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-year-old male complains of generalized fatigue for over more than 7 months. Upon interrogation, the patient reports he has generally unhappy and lacks motivation at work. He spends most his time at home sleeping and when he wakes up he is either watching TV or eating fast food. The patient also mentions that he feels heaviness in his arms and legs and has no energy to move or go out of the house. He denies suicidal ideations or feeling of worthlessness. The patient is started on a medication to relieve his symptoms. Which of the following is the mechanism of action of the drug most likely prescribed to this patient?]] |
| Answer A | AnswerA::Serotonin reuptake inhibitor |
| Answer A Explanation | [[AnswerAExp::Selective serotonin reuptake inhibitors (SSRIs) include paroxetine, sertraline, citalopram and sertraline and they are used to treat depression, general anxiety disorder, bulimia, social phobia, OCD and post traumatic stress disorder.]] |
| Answer B | AnswerB::Norepinephrine reuptake inhibitor |
| Answer B Explanation | [[AnswerBExp::Maprotiline is an atypical antidepressant which blocks norepinephrine reuptake. It can cause sedation as a side effect.]] |
| Answer C | AnswerC::Serotonin receptor agonist |
| Answer C Explanation | [[AnswerCExp::Buspirone, which is used to treat general anxiety disorder, stimulates serotonin (5-HT1a) receptors. It does not cause sedation, addiction or tolerance.]] |
| Answer D | AnswerD::Alpha-2 receptor antagonist |
| Answer D Explanation | [[AnswerDExp::Mirtazapine is an atypical antidepressant. It blocks alpha-2 receptors in the presynaptic neurons which increases the release of norepinephrine and serotonin. It causes sedation and therefore can be used in depressed patients with insomnia. It might also cause an increase in appetite with possible weight gain.]] |
| Answer E | AnswerE::GABA receptor agonist |
| Answer E Explanation | [[AnswerEExp::Different drugs act by increasing the opening of GABA channels such as benzodiazepines and barbiturates.]] |
| 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 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, norepinephrine and dopamine metabolism. MOIs include phenelzine, tranylcypromine, isocarboxacid and selegiline which is a selective MAO-B inhibitor. MOIs are used mainly for atypical depression. The major side effects of MOI are hypertensive crisis when combined with tyramine, a compound found in cheese and wine.
WikiDoc Mnemonics: Duloxetine and venlafaxine are DOBLE HITTERS= They inhibit both norepinephrine and serotonin reuptake. |
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |