WBR0094
| 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 25 y/o male comes to the clinic complaining of fatigue. He has been sleeping more than usual in the past 7 months and has put on 20 lbs. He also complains of a heavy feeling in his legs and arms. He has had a stable job for the last 7 years. Upon interrogation he says that minor things at work make him “happy”, for example finding coupons in the mail. He also states that he feels like his coworkers do not accept him as he wished and he takes professional feedback too personal. He denies suicidal ideations or feeling of worthlessness. The physician at the clinic decides to start a medication. 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::Incorrect. SSRIs specifically inhibit 5-HT reuptake. Examples are paroxetine, sertraline, citalopram and sertraline. They are used for depression, general anxiety disorder, bulimia, social phobias, OCD and PTSD]] |
| Answer B | AnswerB::Inhibits serotonin and NE reuptake |
| Answer B Explanation | [[AnswerBExp::Incorrect. Duloxetine and venlafaxine are DOBLE HITTERS= inhibit both NE and serotonin reuptake. They are atypical antidepressants, which can be used for neuropathic pain.]] |
| Answer C | AnswerC::Inhibits serotonin, NE and Dopamine metabolism |
| Answer C Explanation | [[AnswerCExp::Correct.]] |
| Answer D | AnswerD::Alpha-2 receptor antagonist |
| Answer D Explanation | [[AnswerDExp::Incorrect. Mirtazapine is an alpha-2 receptor antagonist. It is an atypical antidepressant which causes appetite increase and weight gain, therefore useful in the elderly and anorexic patients.]] |
| Answer E | AnswerE::Alpha-2 receptor agonist |
| Answer E Explanation | [[AnswerEExp::Incorrect. Methyldopa and clonidine are selective for α2-adrenergic agonists. Methyldopa is used to treat hypertension, especially in pregnant women. Clonidine can be used for hypertension, anxiety or panic disorder, and certain pain conditions.]] |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::This patient is presenting with atypical depression, the most common subtype of depression. Atypical depression is characterized by hypersomnia, and increase in appetite, which leads to weight gain. It is also associated with a heaven paralysis or a heavy feeling in arms and legs, and long-term interpersonal rejection sensitivity. Atypical depression is also characterized by mood reactivity; the patient is able to improve his mood to positive events. The treatment of choice is a MAO inhibitor, which inhibits 5-HT, NE and DA metabolism. They include drugs like: phenelzine, tranylcypromine, isocarboxacid, selegiline (selective MAO-B inhibitor). They are used mainly for atypical depression. Its major side effects are hypertensive crisis when combined with tyramine, a compound found in cheese and wine.
|
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |