Antidepressants Quiz

MCQs. Bold the correct response

1) Administration of an MAO inhibitor would most likely cause changes in the CNS concentration of:

a) acetylcholine b) histamine c) norepinephrine

2. Therapeutic use(s) of antidepressants include(s):

a) severe anxiety disorder b) post-traumatic stress disorder c) panic-agoraphobia d)

endogenous depression e) all of the above

3. Which class of antidepressants requires dietary restrictions?

a) MAOIs b) SSRIs c) TCAs d)SNRIs

4. Less than 25% decrease in baseline symptoms is

a) Response b) Remission c) Non-response d) Partial response

5) Combination of MAOIs and SSRIs can cause:

a) excess of norepinephrine in the body b) excess of serotonin in the body

c) decreased levels of serotonin d) decreased levels of norepinephrine

6) Sertraline (Zoloft), Citalopram (Celexa), Fluoxetine (Prozac), these drugs belong to the following class
of antidepressants:

a) MAOIs b) SSRIs c) TCAs d)SNRIs

7) ___________ are mostly used as a last resort in cases where other antidepressants have failed.

a) MAOIs b) SSRIs c) TCAs d)SNRIs

8) What does this statement mean “depression is an illness with broken circadian clock”?

a) Depression causes change in appetite b) depression is an illness characterized by low mood

c) Depression alters the sleep wake cycle

9) People in which age group have best chances of response to antidepressants and also best tolerability?

a) 18 to 25 years olds b) 25 to 64 year olds c) 65-85 year olds

10) What are the most common symptoms that persist after antidepressants use, causing the disorder to
not go into remission?

a) insomnia, fatigue, multiple painful physical complaints, problems concentrating, and lack of
interest or motivation
b) depressed mood, suicidal ideation, and psychomotor retardation

Short Question/Answers

1) What are the main classes of antidepressants?

Ans) Antidepressants have four major classes: Monoamine oxidase inhibitors (MAOIs), Serotonin–
norepinephrine reuptake inhibitor (SNRIs), Tricyclic antidepressants (TCAs), and Selective serotonin
reuptake inhibitors (SSRIs).

2) Describe the mechanism of action of TCAs.

Ans) Like reuptake inhibitors, tricyclics seem to block the reabsorption of serotonin and norepinephrine
back into nerve cells after these chemicals are released into a synapse. TCAs do not evenly inhibit
reuptake of these neurotransmitters. Some drugs preferentially inhibit serotonin reuptake, and some
norepinephrine reuptake.

3) What does a partial response to antidepressants mean?

Ans) 25%–50% decrease in baseline symptoms.

4) What is greater than 50% decrease in baseline symptoms called?

Ans) Response

5) What are the two types of MAOs?

Ans) : There are two types of MAOs: MAO-A and MAO-B. MAO-A metabolizes serotonin and
norepinephrine-the neurotransmitters most closely associated with depression. MAO-B metabolizes
dopamine and trace amines. Tyramine is metabolized by both MAO-A and MAO-B. Inhibition of MAO-
B is not effective as an antidepressant because it has no direct effect on serotonin and norepinephrine
metabolism. Brain MAO-A must be inhibited for an antidepressant effect to occur.

6) Define reversibility of MAOIs

Ans) The early MAOIs covalently bound to the monoamine oxidase enzymes, thus inhibiting them
irreversibly; the bound enzyme could not function and thus enzyme activity was blocked until the cell
made new enzymes. The enzymes turn over approximately every two weeks. A few newer MAOIs are
reversible, meaning that they are able to detach from the enzyme to facilitate usual catabolism of the
substrate. The level of inhibition in this way is governed by the concentrations of the substrate and the
MAOI.

7) Can MAOIs be prescribed in combination with SSRIs?

MAOI inhibitors should not be used with other serotonin reuptake inhibitors to avoid the risk of
developing serotonin syndrome. Serotonin syndrome is a group of symptoms that results from excess of
serotonin in the body. Severe serotonin syndrome can be life-threatening.
8) Why are Tricyclic antidepressants named so, what does the name mean?

Ans) They are named after their chemical structure, which contains three rings of atoms.

9) List down the side effects of SSRIs.

