Selective Serotonin Reuptake Inhibitors (SSRIs) and atypical antidepressants are the most commonly prescribed medications for depression and a variety of other psychiatric conditions. Their favorable safety profile compared to older agents has made them mainstays of therapy. For pharmacists, a detailed understanding of the nuances between these drugs is essential for personalizing care and managing side effects. This quiz for PharmD students will test your knowledge of the pharmacology, clinical uses, and management of these critical medications.
1. What is the primary mechanism of action for Selective Serotonin Reuptake Inhibitors (SSRIs)?
- They block the reuptake of both serotonin and norepinephrine.
- They selectively block the presynaptic serotonin reuptake transporter (SERT).
- They inhibit the monoamine oxidase enzyme.
- They are direct agonists at the serotonin 5-HT1A receptor.
Answer: They selectively block the presynaptic serotonin reuptake transporter (SERT).
2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) like venlafaxine and duloxetine differ from SSRIs because they also block the reuptake of:
- Dopamine
- GABA
- Norepinephrine
- Acetylcholine
Answer: Norepinephrine
3. A patient starting an SSRI should be counseled that the full therapeutic effect for depression may take:
- 24-48 hours.
- 1-2 weeks.
- 4-6 weeks.
- 3-4 months.
Answer: 4-6 weeks.
4. Which of the following is a common, often transient side effect when initiating SSRI therapy?
- Severe weight loss.
- Nausea, headache, and insomnia.
- A hypertensive crisis.
- A severe skin rash.
Answer: Nausea, headache, and insomnia.
5. A patient taking an SSRI who abruptly stops their medication may experience dizziness, fatigue, and “electric shock-like” sensations. This is known as:
- Serotonin syndrome.
- A hypertensive crisis.
- Antidepressant Discontinuation Syndrome.
- Neuroleptic Malignant Syndrome.
Answer: Antidepressant Discontinuation Syndrome.
6. Which SSRI has a very long half-life, making discontinuation syndrome less likely?
- Paroxetine
- Sertraline
- Citalopram
- Fluoxetine
Answer: Fluoxetine
7. Bupropion is an atypical antidepressant that is unique because it primarily inhibits the reuptake of:
- Serotonin and norepinephrine.
- Serotonin only.
- Dopamine and norepinephrine.
- GABA.
Answer: Dopamine and norepinephrine.
8. Due to its mechanism, bupropion is less likely than SSRIs to cause which side effect?
- Insomnia
- Dry mouth
- Sexual dysfunction
- Nausea
Answer: Sexual dysfunction
9. Bupropion is contraindicated in patients with a history of:
- Hypertension.
- Seizure disorders or eating disorders.
- Chronic pain.
- Asthma.
Answer: Seizure disorders or eating disorders.
10. Mirtazapine is an atypical antidepressant that works primarily as a(n):
- Serotonin and norepinephrine reuptake inhibitor.
- Presynaptic alpha-2 adrenergic and serotonin receptor antagonist.
- Dopamine reuptake inhibitor.
- Monoamine oxidase inhibitor.
Answer: Presynaptic alpha-2 adrenergic and serotonin receptor antagonist.
11. Which of the following are common side effects of mirtazapine, making it a useful option for certain patients?
- Insomnia and decreased appetite.
- Sedation and increased appetite/weight gain.
- Nausea and diarrhea.
- Sexual dysfunction.
Answer: Sedation and increased appetite/weight gain.
12. Trazodone is an antidepressant that is most commonly used at low, off-label doses for which condition due to its potent sedative effects?
- ADHD
- Neuropathic pain
- Insomnia
- Panic disorder
Answer: Insomnia
13. Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity. Which combination poses the highest risk?
- An SSRI and an NSAID.
- An SSRI and a statin.
- An SSRI and a Monoamine Oxidase Inhibitor (MAOI).
- An SSRI and a proton pump inhibitor.
Answer: An SSRI and a Monoamine Oxidase Inhibitor (MAOI).
14. A patient presents with agitation, confusion, hyperreflexia, and fever after starting a new medication. The pharmacist should suspect:
- A normal therapeutic response.
- Serotonin syndrome.
- A hypertensive crisis.
- Anticholinergic toxicity.
Answer: Serotonin syndrome.
15. Which SNRI is also FDA-approved for the management of neuropathic pain and fibromyalgia?
- Venlafaxine
- Desvenlafaxine
- Levomilnacipran
- Duloxetine
Answer: Duloxetine
16. Citalopram has an FDA warning regarding a dose-dependent risk of:
- Hepatotoxicity.
- QTc prolongation.
- Agranulocytosis.
- Severe skin reactions.
Answer: QTc prolongation.
17. Escitalopram is the S-enantiomer of citalopram. A key principle of this relationship is that escitalopram:
- Is generally considered to be more potent, allowing for a lower dose.
- Has a completely different mechanism of action.
- Causes more side effects than citalopram.
- Is less effective than citalopram.
