Chapter 14: Introduction of Pharmacology 8th Edition

1) The common adverse effects of using of psychomotor stimulants are: A) dry mouth, tachycardia, hypertension, and insomnia. B) increased blood pressure, heart rate, and CNS activation. C) constipation, somnolence, and weight gain. D) urinary retention, constipation, blurred vision, and hypotension.

1) [A, B] dry mouth, tachycardia, hypertension, and insomnia; increased blood pressure, heart rate, and CNS activation. The psychomotor stimulants increase the activity of the sympathetic nervous system, producing dry mouth, rapid heartbeat, increased blood pressure, restlessness, and insomnia.

12) Gabrielle presents with symptoms of depression. She also feels excited or elated at times. This constant state of flux causes her mood to vary often. What is the most likely diagnosis of Gabrielle?s condition? A) Bipolar mood disorder B) Exogenous depression C) Major depressive disorder D) Reactive depression

12) A. Bipolar mood disorder In some cases of depression, there are alternate periods of hyperexcitability and elation, known as mania. Individuals who experience these alternating cycles of depression and mania are classified as manic-depressive. Another term for this condition is bipolar mood disorder.

10) Janine has been diagnosed with posttraumatic stress disorder (PTSD). Which of the following drugs is commonly used to treat this condition? A) Tricyclicantidepressants (TCAs) B) Monoamine oxidase(MAO) inhibitors C) Psychomotorstimulants D) Selective serotonin reuptake inhibitors (SSRIs)

10) D. Selective serotonin reuptake inhibitors (SSRIs) Selective serotonin reuptake inhibitors (SSRIs) are used to treat a range of anxiety disorders, including PTSD and obsessive-compulsive disorder (OCD). They are also currently the drugs most commonly used to treat major depression.

11) Lithium is not contraindicated in patients with: A) hyperthyroidism. B) pregnancy. C) bipolar disorder. D) kidney disease.

11) C. bipolar disorder. The main use of lithium is in the treatment of bipolar disorder and mania. It has a number of dangerous side effects and is contraindicated for patients with cardiac, renal, or thyroid disorders, as well as during pregnancy.

15) Which of the following drugs produces moderate sedation, moderate anticholinergic activity, and high alpha blockade? A) Imipramine B) Desipramine C) Clomipramine D) Doxepin

15) A. Imipramine Imipramine is a tertiary amine that produces moderate sedation, moderate anticholinergic activity, and high alpha blockade.

17) Identify the type of depression in which there is a period of shock followed by a period of readjustment and resolve that life must go on. A) Exogenous depression B) Mania C) Major depressive disorder D) None of the above

17) A. Exogenous depression Depression that is caused by external factors (death or unemployment) is referred to as exogenous, or reactive, depression. Usually, there is a period of shock and depression, which is followed by a period of readjustment and a resolve that life must go on. In this sense, a reactive depression is self-limiting and usually does not require drug therapy.

23) Which of the following is true of SSRIs? A) SSRIs increase the concentration of serotonin in the synaptic cleft, resulting in increased stimulation of serotonin receptors. B) SSRIs decrease the concentration of serotonin in the synaptic cleft, which contributes to its antidepressant effect. C) SSRIs decrease the concentration of serotonin in the synaptic cleft, resulting in decreased stimulation of serotonin receptors. D) SSRIs decrease the release of and increase the reuptake of norepinephrine and dopamine.

23) A. SSRIs increase the concentration of serotonin in the synaptic cleft, resulting in increased stimulation of serotonin receptors. SSRIs increase the concentration of serotonin in the synaptic cleft, resulting in increased stimulation of serotonin receptors. The increase in serotonin activity in the brain is believed to contribute to the antidepressant effect.

24) Compare the effects of monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs) on norepinephrine and serotonin. A) MAOIs increase the levels of norepinephrine and serotonin in the brain, and TCAs decrease the levels of norepinephrine and serotonin in the neuronal nerve endings. B) MAOIs increase the levels of norepinephrine and serotonin in the neuronal nerve endings, and TCAs increase the levels of norepinephrine and serotonin in the brain. C) Both MAOIs and TCAs increase the levels of norepinephrine and serotonin in the brain. D) Both MAOIs and TCAs increase the levels of norepinephrine and serotonin in the neuronal nerve endings.

