PRITE Psychopharmacology: Questions With Solutions
27 y/o depressed patient treated with SSRI and tranylcypromine (and with 5-
hydroxytryptophan) now presents with VH, mild confusion, myoclonic jerks,
diaphoretic, flushing, restless: (6x) Right Ans - SEROTONIN SYNDROME
Which antidepressant med is most likely to cause HTN? (5x) Right Ans -
VENLAFAXINE
Which antidepressant med is best to minimize risk of orthostasis in an 84
y/o? (4x) Right Ans - NORTRIPTYLINE
Antidepressant preferred for >65 y/o for which blood levels are clinically
useful (3x) Right Ans - DESIPRAMINE
62 y/o pt with hx chest pain has and depression, one month ago started on
paroxetine, presents with new onset of lethargy and headache, low Na and
BUN, normal K , and Cr of 0.4. Next test: (2x) Right Ans - URINE
OSMOLALITY
38 y/o taking imipramine 300mg qday for recurrent MDD. After 3 weeks,
mood is improved, but has difficulty passing urine and mild erectile
dysfunction. Appropriate action? (2x) Right Ans - BETHANECHOL 25MG
TID
Antidepressant less likely to cause sexual dysfunction: (3x) Right Ans -
BUPROPION
Which is a muscarinic SE of antidepressants? (2x) Right Ans - URINARY
RETENTION
30 y/o pt has been treated for unreasonable fear of eating in public places,
feeling of embarrassment in public places, and anger over the possibility of
being scrutinized. Pt has not responded to high doses of paroxetine,
citalopram, buspirone, and alprazolam, each of them administered for 4-6
wks. Which meds would be appropriate for next? (2x) Right Ans -
PHENELZINE
,What meds could be helpful in the treatment of depression in persons over
the age of 65 because it does not produce orthostatic hypotension: (2x)
Right Ans - BUPROPION
What antidepressant has plasma level that correlates with therapeutic
response? (3x) Right Ans - IMIPRAMINE
What antidepressant med is considered to be the most effective in the tx of
premature ejaculation? (x2) Right Ans - PAROXETINE
Which opioid has a potentially lethal interaction with monoamine oxidase
inhibitors (MAOIs)? (4x) Right Ans - MEPERIDINE
45 y/o F pt on phenelzine for MDD, takes OTC medication for cold sx and
develops hypertensive crisis. Which OTC medication would most likely cause
this? (3x) Right Ans - PSEUDOEPHEDRINE
Minimum recommended washout period for fluoxetine prior to starting MAOI
(2x) Right Ans - 5 WEEKS
Treatment for patients with MAOI related hypertensive crisis in the ER may
involve the administration of which of the following meds? (2x) Right Ans -
PHENTOLAMINE
What drug has a curvilinear therapeutic window? (6x) Right Ans -
NORTRIPTYLINE
What drug is useful in the Rx of urinary retention secondary to TCA therapy
(5x) Right Ans - BETHANECHOL
Most frequent cause of death following TCA overdose: (2x) Right Ans -
ARRHYTHMIA
After an OD on Amitriptyline, what test is needed? (4x) Right Ans - EKG
Optimal strategy in maintenance tx with TCA for patient with recurrent MDD
(2x) Right Ans - FULL DOSE ANTIDEPRESSANT THERAPY
Monitor TCA overdose using (2x) Right Ans - EKG
, Which SSRI has mild anticholinergic activity due to some affinity at the
muscarinic receptors? (3x) Right Ans - PAROXETINE
Fluoxetine should NOT be prescribed with what? (2x) Right Ans -
PHENELZINE
21 y/o pt experiences a brief manic episode after starting an SSRI. The pt
meets Dx criteria for what disorder? (2x) Right Ans - SUBSTANCE-
INDUCED MOOD DISORDER
Serotonergic antidepressants are appropriate treatment for depression in 54
y/o pt with recent coronary artery bypass graft surgery because they: (2x)
Right Ans - INHIBIT PLATELET FUNCTIONING
The most common reason that people discontinue the use of SSRI: (2x)
Right Ans - GI SIDE EFFECTS
Which SSRI has the greatest potential for discontinuation syndrome with
missed doses (x2)? Right Ans - PAROXETINE
Which of the following has the longest mean half-life: citalopram, paroxetine,
venlafaxine, fluvoxamine, trazodone (x2)? Right Ans - CITALOPRAM
Which SSRI used to treat discontinuation syndrome caused by SSRI
termination (x2)? Right Ans - FLUOXETINE
46 y/o F pt presents w increasing dysphoria, progressively increased
frequency with which she washes her hands to the point of excoriation, dose
range for effective Tx: (x2) Right Ans - FLUVOXAMINE 200-300MG DAILY
First line rx for pt with dilated cardiomyopathy who is depressed and has no
relief with fluoxetine. Pt does not want side effects Right Ans - BUPROPION
Rare occurrences of priapism are most frequently associated with: Right
Ans - TRAZODONE
47 yo overweight female on celexa w sexual side effects. What med to switch
