222 Test 2 Mood-Anxiety

Multiple Choice
Identify the choice that best completes the statement or answers the question.

1 The principal cause of death following SNRI antidepressant overdose is

a cardiac arrhythmia
b dizziness when standing
c hemorrhagic cerebrovascular accident
d increased blood pressure leading to a stroke

2 Which of the following foods do NOT contain a high concentration of tyramine

a pickled herring
b blue cheese
c bagels
d snails from a can
e raisins

3 An agent that offers both norepinephrine and serotonin receptor effects at the same rate at any dose
is:
a tranylcypromine d trilepta
b citalapram e duloxetine
c venlafaxine

4 Clinical studies have shown that 50 to 75 percent of patients taking fluoxetine will experience:
a sexual dysfunction d manic episodes
b tardive dyskinesia e seizures
c priapism f orthostatic hypotension

5 Nora is having trouble getting to sleep because she is stressed about her exam. She decides to take a
Simply Sleep pill (Diphenhydramine) Diphenhydramine has a half life of 8 hours. How many hours
will it take for all of the Diphenhydramine to be cleared from her system?
a 8
b 24
c 64
d 40
e 16

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6 One of the symptoms of a mood disorder is called anhedonia which means:
a indecisiveness
b a feeling of worthlessness
c an inability to experience pleasure
d an altered pattern of sleep

7 In contrast to SNRI’s SSRI’s

a block reputake of both catecholamines and serotonin.
b block the reuptake of only serotonin
c act on the left hemisphere while SNRI’s act on the right.
d increase action potential velocity

8 Which of the following are the most likely side effects of tricyclic antidepressants?
a cramping and diarrhea
b increased reaction to eating cheese
c agranulocytosis
d dry mouth

9 Giving an additional drug to “boost” the effect of the primary drug is referred to as
a titration
b cross-tapering
c augmentation
d therapeutic monitoring

10 At their highest dosage, how are phenelzine and venlafaxine similar?

a They both decrease the rate of d They both increase the amount of
synthesis of monoamines.. monoamines in the synapse.
b They both assert their mechanism of e The both block potassium channels in
action on the reuptake pump. the membrane.
c They both stimulate serotonin f Tranylcypromine and venlafaxine are
receptors. not similar, even at their highest
dosage.

11 This antidepressant is unique in that at low doses, it primarily inhibits the uptake of serotonin, but at
moderate doses (150 to 300 mg/day) it also inhibits the uptake of norepinephrine, and at high doses
(>300mg/day) it also inhibits dopamine re-uptake.
a venlafaxine d amitriptyline
b duloxetine e citalopram
c diazepam f alprazolam

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12 A 44 year old woman comes to your office for a follow up visit. She recently received a diagnosis of
major depressive disorder and began treatment with citalopram 6 weeks ago. She claims to feel
“happy again,” without further depression, crying spells, or insomnia. Her appetite has improved,
and she has been able to focus at work and enjoy time with her family. Although she experienced
occasional headaches and loose stools at the beginning of her treatment, she no longer complains of
any side effects.

Which of the following is the most appropriate next step in her treatment?

a discontinue the duloxetine

b increase the dose of duloxetine
c maintain the current dose of duloxetine
d augment with Cymbalta
e lower the dose of duloxetine

13 Benzodiazepines are
a dopamiergic drugs
b antagonists at GABAergic receptors in the nervous system.
c stimulant drugs
d agonists at GABAergic receptors in the nervous system.

14 Which antidepressant associated with transient increase in diastolic blood pressure and can be lethal in
overdose?
a diazepam d alprazolam
b selegiline e citalopram
c venlafaxine f escitalopram

3
Matching

Match the correct generic name with the brand name of the medication.
a duloxetine
b phenelzine
c selegiline
d diazepam
e alprazolam
f buspirone
15 Nardil

16 Valium

17 Buspar

18 Xanax

19 Emsam

20 Cymbalta

Match the correct generic name with the brand name of the medication.
a amitriptyline
b fluoxetine
c sertraline
d paroxetine
e venlafaxine
f citalopram
21 Prozac

22 Elavil

23 Zoloft

24 Celexa

25 Paxil

26 Effexor

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 Drug vs drug. For each vignette, pick the medication most likely to be associated with the treatment or
side adverse effect.
a selegiline d paroxetine
b flumanzenil e fluoxetine
c diazepam f buspirone
27 A 40-year-old man was told to be careful of the medication because of the abuse potential it has.

28 A 20 year old woman being treated for major depressive disorder who needs a very sedating
antidepressant.

29 A 65-year-old man is prescribed this medication because his prescriber is looking for a very activating
antidepressant.

30 a 30 year-old-man with who has recently overdosed on a benzodiazepine wants something to treat the
overdose..

31 A 45 year-old-man who needs something to treat his chronic anxiety, but doesn’t want anything that
could lead to sexual dysfunction

32 You are treating a 45 year old veteran with a history of alcoholism for PTSD you plan to keep him on
this medication for a year.