24) C. Both MAOIs and TCAs increase the levels of norepinephrine and serotonin in the brain. MAOIs decrease the amounts of norepinephrine and serotonin that are destroyed. Consequently, the MAOIs permit the levels of norepinephrine and serotonin in the brain to increase. TCAs block the reuptake of norepinephrine and serotonin back into the neuronal nerve endings. This action increases the level of neuronal activity of norepinephrine and serotonin and alleviates the symptoms and dysfunction of depression.

26) A patient has been taking amitriptyline for 5 to 6 days, but she is still experiencing the feelings of depression. She wants the doctor to change her medication because she feels that the drug is not working. After doing research on amitriptyline, you tell the patient that: A) amitriptyline is working, but the full antidepressant effect can take as long as 2 to 4 weeks to develop. B) amitriptyline is not working and the doctor will change her medication. C) amitriptyline is working, but the full antidepressant effect can take as long as 7 to 10 days to develop. D) None of the above are correct.

26) A. amitriptyline is working, but the full antidepressant effect can take as long as 2 to 4 weeks to develop. The pharmacological actions of amitriptyline, as other tricyclic antidepressants, occur within a few hours of administration of the drug. However, the full antidepressant effect requires 2 to 4 weeks to develop.

32) Tricyclics interfere with antihistamine and anticholinergic drug agents resulting in _____. A) increased sedation B) dry mouth, constipation, urinary retention, and blurred vision C) increased metabolism of the tricyclics, leading to decreased effectiveness D) increased CNS stimulation, hyperpyrexia, and seizures

32) B. dry mouth, constipation, urinary retention, and blurred vision The tricyclics interact with the antihistamine and anticholinergic agents causing dry mouth, constipation, urinary retention, and blurred vision.

33) Explain the pharmacologic actions of bupropion ( Wellbutrin). A) Bupropion increases the release of norepinephrine and dopamine. B) Bupropion inhibits the reuptake of norepinephrine and dopamine. C) Bupropion has minimal effects to inhibit the reuptake of serotonin. D) All of the above are correct.

33) D. All of the above are correct. The major pharmacologic actions of bupropion ( Wellbutrin) are to increase the release of and inhibit the reuptake of norepinephrine and dopamine. Bupropion has minimal effects to inhibit the reuptake of serotonin.

34) Analyze the different FDA pregnancy categories and determine the appropriate category for lithium. A) Pregnancy Category B B) Pregnancy Category C C) Pregnancy Category D D) Pregnancy Category X

34) C. Pregnancy Category D Lithium has been designated FDA Pregnancy Category D and therefore should not be used during pregnancy.

35) A 50-year-old woman has been diagnosed with major depression. She has no other health issues. Her physician has several choices of drug classes to treat her. Select the drug class from which the physician should prescribe a drug for the patient. A) MAOIs B) SSRIs C) Lithium D) Psychomotor stimulants

35) B. SSRIs The SSRIs are currently considered the preferred drugs for major depression. The advantages of the SSRIs include a lower incidence of adverse and toxic effects than the other drugs used to treat depression.

36) Which of the following is a difference between mania and depression? A) Depression is a mental state characterized by feelings of hopelessness, frustration, and depressed mood, whereas mania is characterized by excitement, hyperactivity, and elevated mood. B) Depression is treated with SSRIs, whereas mania is treated with lithium. C) Depression is associated with low levels of norepinephrine and/or serotonin, while high levels of norepinephrine and/or serotonin are involved in mania. D) All of the above are correct.

36) D. All of the above are correct. During depression, there are changes in mood and behavior, along with feelings of frustration and hopelessness. The SSRIs have become the preferred therapy for treatment of depression. Mania is a mental state of excitement, hyperactivity, and excessive elevation of mood. Lithium is used to treat individuals who experience wide shifts of mood, mania, or alternating cycles of depression and mania (bipolar mood disorder). Low levels of norepinephrine and/or serotonin are associated with mental depression, while high levels of norepinephrine and/or serotonin may be involved in mania.

