ANTIDEPRESSANT QUSTION WITH ANSWERS SECOND
TERM ASSURED SUCCEED
• What is the physiological action of tricyclic antidepressants (TCAs)?
• Inhibiting monoamine oxidase inhibitors that break down norepinephrine
• Inhibiting nerve activity, which prevents over excitability or stimulation
• Blocking the reuptake of serotonin, which increases the levels of norepinephrine
• Inhibiting reuptake of norepinephrine and
serotonin Ans:
Feedback:
TCAs inhibit presynaptic reuptake of norepinephrine and serotonin, which cause an
accumulation of the neurotransmitters that is thought to create the antidepressant
effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that
breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors
block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.
.A nurse is working with a 9-year-old child who exhibits signs and symptoms of
obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may
be prescribed for the child?
• Phenelzine (Nardil)
• Amitriptyline (Elavil)
• Fluvoxamine (Prozac)
• Isocarboxazid (Marplan)
Feedback:
Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric
dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid and
phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric use
because of the potential drug–food interactions and other serious adverse effects.
Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use.
.A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression
and that his physician changed his medication to clomipramine (Anafranil). The patient
is confused and does not understand why his medication was changed. The nurse's best
response to the patient would be what?
• “These drugs are similar but some patients respond better to one
drug than another.”
• “Did you take the amitriptyline like you should have?”
• “Maybe the old medicine wasn't working anymore.”
• “Clomipramine is newer and will be much better for
you.” Ans:
Feedback:
Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of
which TCA depends on individual response to the drug and tolerance of adverse
effects. A patient who does not respond to one TCA may respond to another drug from
this class. In addition, the nurse might inform the physician of the patient's question so
the physician can explain his or her rationale for changing medications. By asking the
patient if he took the medication as prescribed, the nurse is insinuating that he may not
have and could damage the trusting nurse–patient relationship. The nurse has no basis
for commenting that the medication might not be working or that another drug would
work better.
, .A patient comes to the mental health clinic for a regular appointment. The patient tells
the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks
and that he has lost 3 pounds during that time due to a loss of appetite. What action
should the nurse take?
• Teaching the patient about healthy eating to maintain weight
• Congratulating the patient on his weight loss and commenting how well he looks
• Encouraging the patient to increase fluid intake to avoid further weight loss
• Reassuring the patient that a decrease in weight is a common adverse effect
with this medication
Feedback:
Adverse effects of fluoxetine include anorexia and weight loss. Although teaching
about healthy eating is a good idea, it is more important to teach the patient how to
take the medication in a way that will reduce adverse effects as well as how to
optimize healthy calories to maintain weight. The patient should increase caloric
intake, not just fluid intake. The patient should continue the medication to see
whether therapeutic effects are obtained and adjust nutritional intake if necessary.
More information about the patient's baseline weight is needed before congratulating
the patient because a patient who is already too thin would not appreciate the nurse's
comment.
.A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The physician has
prescribed a monoamine oxidase inhibitor (MAOI) to treat this patient's depression.
What interaction will the nurse assess for with this drug combination?
• Increased risk of hypoglycemia
• Increased risk of hyperglycemia
• Increase in appetite
• Increased total cholesterol
Feedback:
MAOIs can cause an additive hypoglycemic effect if taken with insulin or oral
diabetic agents. This patient would have to be monitored closely and appropriate
dosage adjustments made; he should be taught the importance of more frequent blood
sugar monitoring. The drug combination in this question would not cause an increase
in appetite or increased total cholesterol.
.A patient has been taking Prozac (fluoxetine) for the past 3 years for depression. She is
seeing her gynecologist for premenopausal symptoms and during the interview with the
nurse she says that “she would like to try Sarafem because her friend is taking it and she
says it works great.” The nurse's best response is what?
• “Sarafem and Prozac are different brand names for the same generic medication.”
• “Before changing drugs it is important to consider how well you responded
to Prozac.”
• “You cannot take both drugs at the same time so it will be important to
decide which is best.”
• “When taking both of these drugs, it is best to take one in the morning and one
at night.”
