Deck 14: Antidepressants, psychomotor Stimulants, and Lithium

Question 1

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

A) Disorders characterized by alternating cycles of depression and mania
B) Disorders characterized by hyperactivity and excessive elevation of mood
C) Disorders characterized by wide shifts in mood
D) All of these are correct.

Answer 1

All of these are correct.

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:

A) Glaucoma and benign prostatic hypertrophy
B) Glaucoma and hypertension
C) Benign prostatic hypertrophy and hypertension
D) Glaucoma and epilepsy

Answer 2

Glaucoma and benign prostatic hypertrophy

Question 3

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

A) 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.
B) The atypical SSRIs decrease 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.
C) The SSRIs decrease the concentration of serotonin in the synaptic cleft, resulting in decreased stimulation of serotonin receptors. The decrease in serotonin activity in the brain is believed to contribute to the antidepressant effect.
D) The atypical SSRIs decrease the release of and inhibit the reuptake of norepinephrine and dopamine.

Answer 3

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.

A) Changes in the level of epinephrine and serotonin, referred to chemically as the monoamines, lead to depression.
B) Changes in the level of norepinephrine and serotonin, referred to chemically as the monoamines, lead to depression.
C) Changes in the level of norepinephrine and dopamine, referred to chemically as the monoamines, lead to depression.
D) None of these are correct.

Question 5

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

A) Exogenous depression
B) Mania
C) Major depressive disorder
D) Bipolar mood disorder

Question 6

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

A) Sedation, hypertension, and renal insufficiency
B) Orthostatic hypotension, GI disturbances, and renal insufficiency
C) Sedation, orthostatic hypotension, and liver toxicity
D) Sedation, GI disturbances, and renal insufficiency

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.

A) Exogenous
B) Mania
C) Major depressive disorder
D) None of these are correct.

Question 8

Explain how lithium works to decrease nerve conduction.

A) Lithium blocks the reuptake of norepinephrine and serotonin back into the neuronal nerve endings, resulting in increases in the level of neuronal activity, thereby alleviating the symptoms.
B) The body uses lithium as if it were sodium. Na+ is normally required for conduction of nerve impulses; Li+ interferes with the nerve conduction, resulting in a decrease in the excitability of nerve tissue.
C) Lithium acts directly to stimulate norepinephrine and dopamine receptors, which stimulate the release of norepinephrine and dopamine from the nerve endings, and it inhibits the reuptake of these neurotransmitters back into the nerve endings, alleviating the symptoms.
D) None of these are correct.

Question 9

Identify the common characteristics associated with mania.

A) Patient shows signs of hyperactivity.
B) Patient is very talkative.
C) Patient exhibits unrealistic thoughts.
D) All of these are correct.

Question 10

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

A) Amphetamines have the disadvantage of producing drug tolerance and dependence.
B) The psychomotor stimulants decrease the activity of the sympathetic nervous system.
C) Toxic doses may cause cardiac arrhythmias and nephritis.
D) All of these are correct

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:

A) Increased sedation
B) Dry mouth, constipation, urinary retention, and blurred vision
C) Increased metabolism of the tricyclic agent, leading to decreased effectiveness
D) Increased CNS stimulation, hyperpyrexia, and seizures

Question 12

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

A) Pregnancy Category B
B) Pregnancy Category C
C) Pregnancy Category D
D) Pregnancy Category X

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:

A) Excessive agitation and seizures
B) Loss of appetite and nausea
C) Headache and nervousness
D) All of these are correct.

Question 14

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

A) MAOIs increase the levels of norepinephrine and serotonin in the brain, and TCAs decrease the levels of norepinephrine and serotonin in the neuronal nerve endings.
B) MAOIs increase the levels of norepinephrine and serotonin in the neuronal nerve endings, and TCAs increase the levels of norepinephrine and serotonin in the brain.
C) Both MAOIs and TCAs increase the levels of norepinephrine and serotonin in the brain.
D) Both MAOIs and TCAs increase the levels of norepinephrine and serotonin in the neuronal nerve endings.

Question 15

Explain the pharmacologic actions of bupropion (Wellbutrin).

A) Bupropion increases the release of epinephrine and dopamine.
B) Bupropion inhibits the reuptake of norepinephrine and dopamine.
C) Bupropion has minimal effect to inhibit the reuptake of serotonin.
D) All of these are correct.

