MH701 FINAL EXAM QUESTIONS & ANSWERS
How is the amygdala part of the brain involved in anxiety? - Answer -* Amygdala is in
the center of the brain near the hippocampus.
* The amygdala rates the importance of an emotional event and activates the
hippocampus accordingly.
* Determines whether there will be a fear response and initiates your flight or flight
response that helps you respond to a perceived threat.
* When this response remains switched on and there is no danger, or gets switched on
too easily, that is when it becomes an anxiety disorder. Then you can have an initiation
of the flight or fight when memories or emotions occur.
* The amygdala sends a response to the hypothalamus, which activates the pituitary
and it activates the adrenal gland which secretes hormones (adrenaline, noradrenaline
and cortisol).
What are neurotransmitters involved in depression? - Answer -Monoamine
neurotransmitters are responsible for depression which are: serotonin, norepinephrine &
dopamine.
Which neurotransmitters are associated with antipsychotics? - Answer -The FGA's
block dopamine.
The SGA's block dopamine and 5HT.
Some have affinity for histamine and alpha 1 adrenergic receptors.
What is a common mistake leading to unsuccessful antidepressant drug trial? - Answer
-Not giving it enough time.
Major depression is? - Answer -5 or more of the following symptoms in the same 2
week period with at least 1 being depressed mood or loss of interest or pleasure.
SIGECAPS
S: Sleep changes.
I: interest loss.
G: Guilt or worthlessness.
E: Energy lack.
C: Concentration /cognition reduced.
A: Appetite usually declined.
P: Psychomotor retardation.
S: Suicidal or homicidal ideation.
Dysthymia is? - Answer -Persistent depressive symptoms lasting 2 years.
What role does serotonin have in the different aspect of depression? - Answer -
Serotonin regulates mood, sleep, appetite, pain, sex, instincts.
Too much or too little can cause depression or apathy.
,What is the patient education to any patient starting an antidepressant? - Answer -*
Takes 2-6 weeks to see a response
* Can increase suicidal ideation
* SE: sexual dysfunction, GI upset, activation, sedation, insomnia, headaches
* Serotonin syndrome -
* Do not abruptly stop medication, it must be slowly titrated down
Mechanism and action of SSRI: - Answer -- inhibit the reuptake of serotonin, thereby
increasing serotonin activity; have little effect on other neurotransmitters, such as
dopamine or norepinephrine
Mechanism and action of SNRI: - Answer --inhibit the reuptake of the neurotransmitters
serotonin and norepinephrine, which increases extracellular concentrations of serotonin
and norepinephrine and, consequently, an increase in neurotransmission.
Discontinuation syndrome: Risk factors: - Answer -* Extended therapy of SSRI
* Paroxetine bigger offender, then sertraline, citalopram, escitalopram
* Fluoxetine less likely to occur due to long half life
* Taper over several weeks to minimize discontinuation symptoms
Discontinuation syndrome: symptoms - Answer -* Flu-like: Chills, body aches, nausea,
headache, lightheadedness
* Neurological symptoms : paresthesia's, insomnia, electro-shock like phenomena
Sexual side effects of SSRI's and possible intervention: - Answer -Women can be
anorgasmic and men have erectile dysfunction.
Bupropion (Wellbutrin) can reduce sexual side effects.
Which SSRI has the highest risk of drug-drug interactions due to CYP enzymes? -
Answer -Most Problematic - Paroxetine, followed by fluoxetine - Significant effects on
CYP2D6
Least Problematic - Sertraline, Citalopram, and Escitalopram
Mechanism of action of TCA's: - Answer -TCA's: Increase levels of NE and SE. They
do this by interfering with reuptake of them at the synapse. However they also affect
many other neurotransmitters, hence all the SE.
What are the most concerning side effects of TCA's? - Answer -Sedation, cardiac and
anticholinergic.
* Anticholinergic side-effects: dry mouth, constipation, blurred vision, urinary retention,
delirium
* Cardiac : tachycardia, arrhythmias, orthostatic hypotension
More lethal in overdose - cardiac arrhythmias. Monitor blood levels to prevent cardiac
toxicity
* Sedation: increased SS risk
, Risks with patients being on a TCA? - Answer -Cardiac arrhythmias which can be lethal
Mechanism of action of MAOIs: - Answer -Monoamine oxidase is originally responsible
for inhibiting the action of norepinephrine, dopamine, and serotonin. Therefore blocking
its action allows for more to be available in the body. These are JUST AS EFFECTIVE
AS SSRI'S BUT HAVE MORE SERIOUS ADVERSE EFFECTS AND INTERACTIONS.