37) The tricyclics (TCAs) possess significant anticholinergic and alpha-blocking actions. Select the tricyclic agent that causes moderate sedation, moderate anticholinergic effects, and moderate alpha-blocking effect. A) Doxepin B) Amitriptyline C) Nortriptyline D) Imipramine

37) C. Nortriptyline Nortriptyline ( Aventyl) causes moderate sedation, moderate alpha-blocking effects, and moderate anticholinergic effects.

41) Which of the following groups of drugs has a drug each with low, high, and sedating effects on the CNS? A) Citalopram, lithium, and amitriptyline B) Citalopram, fluoxetine, and fluvoxamine C) Paroxetine, lithium, and fluoxetine D) None of the above

41) B. Citalopram, fluoxetine, and fluvoxamine Citalopram ( Celexa), escitalopram ( Lexapro), paroxetine ( Paxil), and sertraline ( Zoloft) are classified as SSRIs with low CNS activation. Fluoxetine ( Prozac) is an SSRI with high CNS activation. Fluvoxamine ( Luvox) is an SSRI that produces sedating effects.

42) Identify a difference between secondary amines and tertiary amines. A) Tertiary amines contain three amine substitutions on the nitrogen, whereas secondary amines contain two amine substitutions on the nitrogen. B) Secondary amines mainly increase brain levels of norepinephrine more than serotonin, while the tertiary amines increase brain levels of serotonin more than epinephrine. C) Tertiary amines produce more sedation than do the secondary amines. D) All of the above are correct

42) D. All of the above are correct Most of the tricyclic antidepressant drugs can be classified as being either secondary amines (two substitutions on the nitrogen) or tertiary amines (three substitutions on the nitrogen). Secondary amines mainly increase brain levels of norepinephrine more than serotonin, while the tertiary amines mainly increase brain levels of serotonin more than norepinephrine. The tertiary amines produce more sedation than do the secondary amines.

46) Kevin, a 12-year-old boy, grew up with his pet dog, Sparky, who was almost the same age as Kevin. Age-related health complications caused Sparky?s death, following which Kevin was distraught. He was depressed for more than a week and refused to go to school. The type of depression affecting Kevin is termed _____. A) exogenous depression B) major depressive disorder C) mania D) bipolar mood disorder

46) A. exogenous depression Depression that is caused by external factors (death or unemployment) is referred to as exogenous, or reactive, depression. Usually, there is a period of shock and depression, which is followed by a period of readjustment and a resolve that life must go on.

48) Jamie, a 50-year-old man, is prescribed fluvoxamine to treat his obsessive-compulsive disorder (OCD). Fluvoxamine is available as a 100-mg scored tablets. Jamie takes half a tablet each day. After two days, Jamie begins experiencing symptoms of sedation such as drowsiness. What is the most likely explanation for this occurrence? A) One of the effects of fluvoxamine on the central nervous system is sedation. B) Jamie is consuming more than the recommended dosage per day. C) Jamie is consuming less than the recommended dosage per day. D) Fluvoxamine is contraindicated in patients aged over 40 years.

48) A. One of the effects of fluvoxamine on the central nervous system is sedation. The SSRIs usually stimulate and activate CNS activity. Unlike other selective serotonin reuptake inhibitors that produce varying degrees of CNS activation, fluvoxamine produces a sedating effect.

5) Which of the following conditions is generally not treated with selective serotonin reuptake inhibitors (SSRIs) ? A) Posttraumatic stress disorder (PTSD) B) Obsessive-compulsive disorders C) Major depressive disorder (MDD) D) Bipolar mood disorder E) Premenstrual dysphoric disorder

5) D. Bipolar mood disorder Selective serotonin reuptake inhibitors (SSRIs) are currently the drugs most commonly used to treat major depression and anxiety disorders. Lithium is used in the treatment of bipolar mood disorder.

9) A patient who is taking a tricyclic antidepressant should not be taking a MAO inhibitor with it because: A) the combination will cause an increase in sedation. B) the combinationwill cause blurred vision. C) the druginteraction might lead to seizures. D) the MAO inhibitor will cancel the effects of the tricyclic antidepressant.

9) C. the druginteraction might lead to seizures. When taken together, tricyclic antidepressants and MAO inhibitors will cause increased stimulation of the central nervous system. This could lead to high fever and seizures.

