PSYCHIATRY SHELF EXAM 2024-2025 NEWEST VERSION !!! ACTUAL
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS
( VERIFIED ANSWERS ) ALREADY GRADED A+
In a pt presenting with a MDE with predominant sxs of anhedonia and
anergia, what would be a good choice for tx? - ANSWER-Bupropion.
Exact MOA unknown; inhibits neuronal uptake of NE and dopamine.
Contraindicated in seizure disorder, bulimia, and anorexia. Also used
for smoking cessation.
"When a pt px with features of psychotic depression, it is imperative
to..." - ANSWER-"Start an antidepressant AND antipsychotic at the
same time." (Usually SSRI + atypical antipsychotic)
Pramipexole - ANSWER-Dopamine agonist. Used in Parkinson's
disease, Parkinsonism (e.g., side effect of antipsychotics), and
restless leg syndrome.
Ropinirole - ANSWER-Dopamine agonist. Used in Parkinson's
disease, restless legs syndrome.
Tx of *melancholic* depression? - ANSWER-SSRIs (first line for
depression in general), SNRIs (venlafaxine, duloxetine), or dopamine
reuptake inhibitors (Bupropion)
A pt has mood reactivity with increased appetite, weight gain,
excessive sleeping, leaden paralysis, and sensitivity to rejection. Tx?
,- ANSWER-SSRIs, MAOIs, TCAs, bupropion, and/or D2 + D3 receptor
agonists (all of these have been shown to be effective in the tx of
atypical depression)
The antidepressant LEAST likely to precipitate a hypomanic episode
in a pt with underlying BPD? - ANSWER-Bupropion
If sexual SEs of SSRIs are bothersome... - ANSWER-Switch the pt to
bupropion or add buspirone.
Buspirone - ANSWER-Anxiolytic used to treat GAD. Can also be
added to SSRIs to counteract the sexual side effects of these
medications.
Fluoxetine (Prozac) should be d/c'd for at least ?? before initiation of
an MAOI (for other SSRIs, the wash-out period is ??) - ANSWER-5
weeks; 2 weeks
Fluvoxamine - ANSWER-SSRI. FDA approved *only* for OCD.
SEs of SSRIs? - ANSWER-Nausea, diarrhea, flushing, anxiety, fatigue,
sexual dysfunction, bruxism, SIADH, hyponatremia, weight gain,
postop bleeding, GI bleed (when combined with NSAIDs), sleep
problems
This SSRI can cause constipation and sedation b/c of its
anticholinergic properties; slow taper is needed to avoid
,discontinuation syndrome; it's also been implicated in neonatal SSRI
w/d, neonatal pHTN, and increased suicidality in pts <30 years of age -
ANSWER-Paroxetine
These SSRIs are LEAST likely to have drug-drug interactions with
other drugs. - ANSWER-citalopram, escitalopram
Venlafaxine is indicated for - ANSWER-MDD (atypical, melancholic,
and refractory), social anxiety disorder, generalized anxiety disorder,
and panic disorder
For a pt on venlafaxine, what should you monitor at every visit? -
ANSWER-Blood pressure!!
This drug has more balanced 5-HT and NE effects than venlafaxine,
but requires baseline LFTs and monitoring and CAUTION if hepatic
impairment because it undergoes extensive metabolism in the liver. -
ANSWER-Duloxetine (Cymbalta), an SNRI ["it undergoes 'dulox'
metabolism in the liver"]
Serotonin receptor antagonists/agonist and reuptake inhibitors
(SARIs) - ANSWER-Trazodone and Nefazodone
Trazodone - ANSWER-Indicated for MDD, insomnia; SE include
priapism, sedation, and orthostatic hypotension; requires HIGH
DOSES to function as an antidepressant
, Nefazodone - ANSWER-Indicated for MDD; has less sexual SE than
trazodone; a/w *severe hepatotoxicity*; contraindicated in pts with
elevated LFTs or acute hepatic disease. May also cause *palinopsia*
Bupropion - ANSWER-NDRI; decreases the seizure threshold, so it's
contraindicated in pts with seizure disorder. Contraindicated also in
pts with eating d/o. Used to treat atypical depression, psychomotor
retardation, smoking cessation. Has less sexual SEs than SSRIs.
Atomoxetine (Strattera) - ANSWER-NDRI (like bupropion); used to tx
ADHD. ASE include sexual SE, insomnia, and mood swings. Do NOT!
use with IV albuterol. Caution using with pressors as BP may
skyrocket. Contraindicated in pheochromocytoma and relatively
contraindicated in any CV disease.
Mirtazepine (Remeron) - ANSWER-a2 antagonist and 5-HT2 antagonist
indicated for MDD. Exhibits reduced anxiety, sedation, and weight
gain due to HI receptor antagonism; less sexual SEs (than SSRIs,
e.g.). GOOD FOR pts with anorexia, HIV and poor appetite, or who are
elderly with weight loss/poor appetite.
General SEs of TCAs - ANSWER-Sedation, cholinergic SEs,
orthostatic hypotension, cardiac SEs (e.g., arrhythmias)
This TCA is a metabolite of a typical antipsychotic and thus can cause
EPS and other SE typically seen with antipsychotic use - ANSWER-
