for the Psychiatry Clerkship

Jeopardy for the Psychiatry Clerkship

And Now Here Is The Host . . . is proud to present Insert Name Here

The categories for today’s Jeopardy will be:

SSRI’s

SNRI’s

NDRI’s

NaSSA’s

TCA’s

SSRI’s TCA’s SNRI’s NDRI’s NaSSA’s 100 100 100 100 100 200 200 200 200 200 300 300 300 300 300 400 400 400 400 400 500 500 500 500 500 600 600 600 600 600 700 700 700 700 700 800 800 800 800 800 900 900 900 900 900

Row 1, Col 1 What is fluoxetine (prozac)? The half-life of this SSRI is about one week

1,2 What is Selective Serotonin Reuptake Inhibitor? SSRI is the abbreviation for this

1,3 What is Discontinuation Syndrome? If an SSRI with a short half life is abruptly stopped it may result in this

1,4 What isserotonin syndrome? SSRI’s and MAOI’s used in combination carry a high risk of this side effect

1,5 What is paroxetine (paxil) This is the most likely SSRI to cause the side effect of weight gain

1,6 What is a 2 weeks? The washout period when switching from an MAOI to any SSRI is this

1,7 What is escitalopram (lexapro)? This SSRI is the S-enantiomer of citalopram (celexa)

1,8 What is paroxetine (paxil) & fluvoxamine (luvox) These two SSRI’s have very short half lives & should be tapered to be discontinued

1,9 What are sexual side effects? This is a common side effect of all SSRI’s & the doctor should specifically ask about it as the patient may otherwise be too embarrassed to talk about it

2,1 What is Serotonin Norepinephrine Reuptake Inhibitor? The mechanism of action of SNRI’s is this

2,2 What is desvenlafaxine(pristiq) This SNRI is the psychoactive metabolite of another SNRI

2,3 What is serotonin? Whether the dose is very high, moderate, or low, this neurotransmitter’s reuptake is blocked by venlafaxine (effexor)

2,4 What is dopamine? At very high doses (>375mg/d) of venlafaxine (effexor) this neurotransmitter’s reuptake may begin to be blocked

2,5 What is duloxetine (cymbalta) This SNRI is preferred for painful symptoms of depression or diabetic neuropathy pain

2,6 What is poop-out syndrome (relapse)? As with the SSRI’s, some patients take SNRI’s for depression, have an initial response, continue taking the medication but then experience this

2,7 What is an induced bipolar state? As with all antidepressants, a depressed patient started on an SNRI who experiences activation & agitation may be having this

2,8 What are hot flashes/flushes? While venlafaxine (effexor) may cause the side effect of sweating, ironically it may be helpful to perimenopausal women with this

2,9 What is increased blood pressure? Venlafaxine (effexor) has this relatively common, dose dependent, cardiac system related side effect

3,1 What is Bupropion (Wellbutrin) This medication is the most well known NDRI

3,2 What is nicotine (smoking cessation)? NDRI’s are useful in treating cravings from dependence on this substance

3,3 What is sexual dysfunction? Not only do NDRI’s not have this common SSRI side effect, NDRI’s may be used to treat patients who have this SSRI side effect

3,4 What is a seizure? Like most anti-depressants, at typical doses NDRI’s carry a small risk of this serious side effect but the risk increases from 0.4% to 4% at very high doses

3,5 What are Anxiety Disorders Compared to SSRI’s or SNRI’s, NDRI’s are less effective in treating this class of psychiatric illnesses

3,6 What is hypersomnia? (> 10 hours/nite) NDRI’s may be especially helpful in treating this sleep disturbance that is seen in atypical depression

3,7 What is decrease? (or no change) NDRI’s commonly do this to a patient’s weight

3,8 What is Attention Deficit Hyperactivity Disorder (ADHD)? While not a first line treatment, NDRI’s “stimulating” effects may be helpful in treating children and adults with this disorder

3,9 What is 2-4 weeks Onset of therapeutic action is usually not immediate, but is delayed until this time period

4,1 What is Noradrenergic and Specific Serotonergic Agent? NaSSA stands for this

4,2 What is pre-synaptic alpha 2 adrenergic antagonist NaSSA’s novel mechanism of action by which norepinephrine and serotonin system activity is increased is this

4,3 What is mirtazepine (remeron)? The medication that is in the NaSSA class is this

4,4 What are GI side effects? (nausea, diarrhea, stomach cramps) SSRIs or venlafaxine (effexor) may cause these common side effects which NaSSA’s 5HT3 antagonism may help reduce or remove

4,5 What is weight gain? This mirtazapine (remeron) side effect is more likely in women than men, before menopause than after, and is unlikely to be a problem if it has not occurred within the first 6 weeks of treatment

4,6 What is serotonin syndrome? Patients taking mirtazapine (remeron) and an MAO-I at the same time, or within 2 weeks of the other, are at risk for this serious side effect

4,7 What is histamine? (H1) Mirtazapine (remeron) is an antagonist of: a presynaptic receptor, serotonin post synaptic receptors, and this post synaptic receptor

4,8 What is almost immediately? Onset of therapeutic effect on insomnia and anxiety is typically in this time period

4,9 What is none? Cytochrome P450 enzyme system that is significantly effected by mirtazepine (remeron) is

5,1 What is nortriptyline (pamelor)? A tertiary amine, amitriptyline (elavil), is metabolized to a secondary amine which is this TCA

5,2 What is anticholinergic activity? Blurred vision, urinary hesitancy, dry mouth, and constipation are due to this neurotransmitter receptor activity by TCA’s

5,3 What is desipramine (norpramin)? A tertiary amine, imipramine (tofranil), is metabolized to a secondary amine which is this TCA

5,4 What are men? TCA’s may be more effective than SSRI’s in treating depression for this sex of the clinical population

5,5 What is cytochrome p450 2D6? Fluoxetine (prozac), paroxetine (paxil), bupropion (wellbutrin), duloxetine (cymbalta) and other medications may increase all TCA’s concentration by inhibiting this p450 enzyme

for the Psychiatry Clerkship