Ans) Nausea, vomiting or diarrhea, Headache, Drowsiness, Dry mouth, Insomnia, Nervousness, agitation
or restlessness, Dizziness, and Sexual problems (such as reduced sexual desire, difficulty reaching orgasm
or erectile dysfunction).

10) How do SSRIs work?

Ans) SSRIs inhibit reuptake of serotonin by the presynaptic neuron, therefore increasing the levels of
serotonin in the synaptic cleft.

Anxiolytics Quiz

MCQs. Bold the correct response.

1) A _____ is a drug that depresses the central nervous system, produces calm and suppresses bodily
reactions, but does not directly induce sleep.

a) Pain killer b) Anxiolytic c) Hypnotic d) Sedative

2) Anxiolytics are also useful for:

a) Treatment of epilepsy and seizures b) Insomnia c)

Muscle relaxation in specific neuromuscular disorders d) All of the above

3) Antianxiety agents have:

a) Sedative and hypnotic activity b) Muscle relaxing and anticonvulsant effects c)

Amnesic properties d) All of the above

4) Indicate the agents of choice in the treatment of most anxiety states:

a) Phenothiazines b) Benzodiazepines c)Lithium salts d) Barbiturates

5) In contrast to benzodiazepines, buspirone:

a) Has maximal abuse liability b) Interact directly with gabaergic system

c) Causes less psychomotor impairment and does not affect driving skills

d) Has more marked hypnotic, anticonvulsant, or muscle relaxant properties

6) This brain structure is most important in the neurobiology of fear:

a) hippocampus b) amygdala c) motor cortex d) brainstem

7) Noradrenergic hyperactivation can cause these symptoms of anxiety:

a) worry and anxiety b) panic attacks and nightmares

c) tremors, sweating, tachycardia and hyperarousal d) All of these

8) First line treatment for PTSD are:

a) NET inhibitors b) benzodiazepines c) SSRIs and SNRIs

9) __________is a key neurotransmitter in anxiety disorders and benzodiazepines act upon this
neurotransmitter system.

a) GABA b) Dopamine c) Norepinephrine d) melatonin

10) Symptoms of worry are associated with malfunctioning of:

a) sensory cortex b) hypothalamus c) cortico-striato-thalamo-cortical (CSTC) loops

Short Question/Answers

1) What is the mechanism of action of benzodiazepines?

Ans) Benzodiazepines work by enhancing the effects of gamma-aminobutyric acid (GABA). GABA is an
inhibitory neurotransmitter: it suppresses the activity of neurons. Excessive activity of neurons in the
amygdale circuits may be the behind anxiety and benzodiazepines reduce the activity of neurons by
enhancing the effects of GABA.

2) What are the risks of long term use of barbiturates?

Ans) A person can develop tolerance of barbiturates and show withdrawal symptoms without it.

3) What is the mechanism of action of barbiturates?

Ans) Barbiturates act as allosteric modulators of GABA receptors.

4) What is half-life of a drug?

Ans) Half-life is the amount of time it takes a drug to reduce to half in the body.

5) What is the disadvantage of short acting benzodiazepines over the long acting ones?

Ans) Drugs with shorter half life has greater potential to cause withdrawal symptoms.

6) What antidepressants are sometimes used as antianxiety medicines?

Ans) Serotonin is a key neurotransmitter that innervates amygdala, and also prefrontal cortex, striatum
and thalamus, and is hypothesized to regulate anxiety and worry. Therefore, drugs that increase the
availability of serotonin may help treat anxiety.

7) How do norepinephrine transport (NET) inhibitors work?

Ans) Norepinephrine provides input to the amygdala. Noradrenergic hyperactivation can lead to stress
and anxiety. Noradrenergic hyperactivity is blocked by norepinephrine transporter (NET) inhibitor, thus
alleviating anxiety symptoms.

8) Why are some clinicians reluctant to prescribe benzodiazepines for GAD?

Ans) Because of long term nature of GAD. Long term term use of benzodiazepine is not free of risk from
abuse, dependency and withdrawal.

9) What is fear extinction?

Ans) Inhibition of fear response through new learning is called fear extinction.

10) Explain the anxiolytic actions of buspirone.

Ans) Buspirone acts a partial agonist of 5HT1A, resulting in enhanced serotonergic activity in
amygdala, prefrontal cortex, striatum, and thalamus.