NSG533|NSG 533 Advanced Pharmacology
Test 1 Week 4 Questions and Answers
|Wilkes
Question 1: A 26-year-old man with a history of depression has been taking
sertraline 200 mg/day for 12 weeks with no response. The patient has no other
complications. What is the most reasonable recommendation?
Correct Answer: Change to venlafaxine
Rationale: When an SSRI has failed at maximum therapeutic dose, switching
to an SNRI is the first line evidence based recommendation. Increasing sertraline
further above 200mg provides no additional benefit.
Question 2: Which of the following is a dangerous and absolutely contraindicated
combination?
Correct Answer: MAOI + meperidine
Rationale: This combination causes fatal serotonin syndrome. It is one of the
most dangerous drug interactions in all of pharmacology. All of the other options
are safe combinations.
Question 3: A 23-year-old woman presents with 6 weeks of MDD symptoms, no
prior psychiatric history. What is the best first line treatment?
Correct Answer: Paroxetine 20 mg po daily
Rationale: An SSRI is the first line treatment for new onset major depressive
disorder. TCAs are second line, St John's Wort is not recommended.
, Question 4: A patient on paroxetine is started on linezolid for MRSA. 3 days later
he is agitated, confused, diaphoretic and has myoclonic jerks. What is the
diagnosis?
Correct Answer: Serotonin Syndrome
Rationale: Linezolid is a weak MAO inhibitor. This is the classic presentation of
serotonin syndrome. This is the single most commonly missed question on this
exam.
Question 5: A 46 year old woman on paroxetine 10mg for 2 months reports no
improvement. What is the appropriate next step?
Correct Answer: Increase paroxetine to 20mg daily
Rationale: 10mg is only the starting dose. The therapeutic dose of paroxetine
is 20-40mg. She has never actually received a therapeutic dose.
Question 6: Which of the following is the primary flaw in the monoamine
hypothesis of depression?
Correct Answer: Antidepressant effects on neurotransmitters do not
temporally correspond to clinical response.
Rationale: Antidepressants change neurotransmitter levels within hours, but
take 4-6 weeks to produce clinical effect. This is the fatal contradiction to the
monoamine hypothesis.
Question 7: Which SSRI requires a 5 week washout period before starting an
MAOI?
Correct Answer: Fluoxetine
Rationale: Fluoxetine and its active metabolite norfluoxetine have a half life of
up to 14 days. It is the only antidepressant that requires this long washout period.
Test 1 Week 4 Questions and Answers
|Wilkes
Question 1: A 26-year-old man with a history of depression has been taking
sertraline 200 mg/day for 12 weeks with no response. The patient has no other
complications. What is the most reasonable recommendation?
Correct Answer: Change to venlafaxine
Rationale: When an SSRI has failed at maximum therapeutic dose, switching
to an SNRI is the first line evidence based recommendation. Increasing sertraline
further above 200mg provides no additional benefit.
Question 2: Which of the following is a dangerous and absolutely contraindicated
combination?
Correct Answer: MAOI + meperidine
Rationale: This combination causes fatal serotonin syndrome. It is one of the
most dangerous drug interactions in all of pharmacology. All of the other options
are safe combinations.
Question 3: A 23-year-old woman presents with 6 weeks of MDD symptoms, no
prior psychiatric history. What is the best first line treatment?
Correct Answer: Paroxetine 20 mg po daily
Rationale: An SSRI is the first line treatment for new onset major depressive
disorder. TCAs are second line, St John's Wort is not recommended.
, Question 4: A patient on paroxetine is started on linezolid for MRSA. 3 days later
he is agitated, confused, diaphoretic and has myoclonic jerks. What is the
diagnosis?
Correct Answer: Serotonin Syndrome
Rationale: Linezolid is a weak MAO inhibitor. This is the classic presentation of
serotonin syndrome. This is the single most commonly missed question on this
exam.
Question 5: A 46 year old woman on paroxetine 10mg for 2 months reports no
improvement. What is the appropriate next step?
Correct Answer: Increase paroxetine to 20mg daily
Rationale: 10mg is only the starting dose. The therapeutic dose of paroxetine
is 20-40mg. She has never actually received a therapeutic dose.
Question 6: Which of the following is the primary flaw in the monoamine
hypothesis of depression?
Correct Answer: Antidepressant effects on neurotransmitters do not
temporally correspond to clinical response.
Rationale: Antidepressants change neurotransmitter levels within hours, but
take 4-6 weeks to produce clinical effect. This is the fatal contradiction to the
monoamine hypothesis.
Question 7: Which SSRI requires a 5 week washout period before starting an
MAOI?
Correct Answer: Fluoxetine
Rationale: Fluoxetine and its active metabolite norfluoxetine have a half life of
up to 14 days. It is the only antidepressant that requires this long washout period.