33 A 36 year-old woman being treated for depression wants a medication that works on all 3
monoamines but doesn’t want any food restrictions.

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Name________________________________
Short answer

34 Bob returns and says that he has stopped taking the medication. What is the most likely side effect that
has caused him to stop taking the medication? (4 points)

35 Bob is a 42-year-old man comes to his outpatient psychiatrist with complaints of a depressed mood,
insomnia, psychomotor agitation, anhedonia, and no appetite. He denies illicit drug use or any recent
traumatic events. What is your first choice of medications to use? Explain the mechanism of action of
the medication and describe 2 areas of the brain it is likely to influence (8 points).

36 Describe the monoamine hypothesis of depression. Be sure to indicate all 4 subtheories of the
hypothesis.

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37 Describe the fear and worry loop in OCD. Compare and contrast the agents alprazolam and sertraline in
the treatment in terms of their mechanism of actions on the fear and worry loop (10 points).

38 Since Bob stopped taking the medication you suggested, what is the next logical choice of medication?
Describe the mechanism of action for this medication and explain what adverse affects are likely (8
points).

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Resource

39
Prozac Zoloft Lexapro Celexa Luvox Paxil

Sedation 1 1 3 3 5 5

Activation 5 4 3 3 1 1

Weight gain 2 2 3 3 5 5

Sexual 3 3 3 3 5 5
dysfunction
1-Least, 3- moderate, 5-most

Stephen M. Stahl, M. (2013). Stahl’s Essential Psychopharmacology (4th ed.). New York, NY:

Cambridge University Press

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222 Test 2 Mood-Anxiety

Answer Section

MULTIPLE CHOICE

1 ANS: A PTS: 2
2 ANS: C PTS: 2
3 ANS: E
duloxetine blocks serotonin and norepinephrine at the same rate at every dose. Venlafaxine always
favors serotonin

PTS: 2
4 ANS: A PTS: 2 DIF: 1 REF: p. 220
OBJ: 7 TYPE: FACT
5 ANS: D
By 5 half-lives, most of the medicine is eliminated from a person's system. If the half life of
Diphenhydramine is 8 hours then after about 40 hours it should all be cleared from her system.

PTS: 2
6 ANS: C PTS: 2 DIF: 1 REF: p. 192
OBJ: 1 TYPE: CON
7 ANS: B PTS: 2
8 ANS: D PTS: 2
9 ANS: C PTS: 2
10 ANS: D PTS: 2
11 ANS: A PTS: 2
12 ANS: C
The proper strategy in the management of an episode of major depression that has recently remitted is
to continue treatment at the same dose if it can be tolerated. Early discontinuation of medication can
lead to an early relapse. A general rule of thumb is “the dose that got you better will keep you well.”
A reasonable duration of continuing the medication is 6 to 9 months.
By the way, duloxetine IS Cymbalta, so you can’t really augment with the same medication.

PTS: 2
13 ANS: D PTS: 2

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14 ANS: C
venlafaxine is cautioned in individuals with high blood pressure. Remember the SRNIs have cardiac
effects at high doses

PTS: 2

MATCHING

15 ANS: B PTS: 2
16 ANS: D PTS: 2
17 ANS: F PTS: 1
18 ANS: E PTS: 2
19 ANS: C PTS: 2
20 ANS: A PTS: 2

21 ANS: B PTS: 2
22 ANS: A PTS: 2
23 ANS: C PTS: 2
24 ANS: F PTS: 1
25 ANS: D PTS: 2
26 ANS: E PTS: 2

27 ANS: C PTS: 1
28 ANS: D PTS: 1
29 ANS: E PTS: 1
30 ANS: B PTS: 1
31 ANS: F PTS: 1
32 ANS: E PTS: 1
33 ANS: A PTS: 1

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ESSAY

34 ANS:
Gastrointestinal symptoms such as stomach pain, nausea, and diarrhea-- occur in the early stages of
treatment. Minor sleep disturbances--either sedation or insomnia can occur. Other side effects include
tremor, dizziness, increased perspiration and sexual dysfunction.

PTS: 4
35 ANS:
A selective serotonin reuptake inhibitor (SSRI) such as sertraline, paroxetine, citalopram, or fluoxetine is
one of the first-line choices of medication for this patient.

PTS: 8
36 ANS:
1. The monoamine hypothesis of depression suggests that symptoms of depression are caused by a
malfunction in a family of neurotransmiters called monoamines. There are 3 monoamines in our
system. Serotonin (5-H2), Norepinephrine (NE) Dopamine (DA). The three subtheories describe
what might happen with these monamines.
a. not enough are released (or we have a deficit of them)
b. reuptake is too aggressive
c. MAO is overactive
d. receptor sites need additional stimuation

PTS: 1
37 ANS:
bla

PTS: 10
38 ANS:
The next logical choice would be an SNRI. Bupropion would NOT be appropriate because of his sleep and
eating problems

PTS: 8

3
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OTHER

39 ANS:
Resource

PTS: 1