2. for the Psychiatry Clerkship

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

4. The categories for today’s Jeopardy will be:

5. SSRI’s

6. SNRI’s

7. NDRI’s

8. NaSSA’s

9. TCA’s

10. 100 200 300 800 700 500 800 SSRI’s NDRI’s TCA’s 100 700 500 700 400 800 600 100 900 300 500 800 NaSSA’s 100 900 500 400 300 200 300 400 600 800 200 300 600 200 500 400 700 600 200 400 700 600 SNRI’s

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

12. 1,2 SSRI is the abbreviation for this What is Selective Serotonin Reuptake Inhibitor?

13. 1,3 If an SSRI with a short half life is abruptly stopped it may result in this What is Discontinuation Syndrome?

14. 1,4 SSRI’s and MAOI’s used in combination carry a high risk of this side effect What is serotonin syndrome?

15. 1,5 This is the most likely SSRI to cause the side effect of weight gain What is paroxetine (paxil)

16. 1,6 The washout period when switching from an MAOI to any SSRI is this What is a 2 weeks?

17. 1,7 This SSRI is the S-enantiomer of citalopram (celexa) What is escitalopram (lexapro)?

18. 1,8 These two SSRI’s have very short half lives & should be tapered to be discontinued What is paroxetine (paxil) & fluvoxamine (luvox)

19. 1,9 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 What are sexual side effects?

20. 2,1 The mechanism of action of SNRI’s is this What is Serotonin Norepinephrine Reuptake Inhibitor?

21. 2,2 This SNRI is the psychoactive metabolite of another SNRI What is desvenlafaxine (pristiq)

22. 2,3 Whether the dose is very high, moderate, or low, this neurotransmitter’s reuptake is blocked by venlafaxine (effexor) What is serotonin?

23. 2,4 At very high doses (>375mg/d) of venlafaxine (effexor) this neurotransmitter’s reuptake may begin to be blocked What is dopamine?

24. 2,5 What is duloxetine (cymbalta) This SNRI is preferred for painful symptoms of depression or diabetic neuropathy pain

25. 2,6 As with the SSRI’s, some patients take SNRI’s for depression, have an initial response, continue taking the medication but then experience this What is poop-out syndrome (relapse)?

26. 2,7 As with all antidepressants, a depressed patient started on an SNRI who experiences activation & agitation may be having this What is an induced bipolar state?

27. 2,8 While venlafaxine (effexor) may cause the side effect of sweating, ironically it may be helpful to perimenopausal women with this What are hot flashes/flushes?

28. 2,9 Venlafaxine (effexor) has this relatively common, dose dependent, cardiac system related side effect What is increased blood pressure?

29. 3,1 This medication is the most well known NDRI What is Bupropion (Wellbutrin)

30. 3,2 NDRI’s are useful in treating cravings from dependence on this substance What is nicotine (smoking cessation)?

31. 3,3 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 What is sexual dysfunction?

32. 3,4 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 What is a seizure?

33. 3,5 Compared to SSRI’s or SNRI’s, NDRI’s are less effective in treating this class of psychiatric illnesses What are Anxiety Disorders

34. 3,6 NDRI’s may be especially helpful in treating this sleep disturbance that is seen in atypical depression What is hypersomnia? (> 10 hours/nite)

35. 3,7 NDRI’s commonly do this to a patient’s weight What is decrease? (or no change)

36. 3,8 While not a first line treatment, NDRI’s “stimulating” effects may be helpful in treating children and adults with this disorder What is Attention Deficit Hyperactivity Disorder (ADHD)?

37. 3,9 Onset of therapeutic action is usually not immediate, but is delayed until this time period What is 2-4 weeks

38. 4,1 NaSSA stands for this What is Noradrenergic and Specific Serotonergic Agent?

39. 4,2 NaSSA’s novel mechanism of action by which norepinephrine and serotonin system activity is increased is this What is pre-synaptic alpha 2 adrenergic antagonist

40. 4,3 The medication that is in the NaSSA class is this What is mirtazepine (remeron)?

41. 4,4 SSRIs or venlafaxine (effexor) may cause these common side effects which NaSSA’s 5HT3 antagonism may help reduce or remove What are GI side effects? (nausea, diarrhea, stomach cramps)

42. 4,5 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 What is weight gain?

43. 4,6 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 What is serotonin syndrome?

44. 4,7 Mirtazapine (remeron) is an antagonist of: a presynaptic receptor, serotonin post synaptic receptors, and this post synaptic receptor What is histamine? (H1)

45. 4,8 Onset of therapeutic effect on insomnia and anxiety is typically in this time period What is almost immediately?

46. 4,9 Cytochrome P450 enzyme system that is significantly effected by mirtazepine (remeron) is What is none?

47. 5,1 A tertiary amine, amitriptyline (elavil), is metabolized to a secondary amine which is this TCA What is nortriptyline (pamelor)?

48. 5,2 Blurred vision, urinary hesitancy, dry mouth, and constipation are due to this neurotransmitter receptor activity by TCA’s What is anticholinergic activity?

49. 5,3 A tertiary amine, imipramine (tofranil), is metabolized to a secondary amine which is this TCA What is desipramine (norpramin)?

50. 5,4 TCA’s may be more effective than SSRI’s in treating depression for this sex of the clinical population What are men?

51. 5,5 Fluoxetine (prozac), paroxetine (paxil), bupropion (wellbutrin), duloxetine (cymbalta) and other medications may increase all TCA’s concentration by inhibiting this p450 enzyme What is cytochrome p450 2D6?

52. 5,6 Side effects of dizziness, sedation, and hypotension likely result from TCA’s antagonist activity of this receptor What is alpha adrenergic-1 receptor?

53. 5,7 Side effects of sedation and weight gain from TCA’s are likely due to antagonist activity at this receptor What is histamine (H1)?

54. 5,8 TCA’s mechanism of action for treating depression is this What is serotonin and norepinephrine reuptake inhibition?

55. 5,9 The dangerous side effects from a TCA overdose are cardiac arrhythmias caused by blockade of this What are sodium channels?