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::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::Duloxetine and velafaxine 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::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::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/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. Educational objective: atypical depression is characterized by mood reactivity, hypersomnia, weight gain and leaden paralysis and long-term interpersonal sensitivity to being rejected. The treatment of choice is a MAO-inhibitor, which inhibits 5-HT, NE and DA metabolism. References: First Aid 2013 page 472-476 Educational Objective: References: ]]
Approved	Approved::Yes
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