to? Right Ans - BUPROPION
27 y/o depressed patient treated with SSRI and tranylcypromine (and with 5-
hydroxytryptophan) now presents with VH, mild confusion, myoclonic jerks,
diaphoretic, flushing, restless: (6x) Right Ans - SEROTONIN SYNDROME
Which antidepressant med is most likely to cause HTN? (5x) Right Ans -
VENLAFAXINE
Which antidepressant med is best to minimize risk of orthostasis in an 84
y/o? (4x) Right Ans - NORTRIPTYLINE
Antidepressant preferred for >65 y/o for which blood levels are clinically
useful (3x) Right Ans - DESIPRAMINE
62 y/o pt with hx chest pain has and depression, one month ago started on
paroxetine, presents with new onset of lethargy and headache, low Na and
BUN, normal K , and Cr of 0.4. Next test: (2x) Right Ans - URINE
OSMOLALITY
38 y/o taking imipramine 300mg qday for recurrent MDD. After 3 weeks,
mood is improved, but has difficulty passing urine and mild erectile
dysfunction. Appropriate action? (2x) Right Ans - BETHANECHOL 25MG
TID
Antidepressant less likely to cause sexual dysfunction: (3x) Right Ans -
BUPROPION
Which is a muscarinic SE of antidepressants? (2x) Right Ans - URINARY
RETENTION
30 y/o pt has been treated for unreasonable fear of eating in public places,
feeling of embarrassment in public places, and anger over the possibility of
being scrutinized. Pt has not responded to high doses of paroxetine,
citalopram, buspirone, and alprazolam, each of them administered for 4-6
wks. Which meds would be appropriate for next? (2x) Right Ans -
PHENELZINE
,What meds could be helpful in the treatment of depression in persons over
the age of 65 because it does not produce orthostatic hypotension: (2x)
Right Ans - BUPROPION
What antidepressant has plasma level that correlates with therapeutic
response? (3x) Right Ans - IMIPRAMINE
What antidepressant med is considered to be the most effective in the tx of
premature ejaculation? (x2) Right Ans - PAROXETINE
Which opioid has a potentially lethal interaction with monoamine oxidase
inhibitors (MAOIs)? (4x) Right Ans - MEPERIDINE
45 y/o F pt on phenelzine for MDD, takes OTC medication for cold sx and
develops hypertensive crisis. Which OTC medication would most likely cause
this? (3x) Right Ans - PSEUDOEPHEDRINE
Minimum recommended washout period for fluoxetine prior to starting MAOI
(2x) Right Ans - 5 WEEKS
Treatment for patients with MAOI related hypertensive crisis in the ER may
involve the administration of which of the following meds? (2x) Right Ans -
PHENTOLAMINE
What drug has a curvilinear therapeutic window? (6x) Right Ans -
NORTRIPTYLINE
What drug is useful in the Rx of urinary retention secondary to TCA therapy
(5x) Right Ans - BETHANECHOL
Most frequent cause of death following TCA overdose: (2x) Right Ans -
ARRHYTHMIA
After an OD on Amitriptyline, what test is needed? (4x) Right Ans - EKG
Optimal strategy in maintenance tx with TCA for patient with recurrent MDD
(2x) Right Ans - FULL DOSE ANTIDEPRESSANT THERAPY
Monitor TCA overdose using (2x) Right Ans - EKG
, Which SSRI has mild anticholinergic activity due to some affinity at the
muscarinic receptors? (3x) Right Ans - PAROXETINE
Fluoxetine should NOT be prescribed with what? (2x) Right Ans -
PHENELZINE
21 y/o pt experiences a brief manic episode after starting an SSRI. The pt
meets Dx criteria for what disorder? (2x) Right Ans - SUBSTANCE-
INDUCED MOOD DISORDER
Serotonergic antidepressants are appropriate treatment for depression in 54
y/o pt with recent coronary artery bypass graft surgery because they: (2x)
Right Ans - INHIBIT PLATELET FUNCTIONING
The most common reason that people discontinue the use of SSRI: (2x)
Right Ans - GI SIDE EFFECTS
Which SSRI has the greatest potential for discontinuation syndrome with
missed doses (x2)? Right Ans - PAROXETINE
Which of the following has the longest mean half-life: citalopram, paroxetine,
venlafaxine, fluvoxamine, trazodone (x2)? Right Ans - CITALOPRAM
Which SSRI used to treat discontinuation syndrome caused by SSRI
termination (x2)? Right Ans - FLUOXETINE
46 y/o F pt presents w increasing dysphoria, progressively increased
frequency with which she washes her hands to the point of excoriation, dose
range for effective Tx: (x2) Right Ans - FLUVOXAMINE 200-300MG DAILY
First line rx for pt with dilated cardiomyopathy who is depressed and has no
relief with fluoxetine. Pt does not want side effects Right Ans - BUPROPION
Rare occurrences of priapism are most frequently associated with: Right
Ans - TRAZODONE
47 yo overweight female on celexa w sexual side effects. What med to switch
to? Right Ans - BUPROPION