13) Emma presents with symptoms of major depressive disorder. Her doctor prescribes 60 mg per day of fluoxetine to treat the disorder. She forgets to carry her medication on a weekend vacation. Once Emma comes back home, she consumes five times the recommended dosage to compensate for the missed doses. In a few hours, Emma presents with symptoms such as confusion, fever, and tremor agitation and is rushed to the ER. Emma?s symptoms are collectively referred to as the _____. A) serotonin syndrome B) discontinuation syndrome C) hyperkinetic syndrome D) psychotomimetic syndrome

13) A. serotonin syndrome The most common symptoms of overdosage of selective serotonin reuptake inhibitors include confusion, fever, tremor agitation, restlessness, and other signs of CNS excitation; seizures also have been reported. These symptoms are referred to as the "serotonin syndrome" and may lead to coma and death if not treated.

14) One of the differences in the mechanism of action of SSRIs and SNRIs is that unlike SSRIs, SNRIs: A) block the reuptake of norepinephrine. B) block the reuptake of serotonin. C) block cholinergic receptors. D) block histamine receptors.

14) A. block the reuptake of norepinephrine. The SNRIs block reuptake of serotonin like the SSRIs and also block the reuptake of norepinephrine to increase the levels of both serotonin and norepinephrine in the brain. Like the SSRIs, they have little effect in blocking cholinergic, adrenergic, or histamine receptors.

16) Martina is prescribed isocarboxazid to treat mental depression. Which of the following foods can be included in Martina's diet? A) Fresh meat B) Beer C) Wine D) Old cheese

16) A. Fresh meat Patients who are under receiving MAO inhibitors therapy need to follow a restricted diet. They are not allowed to consume food substances that contain tyramine. Foods that normally contain tyramine include wine, beer, herring, and certain cheeses.

18) Identify the type of depression that originates from within an individual and may not be linked to easily identifiable causes. A) Exogenous depression B) Mania C) major depressive disorder D) Bipolar mood disorder

18) C. major depressive disorder Major depressive disorder (MDD) is frequently more serious than reactive depression and usually requires both psychotherapy and drug treatment. This type of depression originates from within the individual and may not be associated with easily recognized causes. Psychological disturbances and maladjustments or biochemical defects in the brain are thought to be involved.

19) Identify the common symptoms associated with a patient suffering from mania. A) The patient shows signs of hyperactivity. B) The patient is very talkative. C) The patient exhibits unrealistic thoughts. D) All of the above are true.

19) D. All of the above are true. Mania is characterized by periods of hyperactivity and excitement combined with excessive elevations of mood. Manic individuals are usually very talkative, but their thoughts and ideas are most often unrealistic.

2) Sarah suffers from major depressive disorder (MDD). What does this mean? A) Sarah needs to take a mood stabilizer. B) Sarah will recover without drug treatment. C) Sarah likely has low levels of serotonin. D) Sarah has highlevels of the neurotransmitter norepinephrine. E) Sarah's condition may be traced to a specific cause.

2) C. Sarah likely has low levels of serotonin. The Monoamine Theory of Mental Depression is the concept that major depressive disorder (MDD) is related to the levels of norepinephrine and/or serotonin in the brain. A person with MDD is likely to have low levels of one or both of these neurotransmitters. A person who is manic, on the other hand, will have high levels.

20) Describe the type of disorder that responds to lithium treatment. A) Disorders characterized by alternating cycles of depression and mania B) Disorders characterized by hyperactivity and excessive elevation of mood C) Disorders characterized by wide shifts in mood D) All of the above

20) D. All of the above Lithium is referred to as a mood stabilizer and is used to treat individuals who experience wide shifts of mood, mania, or alternating cycles of depression and mania (bipolar mood disorder).

21) Identify the mechanism through which lithium decreases nerve conduction. A) Lithium blocks the reuptake of norepinephrine and serotonin back into the neuronal nerve endings. B) Lithium interferes with nerve conduction, resulting in a decrease in the excitability of nerve tissue. C) Lithium stimulates norepinephrine and dopamine receptors, which stimulate the release of norepinephrine and dopamine from nerve endings. D) None of the above are true.

21) B. Lithium interferes with nerve conduction, resulting in a decrease in the excitability of nerve tissue. The body utilizes lithium as if it were sodium. Both lithium (Li+) and sodium (Na+) exist in body fluids as charged particles, or ions. However, whereas Na+ is normally required for conduction of nerve impulses, Li+ interferes with nerve conduction. As a result, there is a decrease in the excitability of nerve tissue.

