Question 1

Describe the type of disorder that responds to treatment with lithium.

Accepted Answer

Lithium is referred to as a mood stabilizer and is used to treat individuals who experience wide shifts of mood, mania, or the alternating cycles of depression and mania (bipolar mood disorder).

Question 2

Using the Physicians' Desk Reference,you determine that due to their alpha-blocking,anticholinergic and antihistaminic effects,the TCAs are contraindicated in patients suffering from:

Accepted Answer

The TCAs may be contraindicated in patients with glaucoma and prostatic hypertrophy, and the elderly are more sensitive to anticholinergic drugs.

Question 3

When comparing the SSRI and the atypical SSRI antidepressants,you determine that:

Accepted Answer

The SSRIs increase the concentration of serotonin in the synaptic cleft, resulting in increased stimulation of serotonin receptors. The increase in serotonin activity in the brain is believed to contribute to the antidepressant effect

Question 4

Explain the underlying principle of the Monoamine Theory of Mental Depression.

Accepted Answer

An important advance in understanding depression occurred with the discovery that the levels of norepinephrine and serotonin (5HT) in the brain can influence mental behavior. Low levels of norepinephrine and/or serotonin are associated with mental depression, while high levels of norepinephrine and/or serotonin may be involved in mania. This concept involving norepinephrine and serotonin (referred to chemically as monoamines) is known as the Monoamine Theory of Mental Depression.

Question 5

Identify the type of depression that originates from within the individual and may not be able to be linked to specific causes.

Accepted Answer

The second major type of depression is referred to as major depressive disorder (MDD). MDD is frequently more serious and usually requires both psychotherapy and drug treatment. This type of depression originates from within the individual and may not be associated with easily recognized causes. Psychological disturbances and maladjustments or biochemical defects in the brain are thought to be involved.

Question 6

When summarizing the adverse effects of the atypical SSRIs,you identify the key adverse effects to be:

Accepted Answer

The adverse effects of the atypical SSRIs include sedation, orthostatic hypotension, and liver toxicity.

Question 7

Identify the type of depression in which there is a period of shock followed by a period of readjustment and resolve that life must go on.

Accepted Answer

Depression that is caused by external factors (death or unemployment) is referred to as exogenous, or reactive, depression. Usually, there is a period of shock and depression, which is followed by a period of readjustment and a resolve that life must go on. In this sense, a reactive depression is self-limiting and usually does not require drug therapy.

Question 8

Explain how lithium works to decrease nerve conduction.

Accepted Answer

The body utilizes lithium as if it were sodium. Both lithium (Li+) and sodium (Na+) exist in body fluids as charged particles, or ions. However, whereas Na+ is normally required for conduction of nerve impulses, Li+ interferes with nerve conduction. As a result, there is a decrease in the excitability of nerve tissue.

Question 9

Identify the common characteristics associated with mania.

Accepted Answer

Mania is characterized by periods of hyperactivity and excitement combined with excessive elevations of mood. Manic individuals are usually very talkative, but their thoughts and ideas are most often unrealistic.

Question 10

Use the pharmacological action of the psychomotor stimulant drugs in the treatment of narcolepsy and hyperactivity disorders to select the correct statement.

Accepted Answer

Amphetamines have the disadvantage of producing drug tolerance and drug dependence. The psychomotor stimulants increase the activity of the sympathetic nervous system, producing dry mouth, rapid heartbeat, increased blood pressure, restlessness, and insomnia. Toxic doses may produce severe agitation and a paranoid type of psychosis.

Question 11

The tricyclic antidepressants interact with many other types of drugs.Using the Physicians' Desk Reference,you determine that the tricyclics will interfere with the antihistamine and anticholinergic drug agents,resulting in:

Accepted Answer

The SSRIs interact with the antihistamine and anticholinergic agents, causing dry mouth, constipation, urinary retention, and blurred vision.

Question 12

Differentiate between the FDA pregnancy categories and determine the proper category for lithium.

Accepted Answer

Lithium has been designated FDA Pregnancy Category D and therefore should not be used during pregnancy.

Question 13

You have been asked to explain to a patient the common side effects that he should report while taking the SSRIs.You explain to the patient that the reportable side effects include:

Accepted Answer

The common side effects associated with the use of the selective serotonin reuptake inhibitors include headache, nervousness, insomnia, nausea, loss of appetite, and diarrhea. Instruct patient to report excessive GI and CNS stimulation (agitation or seizures).

Question 14

Describe the effects of drugs classified as monoamine oxidase inhibitors (MAOIs) and drugs classified as tricyclic antidepressants (TCAs) on norepinephrine and serotonin.

Accepted Answer

MAOIs decrease the amounts of norepinephrine and serotonin that are destroyed. Consequently, the MAOIs permit the levels of norepinephrine and serotonin in the brain to increase. TCAs block the reuptake of norepinephrine and serotonin back into the neuronal nerve endings. This action increases the level of neuronal activity of norepinephrine and serotonin and alleviates the symptoms and dysfunction of depression.

Question 15

Explain the pharmacologic actions of bupropion (Wellbutrin).

Accepted Answer

The major pharmacologic actions of bupropion (Wellbutrin) are to increase the release of and inhibit the reuptake of norepinephrine and dopamine. Bupropion has minimal effect to inhibit the reuptake of serotonin.

Question 16

A patient calls the office and states that she has been taking amitriptyline for 2 to 3 days and she is still experiencing the feelings of depression she had before she began the treatment.She wants the doctor to change her medication because the amitriptyline is not working.After doing research on amitriptyline,you call the patient and explain to her that:

Accepted Answer

The pharmacological actions occur within a few hours of administration of the tricyclic antidepressants. However, the full antidepressant effect requires 2 to 4 weeks to develop.

Question 17

A 50-year-old female has been diagnosed with major depression.Her physician has several choices of drug classes to treat her with.Differentiate between the available drug classes for treating depression,and select the drug class from which the physician should prescribe for the patient based on the fact that she has no other health issues.

Accepted Answer

The SSRIs are currently considered the preferred drugs for major depression. The advantages of the SSRIs are the lower incidence of adverse and toxic effects.

Question 18

The statement that best explains bipolar mood disorder is:

Accepted Answer

In some cases of depression, there are alternate periods of hyperexcitability and elation known as mania. Individuals who experience these alternating cycles of depression and mania are classified as manic depressive. Another term for this condition is bipolar mood disorder.

Question 19

You have been asked to explain to a patient that while on MAOI therapy she must avoid foods that contain tyramine.The patient does not know what foods to avoid.You summarize the list of foods to avoid as:

Accepted Answer

One of the main disadvantages of MAO inhibitor therapy is the dietary restrictions. Many foods contain a substance known as tyramine, which causes the release of norepinephrine from storage granules. Foods that normally contain tyramine include wine, beer, herring, and certain cheeses.

Question 20

Using the Physicians' Desk Reference,you determine that the common adverse effects of use of the psychomotor stimulant drugs are:

Accepted Answer

The psychomotor stimulants increase the activity of the sympathetic nervous system, producing dry mouth, rapid heartbeat, increased blood pressure, restlessness, and insomnia.

Quiz 14: Antidepressants, psychomotor Stimulants, and Lithium