Answer: Is generally considered to be more potent, allowing for a lower dose.
18. A key counseling point for a patient taking an SNRI like venlafaxine, which is not typically necessary for an SSRI, is to monitor:
- Blood pressure, due to the effects of norepinephrine.
- Serum sodium levels.
- Weight loss.
- For a dry cough.
Answer: Blood pressure, due to the effects of norepinephrine.
19. Vilazodone is a unique antidepressant that is both a serotonin reuptake inhibitor and a:
- Serotonin 5-HT2A antagonist.
- Serotonin 5-HT1A partial agonist.
- Dopamine D2 partial agonist.
- Norepinephrine reuptake inhibitor.
Answer: Serotonin 5-HT1A partial agonist.
20. A pharmacist providing MTM for a patient on an SSRI should specifically screen for:
- Adherence.
- Efficacy.
- Side effects, including sexual dysfunction.
- All of the above.
Answer: All of the above.
21. Which SSRI is known to be a potent inhibitor of CYP2D6, leading to numerous drug interactions?
- Citalopram
- Escitalopram
- Sertraline
- Fluoxetine and Paroxetine
Answer: Fluoxetine and Paroxetine
22. A patient on tamoxifen for breast cancer (which is a prodrug activated by CYP2D6) should avoid which antidepressant?
- Sertraline
- Citalopram
- Paroxetine
- Mirtazapine
Answer: Paroxetine
23. The “black box warning” for all antidepressants is for an increased risk of ________ in children, adolescents, and young adults.
- Suicidal thoughts and behaviors
- Weight gain
- Insomnia
- Serotonin syndrome
Answer: Suicidal thoughts and behaviors
24. The leadership skill of “advocacy” would be demonstrated by a pharmacist who:
- Negotiates with an insurance plan to cover a needed atypical antidepressant for a patient who has failed SSRIs.
- Insists all patients receive the same SSRI.
- Refuses to counsel patients on antidepressants.
- Only dispenses brand-name products.
Answer: Negotiates with an insurance plan to cover a needed atypical antidepressant for a patient who has failed SSRIs.
25. A pharmacist applying “geriatric sensitivity” would be cautious when an SSRI is prescribed for an older adult due to an increased risk of:
- SIADH and hyponatremia.
- Falls.
- Drug interactions due to polypharmacy.
- All of the above.
Answer: All of the above.
26. In the “Neurologic and Psychiatric Principles” course, the use of SSRIs provides direct support for which theory of depression?
- The dopamine hypothesis.
- The monoamine hypothesis.
- The neuroinflammatory hypothesis.
- The cholinergic hypothesis.
Answer: The monoamine hypothesis.
27. A key part of the “Business Plan” for a new mental health service in a pharmacy would involve protocols for:
- Selecting and monitoring first-line agents like SSRIs.
- Marketing the service to local providers.
- The financial model for the service.
- All of the above.
Answer: All of the above.
28. A “Clinical Decision Support” alert in an EHR would be critical to fire if a prescriber attempts to co-prescribe an MAOI with:
- An SSRI like sertraline.
- An SNRI like venlafaxine.
- An atypical like bupropion.
- All of the above pose a significant risk.
Answer: All of the above pose a significant risk.
29. A “difficult conversation” for a pharmacist may involve discussing which common and sensitive side effect of SSRIs with a patient?
- Dry mouth
- Nausea
- Sexual dysfunction
- Headache
Answer: Sexual dysfunction
30. The ultimate goal of antidepressant therapy is to:
- Eliminate all of life’s stressors.
- Achieve remission of symptoms and improve the patient’s overall functioning and quality of life.
- Ensure the patient remains on the medication for life, regardless of need.
- Find a medication with no side effects.
Answer: Achieve remission of symptoms and improve the patient’s overall functioning and quality of life.
31. Vortioxetine is a multimodal antidepressant that, in addition to inhibiting SERT, has activity at several other serotonin receptors. This is thought to potentially help with:
- Weight loss.
- Cognitive symptoms associated with depression.
- Sleep.
- Blood pressure.
Answer: Cognitive symptoms associated with depression.
32. The service of “deprescribing” an antidepressant requires:
- Abrupt discontinuation.
- A slow and careful taper to prevent discontinuation syndrome.
- A switch to a different class of antidepressant.
- No special precautions.
Answer: A slow and careful taper to prevent discontinuation syndrome.
33. The use of an “analytics and reporting system” in a health system could be used to:
- Identify patients on citalopram doses greater than the FDA-recommended maximum.
- Track adherence rates for patients on antidepressants.
- Identify patients co-prescribed multiple serotonergic agents.
- All of the above.
Answer: All of the above.
34. The “human factors” principle applies to antidepressants in that:
- The wide variety of available agents and doses can lead to selection errors.
- Look-alike/sound-alike names can cause confusion.
- The design of a patient education leaflet can impact understanding.
- All of the above.
Answer: All of the above.