22) Identify the statement that best explains bipolar mood disorder. A) It is a disorder that entails depression caused by external factors. B) It is depression caused by factors that originate within the patient. C) It is a disorder consisting of alternating periods of depression and mania. D) None of the above are true.

22) C. It is a disorder consisting of alternating periods of depression and mania. In some cases of depression, there are alternate periods of hyperexcitability and elation known as mania. Individuals who experience these alternating cycles of depression and mania are classified as manic-depressive. Another term for this condition is bipolar mood disorder.

25) The adverse effects of SNRIs include: A) increased sedation, insomnia, and nephritis. B) cardiac arrhythmias, seizures, and CNS depression. C) GI disturbances, CNS excitation, and increased blood pressure. D) renal insufficiency, mania, and convulsions.

25) C. GI disturbances, CNS excitation, and increased blood pressure. The adverse effects of the SNRIs are similar to the SSRIs regarding the increased levels of serotonin. In addition, the increased levels of norepinephrine can increase blood pressure, heart rate, and CNS activation.

27) Which of the following is true of the use of psychomotor stimulants in the treatment of narcolepsy and hyperactivity? A) Amphetamines have the disadvantage of producing drug tolerance and dependence. B) Psychomotor stimulants decrease the activity of the sympathetic nervous system. C) Toxic doses of psychomotor stimulants may cause cardiac arrhythmias and nephritis. D) All of the above are correct.

27) A. Amphetamines have the disadvantage of producing drug tolerance and dependence. The psychomotor stimulants include the amphetamines and other closely related drugs, which are really not classified as antidepressants. Amphetamines have the disadvantage of producing drug tolerance and drug dependence. The amphetamines are among the leading "street drugs" that are abused and illegally marketed.

28) You have been asked to explain to tell a patient about the common side effects that he should report while taking SSRIs. Which of the following should be included in the reportable side effects? A) Excessive agitation and seizures B) Loss of appetite and nausea C) Headache and nervousness D) All of the above

28) D. All of the above The common side effects associated with the use of the selective serotonin reuptake inhibitors include headache, nervousness, insomnia, nausea, loss of appetite, and diarrhea. Instruct the patient to report excessive GI and CNS stimulation (agitation or seizures).

29) Due to their alpha-blocking, anticholinergic, and antihistaminic effects, tricyclic antidepressants are contraindicated in patients suffering from: A) glaucoma and prostatic hypertrophy. B) hypertension and tachycardia. C) sexual dysfunction and urinary retention. D) obesity and insomnia.

29) A. glaucoma and prostatic hypertrophy. Tricyclic antidepressants may be contraindicated in patients with glaucoma and prostatic hypertrophy.

3) A patient who is taking the MAO inhibitor phenelzine ( Nardil) should be warned to avoid all of the following except _____. A) wine B) over-the-counter decongestants C) draft beer D) aged cheese E) chicken

3) E. chicken People who are taking MAO inhibitors need to avoid ingesting food or other substances that contain tyramine. Tyramine interaction may cause a massive release of norepinephrine and lead to a hypertensive crisis or cerebral stroke. It is usually found in aged, fermented, or spoiled foods.

30) One of your patients is undergoing MAO inhibitor therapy. You have been asked to explain to the patient the dietary restrictions concerning tyramine. The patient does not know what foods should be avoided. You list the foods to avoid as: A) coffee, chocolate, and cookies. B) beer, wine, herring, and certain cheeses. C) skim milk, cottage cheese, and fresh apples. D) oatmeal, cornflakes, and noodles.

30) B. beer, wine, herring, and certain cheeses. One of the main disadvantages of MAO inhibitor therapy is the dietary restrictions. Many foods contain a substance known as tyramine, which causes the release of norepinephrine from storage granules. Foods that normally contain tyramine include wine, beer, herring, and certain cheeses.

31) Explain the underlying principle of the Monoamine Theory of Mental Depression. A) Low levels of epinephrine and serotonin, which are referred to chemically as the monoamines, lead to depression. B) Low levels of norepinephrine and serotonin, which are referred to chemically as the monoamines, lead to depression. C) Low levels of norepinephrine and dopamine, which are referred to chemically as the monoamines, lead to depression. D) None of the above are correct.

