SNRIs Mechanism of Action Quiz
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Questions and Answers

Which statement about the mechanism of action of SNRIs is correct?

  • SNRIs inhibit the synthesis of both norepinephrine and serotonin in the presynaptic neuron.
  • SNRIs selectively block the reuptake of serotonin into the presynaptic nerve terminal.
  • SNRIs cause enhanced noradrenergic neurotransmission but have no effect on serotonergic neurotransmission.
  • SNRIs block the reuptake of both norepinephrine (NE) and serotonin (5-HT) into the presynaptic nerve terminal. (correct)

    • Which of the following SNRIs has high protein binding?

  • Venlafaxine
  • Desvenlafaxine
  • Duloxetine (correct)
  • Levomilnacipran

    • Which of the following adverse effects is commonly associated with lithium therapy?

  • Tardive dyskinesia
  • Postural hand tremor (correct)
  • Akathisia
  • Agranulocytosis

    • Which of the following EKG changes is associated with lithium toxicity?

    <p>Inverted T-waves and U-waves</p> Signup and view all the answers

    Which of the following statements about lithium-induced nephrogenic diabetes insipidus is correct?

    <p>It is a rare adverse effect of lithium therapy, and amiloride can be given for treatment if it develops.</p> Signup and view all the answers

    Which of the following statements about the pharmacokinetics of SNRIs is correct?

    <p>Duloxetine has low protein binding, while venlafaxine, desvenlafaxine, and levomilnacipran have high protein binding.</p> Signup and view all the answers

    Which of the following is the MOST important consideration when transitioning a patient from an SSRI to an MAOI?

    <p>Waiting at least 5 weeks after stopping fluoxetine before starting the MAOI</p> Signup and view all the answers

    Which SSRI is considered the most potent inhibitor of the CYP450 enzyme system?

    <p>Fluoxetine</p> Signup and view all the answers

    Which of the following best describes the metabolism of fluoxetine (Prozac)?

    <p>Fluoxetine has a prolonged half-life and is extensively metabolized in the liver to an active metabolite, norfluoxetine, which also has a long half-life.</p> Signup and view all the answers

    Which CYP450 enzyme is primarily involved in the metabolism of most SSRIs?

    <p>CYP 2D6</p> Signup and view all the answers

    What is the MOST important drug interaction to consider when prescribing an SSRI concurrently with a monoamine oxidase inhibitor (MAOI)?

    <p>Increased risk of serotonin syndrome</p> Signup and view all the answers

    Which SSRI has the LOWEST risk of causing serotonin discontinuation syndrome when abruptly discontinued?

    <p>Fluoxetine</p> Signup and view all the answers

    Which of the following drugs, when combined with an SSRI, can increase the risk of serotonin syndrome?

    <p>Triptans</p> Signup and view all the answers

    Which SSRI is the LEAST likely to cause anticholinergic adverse effects like dry mouth?

    <p>Fluoxetine</p> Signup and view all the answers

    Which SNRI has a slightly higher incidence of anticholinergic side effects compared to other SNRIs?

    <p>Duloxetine</p> Signup and view all the answers

    Which of the following is the MOST important adverse effect to monitor for when a patient is taking an SSRI and an antiplatelet or anticoagulant medication concurrently?

    <p>Increased risk of bleeding</p> Signup and view all the answers

    What response should be anticipated when giving a direct-acting or indirect-acting sympathomimetic to a patient recently started on a tricyclic antidepressant (TCA)?

    <p>Exaggerated pressor response</p> Signup and view all the answers

    Why are smaller than usual doses of direct-acting sympathomimetics recommended when co-administered with TCAs?

    <p>To avoid exaggerated pressor responses</p> Signup and view all the answers

    In patients chronically treated with TCAs, why may conventional sympathomimetics be ineffective in restoring systemic blood pressure?

    <p>Catecholamine stores are depleted</p> Signup and view all the answers

    How should the initial dose of a sympathomimetic be adjusted in patients on TCA therapy for more than 6 weeks?

    <p>Decrease to 1/3rd the usual dose</p> Signup and view all the answers

    Why may patients on TCA therapy exhibit complex and unpredictable systemic blood pressure effects when administered sympathomimetics?

    <p>Desensitization/down-regulation of adrenergic receptors</p> Signup and view all the answers

    What is a potential consequence of administering a direct-acting or indirect-acting sympathomimetic to a patient recently started on a tricyclic antidepressant (TCA)?

