NSG 533 Advanced Pharmacology
Test 1 Week 4 Graded A+
Which of the following SSRIs requires up to a 5-week washout period because of the
long half-life of its potent active metabolite?
A. Escitalopram
B. Fluvoxamine
C. Fluoxetine
D. Sertraline - ANSWER C
Which of the following symptoms is most likely to improve within approximately 1 week
of starting treatment?
A. Depressed mood
B. Suicidal thoughts
C. Anhedonia
D. Sleep - ANSWER D
Of the following combinations of medications, which one would you want to avoid?
A. Fluoxetine-lithium
B. Fluoxetine-phenelzine
C. Citalopram-valproic acid
D. Citalopram-aripiprazole - ANSWER B
,A 26-year-old man with a history of depression has been taking sertraline 200 mg/day for
12 weeks with no response. The patient has no other complications. The physician asks for
your recommendation. The most reasonable recommendation would be to:
A. Increase sertraline
B. Add fluoxetine
C. Switch to amitriptyline
D. Change to venlafaxine
E. Decrease sertraline - ANSWER D
Which of the following is a dangerous combination?
A. MAOI-lorazepam
B. MAOI-acetaminophen
C. MAOI-meperidine
D. MAOI-ziprasidone - ANSWER C
A 23-year-old married white woman comes to the outpatient psychiatric clinic
complaining of decreased sleep, decreased appetite, decreased concentration, depressed
mood, thoughts of death, and lack of interest in activities for 6 weeks' duration. She has
no history of psychiatric illness and takes no medications except for Ortho-Tri Cyclen Lo
daily. Based upon the patients symptoms, choose the best medication to treat this patient.
A. Nefazodone 100 mg po twice daily
B. Paroxetine 20 mg po daily
C. St. John's wort 300 mg po three times daily
D. Amitriptyline 25 mg at bedtime - ANSWER B
, A 36-year-old man is admitted to the hospital for a severe methicillin-resistant
Staphylococcus aureus diabetic foot infection and is started on linezolid 600 mg IV every
12 hours. His medication profile includes paroxetine 40 mg every morning, trazodone 100
mg at bedtime as needed for sleep, and metformin 1000 mg po twice daily. After 3
days on these medications, the patient becomes agitated, confused, and diaphoretic and
develops myoclonic jerks. Which of the following is the most likely diagnosis?
A. Overdose of metformin
B. Bacterial meningitis
C. Neuroleptic malignant syndrome
D. Serotonin syndrome - ANSWER D
A 46-year-old woman presents to the psychiatric outpatient clinic for follow-up treatment
of major depression. She is currently on paroxetine 10 mg at bedtime, which she started
taking 2 months ago when admitted to the psychiatric hospital for suicidal ideation.
During the interview, she says that she does not think the medication is working because
she is just as depressed as she was before taking the medication and has recently started
drinking eight to 10 beers daily to alleviate the depression. Before this episode, she was
sober for 4 years. Which of the following treatment strategies would be the appropriate
choice for this patient?
A. Stop the paroxetine and start nefazodone 100 mg po twice daily
B. Increase the dose of paroxetine to 20 mg po at bedtime
C. Stop the paroxetine and start duloxetine 20 mg/day
D. Continue the paroxetine at them same dose for a longer period of time to evaluate
whether she will respond or not - ANSWER B
Which of the following is a flaw in the monoamine hypothesis of depression?
A. Concentrations of neurotransmitters are reduced in the synaptic cleft
Test 1 Week 4 Graded A+
Which of the following SSRIs requires up to a 5-week washout period because of the
long half-life of its potent active metabolite?
A. Escitalopram
B. Fluvoxamine
C. Fluoxetine
D. Sertraline - ANSWER C
Which of the following symptoms is most likely to improve within approximately 1 week
of starting treatment?
A. Depressed mood
B. Suicidal thoughts
C. Anhedonia
D. Sleep - ANSWER D
Of the following combinations of medications, which one would you want to avoid?
A. Fluoxetine-lithium
B. Fluoxetine-phenelzine
C. Citalopram-valproic acid
D. Citalopram-aripiprazole - ANSWER B
,A 26-year-old man with a history of depression has been taking sertraline 200 mg/day for
12 weeks with no response. The patient has no other complications. The physician asks for
your recommendation. The most reasonable recommendation would be to:
A. Increase sertraline
B. Add fluoxetine
C. Switch to amitriptyline
D. Change to venlafaxine
E. Decrease sertraline - ANSWER D
Which of the following is a dangerous combination?
A. MAOI-lorazepam
B. MAOI-acetaminophen
C. MAOI-meperidine
D. MAOI-ziprasidone - ANSWER C
A 23-year-old married white woman comes to the outpatient psychiatric clinic
complaining of decreased sleep, decreased appetite, decreased concentration, depressed
mood, thoughts of death, and lack of interest in activities for 6 weeks' duration. She has
no history of psychiatric illness and takes no medications except for Ortho-Tri Cyclen Lo
daily. Based upon the patients symptoms, choose the best medication to treat this patient.
A. Nefazodone 100 mg po twice daily
B. Paroxetine 20 mg po daily
C. St. John's wort 300 mg po three times daily
D. Amitriptyline 25 mg at bedtime - ANSWER B
, A 36-year-old man is admitted to the hospital for a severe methicillin-resistant
Staphylococcus aureus diabetic foot infection and is started on linezolid 600 mg IV every
12 hours. His medication profile includes paroxetine 40 mg every morning, trazodone 100
mg at bedtime as needed for sleep, and metformin 1000 mg po twice daily. After 3
days on these medications, the patient becomes agitated, confused, and diaphoretic and
develops myoclonic jerks. Which of the following is the most likely diagnosis?
A. Overdose of metformin
B. Bacterial meningitis
C. Neuroleptic malignant syndrome
D. Serotonin syndrome - ANSWER D
A 46-year-old woman presents to the psychiatric outpatient clinic for follow-up treatment
of major depression. She is currently on paroxetine 10 mg at bedtime, which she started
taking 2 months ago when admitted to the psychiatric hospital for suicidal ideation.
During the interview, she says that she does not think the medication is working because
she is just as depressed as she was before taking the medication and has recently started
drinking eight to 10 beers daily to alleviate the depression. Before this episode, she was
sober for 4 years. Which of the following treatment strategies would be the appropriate
choice for this patient?
A. Stop the paroxetine and start nefazodone 100 mg po twice daily
B. Increase the dose of paroxetine to 20 mg po at bedtime
C. Stop the paroxetine and start duloxetine 20 mg/day
D. Continue the paroxetine at them same dose for a longer period of time to evaluate
whether she will respond or not - ANSWER B
Which of the following is a flaw in the monoamine hypothesis of depression?
A. Concentrations of neurotransmitters are reduced in the synaptic cleft
