CMN 548 – MODULE 5 PSYCHOPHARMACOLOGY
ACTUAL EXAM LATEST 2025/2026 QUESTION AND
CORRECT ANSWERS WITH RATIONALE.
What SNRI is commonly associated with discontinuation syndrome and what are
the presenting symptoms? - answer-; - Venlafaxine (Effexor)
- Can occur with XR form as well
- Dizziness, dry mouth, insomnia, nausea, nervousness, sweating, anorexia,
diarrhea, somnolence, and sensory disturbances
- Mitigate with a taper (75mg/ day weekly decrease) or substitution of a few
doses with fluoxetine
Where are TCAs absorbed and what is the importance of their peak level timing? -
answer-; - Small intestine
- Peak levels have implications for side effect presentation during initial dosing
Which TCAs have demonstrated a relationship between blood levels and response
in melancholic patients? - answer-; - Imipramine, desipramine, and nortriptyline
*It has proven difficult to demonstrate a relationship between blood levels and
response in depressed outpatients.
,At what plasma concentration is the risk of delirium likely in Amitryptyline
therapy? - answer-; >300 ng/mL
* plasma levels are useful in indicating a variety of toxicity responses
What cardiovascular side effects are present in TCA treatment and what is the
cause? - answer-; - Orthostatic hypotension: alpha1 adrenergic blockade
- Tachycardia: more in young patients
- Conduction delay, may be helpful in patients with ventricular excitability
- Risk of sudden death: caution in patients with ischemic heart disease
What are some uses for TCAs aside from depression? - answer-; - Panic disorder
- Amitriptyline (Elavil): Chronic pain and migraines
- Chronic fatigue syndrome
- Nortriptyline (Aventyl) : smoking cessation
- Doxepin (Zonalon): pruritis, topical
- Doxepin (Silenor): insomnia
- Imipramine: nocturnal enuresis children (caution due to cardiac origin sudden
death)
What is the mechanism of action of Bupropion (Wellbutrin)? - answer-; -
Reuptake inhibitor (NET, DAT) and releaser (NE, DA)
- Inhibits nictotinic receptors
- Effects of bupropion on noradrenergic activity appear more consistent than its
dopamine effects.
, This medication is FDA approved in combination with naltrexone for treatment of
obesity. - answer-; Bupropion (wellbutrin)
- 400-400 mg/day
*Does not improve weight loss or reduce binging with binge eating disorder
Burproprion (Wellbutrin) can lower the seizure threshold and is associated with
seizures when combined with which medications? - answer-; - Some TCAs
- Amoxapine
- Clozapine
- Theophylline
Administration of Bupropion with this class of drugs is contraindicated. - answer-;
MAOIs
Vortioxetine (Trintellix) is indicated in the treatment of what condition? - answer-
; MDD in adults
- Insufficient data but logical rationale for anxiety, stress related, OCD, eating and
premenstrual dysphoric disorder
What is the recommended dosing regimen for patients taking Vortioxetine
(Trintellix) for MDD? - answer-; - Starting dose 10 mg/day ages 18-65
- Target dose 5-20 mg/day
- Increase in at least 2 week intervals
Why are MAOIs effective? - answer-; Thought that MAOIs alleviate depression by
direct inhibition of MAO and an increase in catecholamines available within the
synapse.
ACTUAL EXAM LATEST 2025/2026 QUESTION AND
CORRECT ANSWERS WITH RATIONALE.
What SNRI is commonly associated with discontinuation syndrome and what are
the presenting symptoms? - answer-; - Venlafaxine (Effexor)
- Can occur with XR form as well
- Dizziness, dry mouth, insomnia, nausea, nervousness, sweating, anorexia,
diarrhea, somnolence, and sensory disturbances
- Mitigate with a taper (75mg/ day weekly decrease) or substitution of a few
doses with fluoxetine
Where are TCAs absorbed and what is the importance of their peak level timing? -
answer-; - Small intestine
- Peak levels have implications for side effect presentation during initial dosing
Which TCAs have demonstrated a relationship between blood levels and response
in melancholic patients? - answer-; - Imipramine, desipramine, and nortriptyline
*It has proven difficult to demonstrate a relationship between blood levels and
response in depressed outpatients.
,At what plasma concentration is the risk of delirium likely in Amitryptyline
therapy? - answer-; >300 ng/mL
* plasma levels are useful in indicating a variety of toxicity responses
What cardiovascular side effects are present in TCA treatment and what is the
cause? - answer-; - Orthostatic hypotension: alpha1 adrenergic blockade
- Tachycardia: more in young patients
- Conduction delay, may be helpful in patients with ventricular excitability
- Risk of sudden death: caution in patients with ischemic heart disease
What are some uses for TCAs aside from depression? - answer-; - Panic disorder
- Amitriptyline (Elavil): Chronic pain and migraines
- Chronic fatigue syndrome
- Nortriptyline (Aventyl) : smoking cessation
- Doxepin (Zonalon): pruritis, topical
- Doxepin (Silenor): insomnia
- Imipramine: nocturnal enuresis children (caution due to cardiac origin sudden
death)
What is the mechanism of action of Bupropion (Wellbutrin)? - answer-; -
Reuptake inhibitor (NET, DAT) and releaser (NE, DA)
- Inhibits nictotinic receptors
- Effects of bupropion on noradrenergic activity appear more consistent than its
dopamine effects.
, This medication is FDA approved in combination with naltrexone for treatment of
obesity. - answer-; Bupropion (wellbutrin)
- 400-400 mg/day
*Does not improve weight loss or reduce binging with binge eating disorder
Burproprion (Wellbutrin) can lower the seizure threshold and is associated with
seizures when combined with which medications? - answer-; - Some TCAs
- Amoxapine
- Clozapine
- Theophylline
Administration of Bupropion with this class of drugs is contraindicated. - answer-;
MAOIs
Vortioxetine (Trintellix) is indicated in the treatment of what condition? - answer-
; MDD in adults
- Insufficient data but logical rationale for anxiety, stress related, OCD, eating and
premenstrual dysphoric disorder
What is the recommended dosing regimen for patients taking Vortioxetine
(Trintellix) for MDD? - answer-; - Starting dose 10 mg/day ages 18-65
- Target dose 5-20 mg/day
- Increase in at least 2 week intervals
Why are MAOIs effective? - answer-; Thought that MAOIs alleviate depression by
direct inhibition of MAO and an increase in catecholamines available within the
synapse.