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:

A) The amitriptyline is working, but the full antidepressant effect can take as long as 2 to 4 weeks to develop.
B) The amitriptyline is not working and the doctor will change her medication.
C) The amitriptyline is working, but the full antidepressant effect can take as long as 7 to 10 days to develop.
D) None of these are correct.

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.

A) MAOIs
B) SSRIs
C) Lithium
D) Psychomotor stimulants

Question 18

The statement that best explains bipolar mood disorder is:

A) Disorder consisting of depression caused by external factors
B) Disorder consisting of depression caused by factors from within the patient
C) Disorder consisting of alternating periods of depression and hyperexcitability and elation
D) None of these are correct.

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:

A) Coffee, beer, wine, and certain cheeses
B) Beer, wine, herring, and certain cheeses
C) Pickles, herring, and certain cheeses
D) Hamburgers, beer, 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:

A) Dry mouth, tachycardia, hypertension, and insomnia
B) Excess saliva production, bradycardia, hypotension, and sedation
C) Dry mouth, bradycardia, hypotension, and sedation
D) Excess saliva production, tachycardia, hypertension, and insomnia

Question 21

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

A) The tricyclics are referred to as tertiary amines because they contain three amine substitutions on the nitrogen in the chemical structure.
B) The bicyclics are referred to as secondary amines because they contain two amine substitutions on the nitrogen in the chemical structure.
C) Secondary amines mainly increase brain levels of norepinephrine more than serotonin, while the tertiary amines increase brain levels of serotonin more than epinephrine.
D) All of these are correct.

Question 22

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.

A) Amphetamines stimulate the release of norepinephrine and epinephrine from the nerve endings and prevent the reuptake of these back into the nerve endings, producing CNS stimulation, reticular formation, elevation of mood, and an increase in wakefulness and alertness.
B) Amphetamines stimulate the release of norepinephrine and serotonin from the nerve endings and prevent the reuptake of these back into the nerve endings, producing CNS stimulation, reticular formation, elevation of mood, and an increase in wakefulness and alertness.
C) Amphetamines stimulate the release of norepinephrine and dopamine from the nerve endings and prevent the reuptake of these back into the nerve endings, producing CNS stimulation, reticular formation, elevation of mood, and an increase in wakefulness and alertness.
D) None of these are correct.

Question 23

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.

A) Doxepin
B) Amitriptyline
C) Nortriptyline
D) Imipramine

Question 24

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

A) Mirtazapine decreases the release of norepinephrine and serotonin.
B) Mirtazapine has a potent histamine receptor blocking action.
C) Mirtazapine does not cause GI disturbances or sexual dysfunction.
D) Mirtazapine use has been associated with weight gain.

Question 25

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

A) Depression is a mental state characterized by feelings of hopelessness, frustration, and depressed mood, whereas mania is characterized by excitement, hyperactivity, and elevated mood.
B) Depression is treated with SSRIs, and mania is treated with lithium.
C) Depression is associated with low levels of norepinephrine and/or serotonin, while high levels of norepinephrine and/or serotonin are involved in mania.
D) All of these are correct.

Question 26

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.

A) Citalopram, lithium, and amitriptyline
B) Citalopram, fluoxetine, and sertraline
C) Paroxetine, lithium, and fluoxetine
D) None of these are correct.

Question 27

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

A) 40-60 mg by mouth
B) 300-600 mg by mouth
C) 50-200 mg by mouth
D) 225-375 mg by mouth

Question 28

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.

A) Hyponatremia promotes the retention of lithium, which can lead to toxic levels of lithium in the blood.
B) Sodium ions and lithium compete against each other for renal elimination.
C) Lithium is a salt and will lead to an increase in thirst and an increase in the frequency of urination.
D) All of these are correct.

Question 29

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

A) Escitalopram and citalopram
B) Fluoxetine and sertraline
C) Fluoxetine and citalopram
D) Sertraline and escitalopram

Question 30

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).

A) Nefazodone (Serzone) and trazodone (Desyrel) are drugs that are weak reuptake inhibitors of serotonin and norepinephrine.
B) Nefazodone (Serzone) and trazodone (Desyrel) provide some antipsychotic activity.
C) Nefazodone (Serzone) is associated with priapism.
D) Adverse effects include sedation, orthostatic hypotension, and liver toxicity.