    <p>Exaggerated pressor response</p> Signup and view all the answers

    Why are smaller than usual doses of direct-acting sympathomimetics recommended when co-administered with TCAs?

    <p>To mitigate an exaggerated pressor response</p> Signup and view all the answers

    Which enzyme is primarily involved in the metabolism of most SSRIs?

    <p>CYP2D6</p> Signup and view all the answers

    What response should be expected when giving a conventional sympathomimetic to a patient chronically treated with TCAs?

    <p>No response due to receptor desensitization</p> Signup and view all the answers

    Which of the following is a potential consequence of administering a direct-acting or indirect-acting sympathomimetic to a patient recently started on a TCA?

    <p>Exaggerated pressor response</p> Signup and view all the answers

    Which SNRI has the highest incidence of anticholinergic side effects compared to other SNRIs?

    <p>Duloxetine (Cymbalta)</p> Signup and view all the answers

    What happens to adrenergic receptors in patients chronically treated with TCAs?

    <p>They are desensitized/down-regulated</p> Signup and view all the answers

    Which of the following is the MOST important drug interaction to consider when prescribing an SSRI concurrently with a monoamine oxidase inhibitor (MAOI)?

    <p>Increased risk of serotonin syndrome</p> Signup and view all the answers

    Which SSRI is considered the MOST potent inhibitor of the CYP450 enzyme system?

    <p>Fluoxetine (Prozac)</p> Signup and view all the answers

    Which of the following best describes the metabolism of fluoxetine (Prozac)?

    <p>Primarily metabolized by CYP2D6</p> Signup and view all the answers

    Which of the following drugs, when combined with an SSRI, can increase the risk of serotonin syndrome?

    <p>Lithium</p> Signup and view all the answers

    Which of the following is a potential consequence of administering a direct-acting or indirect-acting sympathomimetic to a patient recently started on a tricyclic antidepressant (TCA)?

    <p>Decreased effectiveness of the sympathomimetic</p> Signup and view all the answers

    Which of the following is the LEAST likely to cause anticholinergic adverse effects like dry mouth when compared to other SSRIs?

    <p>Sertraline (Zoloft)</p> Signup and view all the answers

    Which of the following statements regarding the interaction between SSRIs and monoamine oxidase inhibitors (MAOIs) is correct?

    <p>At least 14 days must elapse after stopping an SSRI before starting an MAOI, except for fluoxetine, which requires a 5-week washout period.</p> Signup and view all the answers

    Which of the following statements regarding CYP2D6 inhibition by SSRIs is correct?

    <p>CYP2D6 inhibition by SSRIs can lead to increased plasma concentrations of other drugs metabolized by CYP2D6, potentially increasing the risk of adverse effects.</p> Signup and view all the answers

    Which of the following statements regarding the metabolism of SSRIs is correct?

    <p>CYP2D6 is involved in the metabolism of most SSRIs, but other enzymes like CYP2C9 and CYP2C19 may also play a role.</p> Signup and view all the answers

    Which of the following SSRIs is considered the most potent inhibitor of the CYP450 enzyme system?

    <p>Fluoxetine</p> Signup and view all the answers

    Which of the following drugs, when combined with an SSRI, can increase the risk of serotonin syndrome?

    <p>Linezolid</p> Signup and view all the answers

    Which of the following statements regarding the interaction between SSRIs and antiplatelet or anticoagulant agents is correct?

    <p>Patients taking SSRIs in combination with antiplatelet or anticoagulant agents should be monitored closely for an increased risk of bleeding.</p> Signup and view all the answers

    Which of the following statements regarding the metabolism of fluoxetine (Prozac) is correct?

    <p>Fluoxetine is extensively metabolized in the liver to norfluoxetine, an active metabolite with an even longer half-life than fluoxetine.</p> Signup and view all the answers

    Which of the following drugs, when combined with an SSRI, can increase the risk of serotonin syndrome?

    <p>Triptan medications</p> Signup and view all the answers

    Which of the following statements regarding the interaction between SSRIs and CYP2D6 inhibitors is correct?

    <p>Concomitant use of CYP2D6 inhibitors with SSRIs can lead to increased plasma concentrations of the SSRI, potentially increasing the risk of adverse effects.</p> Signup and view all the answers

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