Side effects you would be most concerned about with MAOIs: - Answer -Hypertensive
crisis.
-Patient education that is important related to the MAOIs: - Answer -Diet that avoids
tyramine
Sauerkraut, ETOH- beer and wine, cured meats, such as sausage, salami, pepperoni,
hot dogs, bologna, smoke fish, pickled foods, figs, raisins, chocolate, yeast and aged
cheeses .
Drug -Drug interactions: MAOIs - Answer -mixing with barbitutes, tricyclic
antidepressants, antihistamines, CNS depressants, OTC cold meds, antihypertensives
and SSRI/SNRI
Serotonin Syndrome Risk with M AOIs: - Answer -When switching from SSRI or SNRI
risk of serotonin syndrome -complete taper and wash out before switching to MAOI
Define GAD: - Answer -excessive anxiety and worry about several events or activities
for most days in at least a 6 month period. Worry is difficult to control and can be
associated with somatic symptoms. Produces impairment in a person's life.
Define Social anxiety: - Answer -Involves the fear of social situations, including
situations that involve scrutiny or contact with strangers. Clients are fearful of
embarrassing themselves in social situations.
What is serotonin syndrome? - Answer -Serotonin syndrome - abdominal pain,
diarrhea, flushing, diaphoresis, hyperthermia, mental status changes. renal failure,
rhabdomyolysis, cardiovascular shock, death
Which of the SSRIs has an indication for the treatment of bulimia to decrease binging
patterns? - Answer -Fluoxetine (Prozac)
Panic disorder define: - Answer -An acute intense attack of anxiety accompanied by
feelings of impending doom. Characterized by discrete periods of intense fear that can
vary from several attacks during one day to only a few attacks during a year.
OCD define: - Answer -Diverse group of sx that include intrusive thoughts, rituals,
preoccupations and compulsions. Causes severe stress to a person, is time-consuming
and interferes with a person's normal routine, occupational functioning, usual social
activities, or relationships
How is the amygdala part of the brain involved in anxiety? - Answer -* Amygdala is in
the center of the brain near the hippocampus.
* The amygdala rates the importance of an emotional event and activates the
hippocampus accordingly.
* Determines whether there will be a fear response and initiates your flight or flight
response that helps you respond to a perceived threat.
* When this response remains switched on and there is no danger, or gets switched on
too easily, that is when it becomes an anxiety disorder. Then you can have an initiation
of the flight or fight when memories or emotions occur.
* The amygdala sends a response to the hypothalamus, which activates the pituitary
and it activates the adrenal gland which secretes hormones (adrenaline, noradrenaline
and cortisol).
What are neurotransmitters involved in depression? - Answer -Monoamine
neurotransmitters are responsible for depression which are: serotonin, norepinephrine &
dopamine.
Which neurotransmitters are associated with antipsychotics? - Answer -The FGA's
block dopamine.
The SGA's block dopamine and 5HT.
Some have affinity for histamine and alpha 1 adrenergic receptors.
What is a common mistake leading to unsuccessful antidepressant drug trial? - Answer
-Not giving it enough time.
Major depression is? - Answer -5 or more of the following symptoms in the same 2
week period with at least 1 being depressed mood or loss of interest or pleasure.
SIGECAPS
S: Sleep changes.
I: interest loss.
G: Guilt or worthlessness.
E: Energy lack.
C: Concentration /cognition reduced.
A: Appetite usually declined.
P: Psychomotor retardation.
S: Suicidal or homicidal ideation.
Dysthymia is? - Answer -Persistent depressive symptoms lasting 2 years.
What role does serotonin have in the different aspect of depression? - Answer -
Serotonin regulates mood, sleep, appetite, pain, sex, instincts.
Too much or too little can cause depression or apathy.