35. A “negotiation” with a patient who is hesitant to start an SSRI due to fear of side effects should involve:
- Dismissing their fears.
- A shared decision-making process that acknowledges their concerns and provides balanced information.
- Refusing to fill the prescription.
- Insisting they start the medication immediately.
Answer: A shared decision-making process that acknowledges their concerns and provides balanced information.
36. In which “practice setting” is a pharmacist most likely to be involved in the initial selection and titration of an antidepressant for a complex patient?
- A chain community pharmacy.
- An ambulatory care mental health clinic or inpatient psychiatric unit.
- A mail-order pharmacy.
- A nuclear pharmacy.
Answer: An ambulatory care mental health clinic or inpatient psychiatric unit.
37. From a “policy” perspective, the development of SSRIs was a major advancement because:
- Their improved safety in overdose compared to TCAs changed prescribing guidelines and public health outcomes.
- They are less effective than older agents.
- They are significantly more expensive than all other options.
- They have no drug interactions.
Answer: Their improved safety in overdose compared to TCAs changed prescribing guidelines and public health outcomes.
38. The “financials” of antidepressant therapy have been significantly impacted by:
- The widespread availability of low-cost, generic SSRIs and SNRIs.
- The high cost of all antidepressant medications.
- The refusal of insurance companies to cover any mental health medications.
- The lack of any new medications being developed.
Answer: The widespread availability of low-cost, generic SSRIs and SNRIs.
39. A pharmacist’s knowledge of “pharmacogenomics” is useful because CYP2C19 variants can significantly affect the metabolism of which SSRIs?
- Fluoxetine and Paroxetine
- Citalopram and Escitalopram
- Fluvoxamine
- Sertraline
Answer: Citalopram and Escitalopram
40. A pharmacist who is a leader and “forging ahead” would view the management of depression as:
- A simple task of dispensing the prescribed SSRI.
- A comprehensive process involving medication optimization, adherence counseling, and collaboration with other mental health providers.
- The sole responsibility of the psychiatrist.
- Outside the scope of pharmacy practice.
Answer: A comprehensive process involving medication optimization, adherence counseling, and collaboration with other mental health providers.
41. Which of the following is NOT a first-line agent for major depressive disorder?
- SSRI
- SNRI
- Bupropion
- Phenelzine (an MAOI)
Answer: Phenelzine (an MAOI)
42. The “antidotal therapy” for severe serotonin syndrome is primarily:
- Supportive care and discontinuation of the offending agents.
- Administration of a specific reversal agent like naloxone.
- Administration of an SSRI.
- Hemodialysis.
Answer: Supportive care and discontinuation of the offending agents.
43. The “Cardiovascular Principles” are relevant to antidepressants because:
- Venlafaxine can increase blood pressure.
- Citalopram can prolong the QTc interval.
- TCAs have significant cardiotoxicity.
- All of the above.
Answer: All of the above.
44. A key part of the “Business Plan” for a new mental health service would be:
- A list of the most commonly prescribed SSRIs and their costs.
- A protocol for how the service will manage patients on these medications.
- A marketing plan targeting local primary care providers.
- All of the above.
Answer: All of the above.
45. Which atypical antidepressant is often used as an augmenting agent with an SSRI?
- Trazodone
- Bupropion
- Mirtazapine
- Both B and C are common.
Answer: Both B and C are common.
46. The use of St. John’s Wort, an herbal product, with an SSRI is a concern because:
- It is a potent CYP450 inhibitor.
- It can increase the risk of serotonin syndrome.
- It will decrease the effectiveness of the SSRI.
- It will cause a hypertensive crisis.
Answer: It can increase the risk of serotonin syndrome.
47. A “human resources” issue could arise if a pharmacy staff member is experiencing a side effect from their own antidepressant. The manager should:
- Terminate the employee.
- Offer support and consider a reasonable accommodation if needed.
- Ignore the issue.
- Discuss the employee’s health condition with the rest of the staff.
Answer: Offer support and consider a reasonable accommodation if needed.
48. In which “practice setting” would a pharmacist’s role be focused on ensuring access to antidepressants through formulary management?
- Community pharmacy
- Hospital pharmacy
- Managed care pharmacy
- Ambulatory care pharmacy
Answer: Managed care pharmacy
49. An effective “leadership practice” when a patient expresses frustration with the trial-and-error process of finding the right antidepressant is:
- To show empathy and provide encouragement and education.
- To tell them they must continue the current medication regardless of side effects.
- To suggest they stop all treatment.
- To agree that the process is hopeless.
Answer: To show empathy and provide encouragement and education.
50. The ultimate principle guiding the use of SSRIs and atypical antidepressants is to:
- Select an agent based on a collaborative decision that considers the patient’s symptoms, comorbidities, and preferences.
- Always start with the newest and most expensive medication.
- Use the same drug for every patient with depression.
- Focus only on the mechanism of action.
Answer: Select an agent based on a collaborative decision that considers the patient’s symptoms, comorbidities, and preferences.
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com