31) B. Low levels of norepinephrine and serotonin, which are referred to chemically as the monoamines, lead to depression. The levels of norepinephrine and serotonin (5HT) in the brain can influence mental behavior. Low levels of norepinephrine and/or serotonin are associated with mental depression, while high levels of norepinephrine and/or serotonin may be involved in mania. This concept involving norepinephrine and serotonin (referred to chemically as monoamines) is known as the Monoamine Theory of Mental Depression.

38) A 45-year-old male has been diagnosed with narcolepsy, a disorder characterized by an uncontrolled tendency to fall asleep. His physician has prescribed a psychomotor stimulant. Select a correct statement about the mechanism of action of the amphetamine class of drugs. A) Amphetamines stimulate the release of epinephrine and acetylcholine from the nerve endings and prevent the reuptake of these back into the nerve endings. B) Amphetamines stimulate the release of serotonin from the nerve endings and increase the reuptake of serotonin back into the nerve endings. C) Amphetamines stimulate the release of norepinephrine and dopamine from the nerve endings and prevent the reuptake of these back into the nerve endings. D) None of the above are correct.

38) C. Amphetamines stimulate the release of norepinephrine and dopamine from the nerve endings and prevent the reuptake of these back into the nerve endings. Amphetamines stimulate the reticular formation, which increases wakefulness and alertness and reduces the number of attacks of narcolepsy. They act directly to stimulate norepinephrine and dopamine receptors, stimulate the release of norepinephrine and dopamine from the nerve endings, and inhibit the reuptake of these neurotransmitters back into the nerve endings. These actions produce CNS stimulation and an elevation in mood.

39) Which of the following pairs of drugs is approved for the treatment of premenstrual dysphoric disorder, where mood disturbances occur in relation to the menstrual cycle? A) Escitalopram and citalopram B) Fluoxetine and sertraline C) Fluoxetine and citalopram D) Sertraline and escitalopram

39) B. Fluoxetine and sertraline Fluoxetine and sertraline are approved for the treatment of premenstrual dysphoric disorder, where mood disturbances occur in relation to the menstrual cycle.

4) Which of the following statements is true of tricyclic antidepressant drugs? A) Drugs in this group are only used in the treatment of depression. B) Tricyclic drugs require 5 to 10 days to exert maximum effect in most patients. C) It may require several tries before the right tricyclic antidepressant drug therapy is found for a patient. D) Tricyclic drugs cause very few drug interactions. E) It has been discovered that tricyclic drugs work by blocking the reuptake of serotonin.

4) C. It may require several tries before the right tricyclic antidepressant drug therapy is found for a patient. To be effective, tricyclic antidepressant drugs need to increase a person's brain levels of either norepinephrine or serotonin in just the right amount. This process is not easy and may require a patient to try several drugs before the right one is found.

40) Select the correct daily dosage range of duloxetine ( Cymbalta). A) 40-120 mg PO B) 300-600 mg PO C) 50-200 mg PO D) 225-375 mg PO

40) A. 40-120 mg PO The daily dosage range of duloxetine ( Cymbalta) is 40-60 mg PO.

43) Patients taking lithium should be instructed to drink adequate amounts of fluids and take adequate amounts of sodium. Select the reason for this instruction. A) Hyponatremia promotes the retention of lithium, which can lead to toxic levels of lithium in the blood. B) Sodium ions and lithium ions compete against each other for renal elimination. C) Lithium is a salt and leads to an increase in thirst and an increase in the frequency of urination. D) All of the above are correct.

43) D. All of the above are correct. Lithium is administered as a salt. Lithium and sodium ions compete with each other for renal elimination. Adequate sodium intake is necessary for proper urinary excretion of lithium. Decreased sodium intake and hyponatremia (low sodium levels) promote the retention of lithium and can lead to toxicity.

44) Select the statement that is not consistent with the mechanism of action or adverse effect profile of the SSRI mirtazapine ( Remeron). A) Mirtazapine decreases the release of norepinephrine and serotonin. B) Mirtazapine has potent antihistaminic actions. C) Mirtazapine antagonizes serotonin 5HT2 and 5HT3 receptors. D) Mirtazapine use has been associated with weight gain.

