptor antagonism

Which medication is not recommended for GS due to insomnia?

A) Fluoxetine

B) Escitalopram

C) Duloxetine

D) Mirtazapine

A) Fluoxetine

What drug inhibits CYP2D6 and may affect propranolol metabolism?

A) Escitalopram

B) Duloxetine

C) Sertraline

D) Bupropion

B) Duloxetine

What is the safest next antidepressant choice for GS?

A) Fluoxetine

B) Paroxetine

C) Escitalopram

D) Duloxetine

C) Escitalopram

What patient counseling point is important regarding alcohol and SSRIs?

A) Alcohol can block serotonin

B) Alcohol reduces SSRI effectiveness

C) Alcohol increases SSRI side effects

D) Alcohol enhances alertness

C) Alcohol increases SSRI side effects

What physical symptom is associated with GS's initial depression?

A) Weight gain

B) Increased appetite

C) Weight loss

D) Headaches

C) Weight loss