Question 1

Which of the following practices is NOT associated with rational prescribing of antidepressants?&#10;A) The use of a combination of antidepressant agents is the best way of treating depression.&#10;B) When changing antidepressant agents, the patient should have a 'washout' period.&#10;C) If one antidepressant does not work at therapeutic doses, the patient should be changed to another antidepressant.&#10;D) Significant antidepressant benefit is not apparent immediately upon starting treatment. The prescriber should wait three to four weeks before assessing the benefit.

Accepted Answer

The use of combination therapy for depression is controversial and not currently recommended as the first-line treatment for depression. Most guidelines recommend starting with monotherapy and only considering combination therapy in cases of treatment resistance.

Question 2

The psychological disorder characterised by persistent thoughts and repetitive,ritualistic behaviours is called:&#10;A) endogenous depression.&#10;B) panic disorder.&#10;C) mania.&#10;D) obsessive-compulsive disorder.

Accepted Answer

The psychological disorder characterised by persistent thoughts and repetitive, ritualistic behaviors is called obsessive-compulsive disorder (OCD). Endogenous depression is a type of depression caused by internal factors, panic disorder is characterised by sudden and unexpected panic attacks, and mania is a symptom of bipolar disorder.

Question 3

Which of the following measures does NOT help to avoid the serotonin syndrome associated with the use of selective serotonin reuptake inhibitors (SSRIs)?&#10;A) Co-administration of two SSRI preparations&#10;B) Having a 'washout' period when switching drugs&#10;C) Administering a therapeutic dose of a single SSRI agent&#10;D) Tapering high doses of the SSRI agent

Accepted Answer

Co-administration of two SSRI preparations increases the risk of serotonin syndrome. The other measures listed (having a 'washout' period, administering a therapeutic dose, and tapering high doses) are all helpful in avoiding serotonin syndrome.

Question 4

The potential role of antiseizure drugs in the management of bipolar disorder is to:&#10;A) elevate the synaptic levels of noradrenaline and serotonin.&#10;B) antagonise the effects of GABA.&#10;C) substitute for sodium ion in neuronal processes.&#10;D) stabilise the erratic firing in pathways associated with mood.

Accepted Answer

Antiseizure drugs are known to stabilize the erratic firing of neurons, which can be beneficial in managing the mood swings associated with bipolar disorder. This is achieved by regulating the activity of neurotransmitters such as glutamate and gamma-aminobutyric acid (GABA).

Question 5

All of the following antidepressants are suitable forms of therapy for a woman with postpartum depression who is breastfeeding,EXCEPT for:&#10;A) paroxetine.&#10;B) fluoxetine.&#10;C) sertraline.&#10;D) fluvoxamine.

Accepted Answer

Fluoxetine has a longer half-life and can accumulate in the breastfed infant, potentially leading to side effects, making it less suitable for breastfeeding mothers compared to other options like paroxetine, sertraline, and fluvoxamine, which are considered safer.

Question 6

An adverse effect profile of antimuscarinic and antiadrenergic activity and potentially lethal cardiac dysrhythmias is characteristic of which antidepressant drug group?&#10;A) Non-selective MAO inhibitors&#10;B) Tricyclic antidepressants&#10;C) Selective serotonin reuptake inhibitors&#10;D) Tetracyclic antidepressants

Accepted Answer

The adverse effect profile of antimuscarinic and antiadrenergic activity and potentially lethal cardiac dysrhythmias is characteristic of tricyclic antidepressants. Non-selective MAO inhibitors can cause hypertensive crisis when combined with tyramine-rich foods. Selective serotonin reuptake inhibitors and tetracyclic antidepressants have a different adverse effect profile.

Question 7

The proposed action of tetracyclic antidepressant drugs is:&#10;A) block transmitter reuptake.&#10;B) block the amine reuptake pump on the presynaptic terminal.&#10;C) inhibit monoamine oxidase.&#10;D) selectively block postsynaptic 5-HT? receptors.

Accepted Answer

Tetracyclic antidepressants (such as mirtazapine) block the amine reuptake pump on the presynaptic terminal, increasing the concentration of neurotransmitters such as serotonin and norepinephrine in the synaptic cleft. This leads to increased activation of postsynaptic receptors and a gradual improvement in mood. Tetracyclic antidepressants do not selectively block specific receptors or inhibit monoamine oxidase.

Question 8

The potentially fatal 'serotonin syndrome' is associated with SSRI therapy for depression.Which of the following signs or symptoms are not linked to serotonin syndrome?&#10;A) Weight gain&#10;B) Hyperthermia&#10;C) Sweating&#10;D) Euphoria or drowsiness

Accepted Answer

Weight gain is not a symptom of serotonin syndrome. The other options, hyperthermia, sweating, and euphoria or drowsiness, are all associated with serotonin syndrome.

Question 9

In terms of the proposed sites of action of antidepressant drugs,which of the following would be expected to produce a therapeutic benefit?&#10;A) The induction of monoamine oxidase activity&#10;B) An increase in the synaptic levels of neurotransmitters serotonin and/or noradrenaline&#10;C) A centrally acting ?2 agonist&#10;D) Depletion of amine transmitter levels in the presynaptic nerve terminal

Accepted Answer

Antidepressant drugs are known to increase the synaptic levels of neurotransmitters serotonin and/or noradrenaline, thereby enhancing neurotransmission in brain regions that regulate mood and emotions. Options A and D are contradictory to the mechanism of action of antidepressants, as monoamine oxidase inhibitors (which block the enzyme that breaks down serotonin and noradrenaline) and amine depletors (which reduce the amount of these neurotransmitters in nerve terminals) have been found to have antidepressant effects. Option C, a centrally acting beta-2 agonist, is not typically used as an antidepressant medication.

Question 10

Which one of the following statements about lithium carbonate is true?&#10;A) It has a high therapeutic index.&#10;B) The body treats it like it is sodium.&#10;C) It enhances the synaptic levels of noradrenaline.&#10;D) It is used in the management of panic disorders.

Accepted Answer

The body treats lithium carbonate similarly to sodium, affecting sodium transport across cell membranes and influencing various neurotransmitter systems, which is part of its mechanism of action in mood stabilization.

Deck 35: Antidepressants and Mood Stabilisers