44) A. Mirtazapine decreases the release of norepinephrine and serotonin. The actions of mirtazapine (Remeron) include the increased release of norepinephrine and serotonin, blockade of 5HT2 and 5HT3 receptors, and potent antihistaminic actions. Mirtazapine is sedating and usually does not cause GI disturbances or sexual dysfunction. Weight gain has been associated with this drug.

45) Select the statement that is not consistent with the mechanism of action or adverse effect profiles of the atypical SSRIs nefazodone (generic) and trazodone ( Desyrel). A) Nefazodone and trazodone are weak reuptake inhibitors of serotonin and norepinephrine. B) Nefazodone and trazodone provide some antidepressant effects. C) Nefazodone and trazodone are prescribed for patients who are trying to quit smoking. D) Nefazodone and trazodone cause sedation, orthostatic hypotension, and liver toxicity.

45) C. Nefazodone and trazodone are prescribed for patients who are trying to quit smoking. Nefazodone (generic) and trazodone ( Desyrel) are drugs that are weak reuptake inhibitors of serotonin and norepinephrine but potent antagonists of serotonin 5HT2A receptors. This action also causes some antidepressant effects. Adverse effects include sedation, orthostatic hypotension, and liver toxicity.

47) Linda, a teenager, is slightly depressed after the death of her pet cat. She presents with symptoms such as decreased appetite and shock. What is the most common method of treatment for such depression? A) Love and understanding of family or friends B) Extensive drug therapy C) Psychotherapy D) Tricyclic antidepressant therapy

47) A. Love and understanding of family or friends Depression that is caused by external factors (death or unemployment) is referred to as exogenous, or reactive, depression. A reactive depression is self-limiting and usually does not require drug therapy. The love and understanding of family or friends support the individual through the crisis.

49) Martina is prescribed isocarboxazid to treat mental depression. Which of the following foods can be included in Martina's diet? A) Fresh meat B) Beer C) Wine D) Old cheese

49) A. Fresh meat Patients who are under receiving MAO inhibitors therapy need to follow a restricted diet. They are not allowed to consume food substances that contain tyramine. Foods that normally contain tyramine include wine, beer, herring, and certain cheeses.

50) Roger, a chain smoker, decides to quit smoking. He experiences severe CNS effects of nicotine withdrawal. Which of the following drugs may be used to treat Roger? A) Bupropion B) Mirtazapine C) Nefazodone D) Trazodone

50) A. Bupropion Bupropion is prescribed for patients who are trying to quit the smoking habit where it appears to reduce the CNS effects of nicotine withdrawal. Bupropion is highly activating and may cause seizures.

6) One of your female patients has been prescribed lithium. Which of the following is not true of this situation? A) It is normal to experience thirst while on lithium. B) It is safe to continue lithium therapy during pregnancy. C) She may experience a ringing in her ears while on the drug. D) She will need to wait for about 1-2 weeks to feel better. E) She will need to have her blood levels tested periodically.

6) B. It is safe to continue lithium therapy during pregnancy. Because lithium has been classified as Pregnancy Category D by the FDA, it is not safe to continue its use during pregnancy. Your patient should be warned to alert her physician immediately should pregnancy occur while on lithium.

7) Which of the following is true of bipolar disorder? A) The drug treatment for bipolar disorder usually involves a mood stabilizer. B) Patients with bipolar disorder recover without drug treatment. C) Patients with bipolar disorder tend to have low levels of serotonin and norepinephrine. D) The disorder can usually be linked to a specific cause such as the death of a spouse.

7) A Bipolar disorder is a condition in which a person alternates between periods of depression and mania. Patients with this condition often take a mood stabilizer, such as lithium, to help regulate their moods.

8) Suki has just been prescribed an MAO inhibitor and needs to modify her diet. She should avoid all of the following except: A) wine. B) draft beer. C) aged cheese. D) fresh meat.

8) D. fresh meat. People who are taking MAO inhibitors need to avoid ingesting food or other substances that contain tyramine. Tyramine interaction may cause a massive release of norepinephrine and lead to a hypertensive crisis or cerebral stroke. Tyramine is usually found in aged, fermented, or spoiled foods.