Feedback:
Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in
changing the patient's medication regimen and, if taken together, would result in a drug
overdose. The other three responses are incorrect or inappropriate because they do not
TERM ASSURED SUCCEED
• What is the physiological action of tricyclic antidepressants (TCAs)?
• Inhibiting monoamine oxidase inhibitors that break down norepinephrine
• Inhibiting nerve activity, which prevents over excitability or stimulation
• Blocking the reuptake of serotonin, which increases the levels of norepinephrine
• Inhibiting reuptake of norepinephrine and
serotonin Ans:
Feedback:
TCAs inhibit presynaptic reuptake of norepinephrine and serotonin, which cause an
accumulation of the neurotransmitters that is thought to create the antidepressant
effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that
breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors
block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.
.A nurse is working with a 9-year-old child who exhibits signs and symptoms of
obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may
be prescribed for the child?
• Phenelzine (Nardil)
• Amitriptyline (Elavil)
• Fluvoxamine (Prozac)
• Isocarboxazid (Marplan)
Feedback:
Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric
dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid and
phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric use
because of the potential drug–food interactions and other serious adverse effects.
Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use.
.A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression
and that his physician changed his medication to clomipramine (Anafranil). The patient
is confused and does not understand why his medication was changed. The nurse's best
response to the patient would be what?
• “These drugs are similar but some patients respond better to one
drug than another.”
• “Did you take the amitriptyline like you should have?”
• “Maybe the old medicine wasn't working anymore.”
• “Clomipramine is newer and will be much better for
you.” Ans:
Feedback:
Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of
which TCA depends on individual response to the drug and tolerance of adverse
effects. A patient who does not respond to one TCA may respond to another drug from
this class. In addition, the nurse might inform the physician of the patient's question so
the physician can explain his or her rationale for changing medications. By asking the
patient if he took the medication as prescribed, the nurse is insinuating that he may not
have and could damage the trusting nurse–patient relationship. The nurse has no basis
for commenting that the medication might not be working or that another drug would
work better.
, .A patient comes to the mental health clinic for a regular appointment. The patient tells
the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks
and that he has lost 3 pounds during that time due to a loss of appetite. What action
should the nurse take?
• Teaching the patient about healthy eating to maintain weight
• Congratulating the patient on his weight loss and commenting how well he looks
• Encouraging the patient to increase fluid intake to avoid further weight loss
• Reassuring the patient that a decrease in weight is a common adverse effect
with this medication
Feedback:
Adverse effects of fluoxetine include anorexia and weight loss. Although teaching
about healthy eating is a good idea, it is more important to teach the patient how to
take the medication in a way that will reduce adverse effects as well as how to
optimize healthy calories to maintain weight. The patient should increase caloric
intake, not just fluid intake. The patient should continue the medication to see
whether therapeutic effects are obtained and adjust nutritional intake if necessary.
More information about the patient's baseline weight is needed before congratulating
the patient because a patient who is already too thin would not appreciate the nurse's
comment.
.A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The physician has
prescribed a monoamine oxidase inhibitor (MAOI) to treat this patient's depression.
What interaction will the nurse assess for with this drug combination?
• Increased risk of hypoglycemia
• Increased risk of hyperglycemia
• Increase in appetite
• Increased total cholesterol
Feedback:
MAOIs can cause an additive hypoglycemic effect if taken with insulin or oral
diabetic agents. This patient would have to be monitored closely and appropriate
dosage adjustments made; he should be taught the importance of more frequent blood
sugar monitoring. The drug combination in this question would not cause an increase
in appetite or increased total cholesterol.
.A patient has been taking Prozac (fluoxetine) for the past 3 years for depression. She is
seeing her gynecologist for premenopausal symptoms and during the interview with the
nurse she says that “she would like to try Sarafem because her friend is taking it and she
says it works great.” The nurse's best response is what?
• “Sarafem and Prozac are different brand names for the same generic medication.”
• “Before changing drugs it is important to consider how well you responded
to Prozac.”
• “You cannot take both drugs at the same time so it will be important to
decide which is best.”
• “When taking both of these drugs, it is best to take one in the morning and one
at night.”
Feedback:
Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in
changing the patient's medication regimen and, if taken together, would result in a drug
overdose. The other three responses are incorrect or inappropriate because they do not