,What is the patient education to any patient starting an antidepressant? - Answer -*
Takes 2-6 weeks to see a response
* Can increase suicidal ideation
* SE: sexual dysfunction, GI upset, activation, sedation, insomnia, headaches
* Serotonin syndrome -
* Do not abruptly stop medication, it must be slowly titrated down
Mechanism and action of SSRI: - Answer -- inhibit the reuptake of serotonin, thereby
increasing serotonin activity; have little effect on other neurotransmitters, such as
dopamine or norepinephrine
Mechanism and action of SNRI: - Answer --inhibit the reuptake of the neurotransmitters
serotonin and norepinephrine, which increases extracellular concentrations of serotonin
and norepinephrine and, consequently, an increase in neurotransmission.
Discontinuation syndrome: Risk factors: - Answer -* Extended therapy of SSRI
* Paroxetine bigger offender, then sertraline, citalopram, escitalopram
* Fluoxetine less likely to occur due to long half life
* Taper over several weeks to minimize discontinuation symptoms
Discontinuation syndrome: symptoms - Answer -* Flu-like: Chills, body aches, nausea,
headache, lightheadedness
* Neurological symptoms : paresthesia's, insomnia, electro-shock like phenomena
Sexual side effects of SSRI's and possible intervention: - Answer -Women can be
anorgasmic and men have erectile dysfunction.
Bupropion (Wellbutrin) can reduce sexual side effects.
Which SSRI has the highest risk of drug-drug interactions due to CYP enzymes? -
Answer -Most Problematic - Paroxetine, followed by fluoxetine - Significant effects on
CYP2D6
Least Problematic - Sertraline, Citalopram, and Escitalopram
Mechanism of action of TCA's: - Answer -TCA's: Increase levels of NE and SE. They
do this by interfering with reuptake of them at the synapse. However they also affect
many other neurotransmitters, hence all the SE.
What are the most concerning side effects of TCA's? - Answer -Sedation, cardiac and
anticholinergic.
* Anticholinergic side-effects: dry mouth, constipation, blurred vision, urinary retention,
delirium
* Cardiac : tachycardia, arrhythmias, orthostatic hypotension
More lethal in overdose - cardiac arrhythmias. Monitor blood levels to prevent cardiac
toxicity
* Sedation: increased SS risk
, Risks with patients being on a TCA? - Answer -Cardiac arrhythmias which can be lethal
Mechanism of action of MAOIs: - Answer -Monoamine oxidase is originally responsible
for inhibiting the action of norepinephrine, dopamine, and serotonin. Therefore blocking
its action allows for more to be available in the body. These are JUST AS EFFECTIVE
AS SSRI'S BUT HAVE MORE SERIOUS ADVERSE EFFECTS AND INTERACTIONS.
Side effects you would be most concerned about with MAOIs: - Answer -Hypertensive
crisis.
-Patient education that is important related to the MAOIs: - Answer -Diet that avoids
tyramine
Sauerkraut, ETOH- beer and wine, cured meats, such as sausage, salami, pepperoni,
hot dogs, bologna, smoke fish, pickled foods, figs, raisins, chocolate, yeast and aged
cheeses .
Drug -Drug interactions: MAOIs - Answer -mixing with barbitutes, tricyclic
antidepressants, antihistamines, CNS depressants, OTC cold meds, antihypertensives
and SSRI/SNRI
Serotonin Syndrome Risk with M AOIs: - Answer -When switching from SSRI or SNRI
risk of serotonin syndrome -complete taper and wash out before switching to MAOI
Define GAD: - Answer -excessive anxiety and worry about several events or activities
for most days in at least a 6 month period. Worry is difficult to control and can be
associated with somatic symptoms. Produces impairment in a person's life.
Define Social anxiety: - Answer -Involves the fear of social situations, including
situations that involve scrutiny or contact with strangers. Clients are fearful of
embarrassing themselves in social situations.
What is serotonin syndrome? - Answer -Serotonin syndrome - abdominal pain,
diarrhea, flushing, diaphoresis, hyperthermia, mental status changes. renal failure,
rhabdomyolysis, cardiovascular shock, death
Which of the SSRIs has an indication for the treatment of bulimia to decrease binging
patterns? - Answer -Fluoxetine (Prozac)
Panic disorder define: - Answer -An acute intense attack of anxiety accompanied by
feelings of impending doom. Characterized by discrete periods of intense fear that can
vary from several attacks during one day to only a few attacks during a year.
OCD define: - Answer -Diverse group of sx that include intrusive thoughts, rituals,
preoccupations and compulsions. Causes severe stress to a person, is time-consuming
and interferes with a person's normal routine, occupational functioning, usual social
activities, or relationships
