WBR0092
| Author | PageAuthor::Gonzalo Romero |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Behavioral Science/Psychiatry, MainCategory::Pharmacology |
| Sub Category | SubCategory::Neurology |
| Prompt | [[Prompt::A 35 y/o male comes to the ER for acute medical care due to a persistent erection, which he thought it would go away. The patient is very concerned because he usually has erections throughout the night and in the morning, but they normally last a couple of minutes. He denies any sexual encounters the night before. The nurse practitioner meets the patient in the ER and starts asking for health relevant questions. Upon interrogation, he states that he has a very intense pain over his penis, and that the erection has lasted more than 6 hours. He states that he recently was prescribed a medication to aid with his sleep, which he has been taking for the last 6 weeks. He has a history of depression. His vitals are BP=126/70 mmHg, HR=87, RR=16, T=37 C. The nurse practitioner communicates the information to the medical team. They team is concerned that the drug prescribed to this patient to “aid with his sleep” is associated with his symptoms. Which of the following is the mechanism of action of the drug most likely prescribed to this patient?]] |
| Answer A | AnswerA::Inhibits serotonin reuptake |
| Answer A Explanation | AnswerAExp::Correct |
| Answer B | AnswerB::Inhibits NE reuptake |
| Answer B Explanation | AnswerBExp::B. Another drug that can cause sedation is maprotiline, an atypical antidepressant. It acts by blocking NE reuptake. |
| Answer C | AnswerC::Serotonin receptor agonist |
| Answer C Explanation | AnswerCExp::C. Buspirone used to treat general anxiety disorder acts by stimulating setononin (5-HT1a receptors). It does not cause sedation, addiction or tolerance. |
| Answer D | AnswerD::Alpha-2 receptor antagonist |
| Answer D Explanation | [[AnswerDExp::D. Mirtazapine is an atypical antidepressant, which acts blocking the alpha-2 receptors in the presynaptic neurons increasing the release of NE and serotonin. It causes sedation; therefore it can be used in depressed patients with insomnia. Also causes an increase in the appetite leading to weight gain (this could be beneficial in elderly or anorexic patients).]] |
| Answer E | AnswerE::GABA receptor moduling |
| Answer E Explanation | AnswerEExp::E. Different drugs act by increasing the opening of GABA channels such as benzodiazepines and barbiturates. |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::Trazadone [1] is a drug used for insomnia. With high doses it can be used to treat depression. An important side effect is priapism, which is a painful sustained penile erection. It also causes sedation, nausea, and postural hypotension.
Educational objective: Trazadone is an atypical antidepressant, which is used to treat insomnia. It acts by inhibiting serotonin reuptake primarily. Its typical side effect is priapism Tags: #Pharmacology #Psychiatry
References: First Aid 2013 page 476 |
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
Image [[WBRImage::|]] Caption WBRImageCaption::no-display Position [[WBRImagePlace::Explanation|]]