for the

1
Jeopardy

• for the
• Psychiatry Clerkship

2
And Now Here Is The Host . . .
is proud to present
Insert Name Here
3

• The categories for todays Jeopardy will be

4
SSRIs
5
SNRIs
6
NDRIs
7
NaSSAs
8
TCAs
9
SSRIs
TCAs
SNRIs
NDRIs
NaSSAs
100
100
100
100
100
200
200
200
200
200
300
300
300
300
300
400
400
400
400
400
500
500
500
500
500
600
600
600
600
600
700
700
700
700
700
800
800
800
800
800
900
900
900
900
900
10
What is fluoxetine (prozac)?
The half-life of this SSRI is about one week

• Row 1, Col 1

11
What is Selective Serotonin Reuptake Inhibitor?
SSRI is the abbreviation for this

• 1,2

12
What is Discontinuation Syndrome?
If an SSRI with a short half life is abruptly
stopped it may result in this

• 1,3

13
What is serotonin syndrome?
SSRIs and MAOIs used in combination carry a
high risk of this side effect

• 1,4

14
What is paroxetine (paxil)
This is the most likely SSRI to cause the side
effect of weight gain

• 1,5

15
What is a 2 weeks?
The washout period when switching from an MAOI
to any SSRI is this

• 1,6

16
What is escitalopram (lexapro)?
This SSRI is the S-enantiomer of citalopram
(celexa)

• 1,7

17
What is paroxetine (paxil) fluvoxamine (luvox)
These two SSRIs have very short half lives
should be tapered to be discontinued

• 1,8

18
What are sexual side effects?
This is a common side effect of all SSRIs the
doctor should specifically ask about it as the
patient may otherwise be too embarrassed to
talk about it

• 1,9

19
What is Serotonin Norepinephrine Reuptake
Inhibitor?
The mechanism of action of SNRIs is this

• 2,1

20
What is desvenlafaxine (pristiq)
This SNRI is the psychoactive metabolite of
another SNRI

• 2,2

21
What is serotonin?
Whether the dose is very high, moderate, or low,
this neurotransmitters reuptake is blocked by
venlafaxine (effexor)

• 2,3

22
What is dopamine?
At very high doses (gt375mg/d) of venlafaxine
(effexor) this neurotransmitters reuptake may
begin to be blocked

• 2,4

23
What is duloxetine (cymbalta)
This SNRI is preferred for painful symptoms of
depression or diabetic neuropathy pain

• 2,5

24
What is poop-out syndrome (relapse)?
As with the SSRIs, some patients take SNRIs for
depression, have an initial response, continue
taking the medication but then experience this

• 2,6

25
What is an induced bipolar state?
As with all antidepressants, a depressed patient
started on an SNRI who experiences activation
agitation may be having this

• 2,7

26
What are hot flashes/flushes?
While venlafaxine (effexor) may cause the side
effect of sweating, ironically it may be helpful
to perimenopausal women with this

• 2,8

27
What is increased blood pressure?
Venlafaxine (effexor) has this relatively
common, dose dependent, cardiac system related
side effect

• 2,9

28
What is Bupropion (Wellbutrin)
This medication is the most well known NDRI

• 3,1

29
What is nicotine (smoking cessation)?
NDRIs are useful in treating cravings from
dependence on this substance

• 3,2

30
What is sexual dysfunction?
Not only do NDRIs not have this common SSRI side
effect, NDRIs may be used to treat patients who
have this SSRI side effect

• 3,3

31
What is a seizure?
Like most anti-depressants, at typical doses
NDRIs carry a small risk of this serious side
effect but the risk increases from 0.4 to 4
at very high doses

• 3,4

32
What are Anxiety Disorders
Compared to SSRIs or SNRIs, NDRIs are less
effective in treating this class of psychiatric
illnesses

• 3,5

33
What is hypersomnia? (gt 10 hours/nite)
NDRIs may be especially helpful in treating this
sleep disturbance that is seen in atypical
depression

• 3,6

34
What is decrease? (or no change)
NDRIs commonly do this to a patients weight

• 3,7

35
What is Attention Deficit Hyperactivity Disorder
(ADHD)?
While not a first line treatment, NDRIs
stimulating effects may be helpful in treating
children and adults with this disorder

• 3,8

36
What is 2-4 weeks
Onset of therapeutic action is usually not
immediate, but is delayed until this time period

• 3,9

37
What is Noradrenergic and Specific Serotonergic
Agent?
NaSSA stands for this

• 4,1

38
What is pre-synaptic alpha 2 adrenergic antagonist
NaSSAs novel mechanism of action by which
norepinephrine and serotonin system activity is
increased is this

• 4,2

39
What is mirtazepine (remeron)?
The medication that is in the NaSSA class is this

• 4,3

40
What are GI side effects? (nausea, diarrhea,
stomach cramps)
SSRIs or venlafaxine (effexor) may cause these
common side effects which NaSSAs 5HT3 antagonism
may help reduce or remove

• 4,4

41
What is weight gain?
This mirtazapine (remeron) side effect is more
likely in women than men, before menopause than
after, and is unlikely to be a problem if it
has not occurred within the first 6 weeks of
treatment

• 4,5

42
What is serotonin syndrome?
Patients taking mirtazapine (remeron) and an
MAO-I at the same time, or within 2 weeks of the
other, are at risk for this serious side effect

• 4,6

43
What is histamine? (H1)
Mirtazapine (remeron) is an antagonist of a
presynaptic receptor, serotonin post synaptic
receptors, and this post synaptic receptor

• 4,7

44
What is almost immediately?
Onset of therapeutic effect on insomnia and
anxiety is typically in this time period

• 4,8

45
What is none?
Cytochrome P450 enzyme system that is
significantly effected by mirtazepine (remeron) is

• 4,9

46
What is nortriptyline (pamelor)?
A tertiary amine, amitriptyline (elavil), is
metabolized to a secondary amine which is this
TCA

• 5,1

47
What is anticholinergic activity?
Blurred vision, urinary hesitancy, dry mouth, and
constipation are due to this neurotransmitter
receptor activity by TCAs

• 5,2

48
What is desipramine (norpramin)?

• A tertiary amine, imipramine (tofranil), is
  metabolized to a secondary amine which is
• this TCA

• 5,3

49
What are men?
TCAs may be more effective than SSRIs in
treating depression for this sex of the clinical
population

• 5,4

50
What is cytochrome p450 2D6?
Fluoxetine (prozac), paroxetine (paxil),
bupropion (wellbutrin), duloxetine (cymbalta) and
other medications may increase all TCAs
concentration by inhibiting this p450 enzyme

• 5,5

51
What is alpha adrenergic-1 receptor?
Side effects of dizziness, sedation, and
hypotension likely result from TCAs antagonist
activity of this receptor

• 5,6

52
What is histamine (H1)?
Side effects of sedation and weight gain from
TCAs are likely due to antagonist activity at
this receptor

• 5,7

53
What is serotonin and norepinephrine reuptake
inhibition?
TCAs mechanism of action for treating depression
is this

• 5,8

54
What are sodium channels?
The dangerous side effects from a TCA overdose
are cardiac arrhythmias caused by blockade of
this

• 5,9