Question 1

Differentiate between the tricyclic and bicyclic antidepressants,and select the correct statement.

Accepted Answer

The tricyclic antidepressants can be classified as being either secondary amines (two substitutions on the nitrogen) or tertiary amines (three substitutions on the nitrogen). Secondary amines mainly increase brain levels of norepinephrine more than serotonin, while the tertiary amines mainly increase brain levels of serotonin more than norepinephrine.

Question 2

A 45-year-old male has been diagnosed with narcolepsy,a disorder characterized by an uncontrolled tendency to fall asleep.His physician has decided to prescribe a psychomotor stimulant drug.Select the correct statement related to the mechanism of action of the amphetamine class of drugs.

Accepted Answer

Amphetamines stimulate the reticular formation, which increases wakefulness and alertness and reduces the number of attacks of narcolepsy. They act directly to stimulate norepinephrine and dopamine receptors, they stimulate the release of norepinephrine and dopamine from the nerve endings, and they inhibit the reuptake of these neurotransmitters back into the nerve endings. These actions produce CNS stimulation and an elevation in mood.

Question 3

The TCAs possess significant anticholinergic and alpha-blocking actions.Differentiate between the TCAs,and select the tricyclic agent that causes moderate sedation,moderate anticholinergic effects,and moderate alpha-blocking effect.

Accepted Answer

Nortriptyline (Aventyl) causes moderate sedation, moderate alpha-blocking effects, and moderate anticholinergic effects.

Question 4

Select the statement that is not consistent with the mechanism of action or adverse effect profile of the SSRI mirtazapine (Remeron).

Accepted Answer

The actions of mirtazapine (Remeron) include the increased release of norepinephrine and serotonin, blockade of 5HT₂ and 5HT₃ receptors, and potent histamine receptor blocking actions. Mirtazapine is sedating and usually does not cause GI disturbances or sexual dysfunction. Weight gain has been associated with this drug.

Question 5

Differentiate between mania and depression,and select the correct statement.

Accepted Answer

During depression, there are changes in mood and behavior, along with feelings of frustration and hopelessness. The SSRIs have become the preferred therapy for treatment of depression. Mania is a mental state of excitement, hyperactivity, and excessive elevation of mood. Lithium is used to treat individuals who experience wide shifts of mood, mania, or the alternating cycles of depression and mania (bipolar mood disorder). 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.

Question 6

Using the Drug Facts and Comparisons reference manual,you learn that the selective serotonin reuptake inhibitors have low,high,or sedating effects on the CNS.Select the drugs that fall into this category.

Accepted Answer

Citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft) are classified as SSRIs with low CNS activation, fluoxetine (Prozac) is an SSRI with high CNS activation, and fluvoxamine (luvox) is an SSRI that produces sedating effects.

Question 7

Differentiate between the common dosage ranges of the atypical SSRIs,and select the correct daily dosage range of duloxetine (Cymbalta).

Accepted Answer

The daily dosage range of duloxetine (Cymbalta) is 40-60 mg PO and causes low CNS activation.

Question 8

Patients taking lithium should be instructed to drink an adequate amount of fluids and take adequate amounts of sodium.Select the reason why this precaution is necessary.

Accepted Answer

Lithium is administered as a salt. Lithium and sodium ions compete with each other for renal elimination. Adequate sodium intake is necessary for proper urinary excretion of lithium. Decreased sodium intake and hyponatremia (low sodium levels) promote the retention of lithium and can lead to toxicity.

Question 9

Select the pair that is approved for the treatment of premenstrual dysphoric disorder,where the mood disturbances occur in relation to the menstrual cycle.

Accepted Answer

Fluoxetine and sertraline are approved for the treatment of premenstrual dysphoric disorder, where mood disturbances occur in relation to the menstrual cycle.

Question 10

Select the statement that is not consistent with the mechanism of action or adverse effect profiles of the atypical SSRIs nefazodone (Serzone) and trazodone (Desyrel).

Accepted Answer

Nefazodone (Serzone) and trazodone (Desyrel) are drugs that are weak reuptake inhibitors of serotonin and norepinephrine but potent antagonists of serotonin 5HT_2A receptors. This action also provides some antipsychotic activity. Adverse effects include sedation, orthostatic hypotension, and liver toxicity. Trazodone also is associated with priapism, which is the development of sustained and painful penile erections.

Quiz 14: Antidepressants, psychomotor Stimulants, and Lithium