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Difficulty: MediumPsychopharmacology and Psychological Therapies

A number of patients present with unique adverse effects after initiating pharmacological treatment for major depressive disorder. For each clinical presentation, select the most likely responsible antidepressant.

  • Sustained, dose-dependent elevations in blood pressure requiring antihypertensive management.Venlafaxine
  • Significant weight gain and increased appetite in a patient who specifically requested a medication without sexual side effects.Mirtazapine
  • A prolonged, painful erection lasting over four hours requiring emergency urologic intervention.Trazodone
  • A new-onset generalized tonic-clonic seizure in a patient with a history of electrolyte abnormalities secondary to frequent purging.Bupropion

Answer

Venlafaxine matches with dose-dependent hypertension; Mirtazapine matches with weight gain and preserved sexual function; Trazodone matches with priapism; Bupropion matches with seizures in bulimia.
Each antidepressant agent has unique receptor binding affinities that produce distinct toxicity profiles. Norepinephrine reuptake inhibition (Venlafaxine) raises blood pressure. H1 antagonism combined with alpha-2 antagonism (Mirtazapine) stimulates appetite while sparing sexual function. Alpha-1 antagonism (Trazodone) disrupts penile detumescence, causing priapism. Norepinephrine-dopamine reuptake inhibition (Bupropion) lowers the seizure threshold, making it dangerous in bulimia.

Step-by-Step Solution

1
Evaluate the clinical presentation of dose-dependent hypertension.
Match with Venlafaxine.
Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that increases vascular tone at higher doses due to noradrenergic effects.
2
Evaluate the clinical presentation of weight gain without sexual dysfunction.
Match with Mirtazapine.
Mirtazapine's strong antihistaminic (H1) action causes increased appetite, while its 5-HT2 and 5-HT3 antagonism prevents the sexual dysfunction typical of SSRIs.
3
Evaluate the clinical presentation of a prolonged, painful erection (priapism).
Match with Trazodone.
Trazodone can induce priapism due to its strong alpha-1 adrenergic receptor antagonism, which alters penile blood flow.
4
Evaluate the clinical presentation of a seizure in a patient with bulimia.
Match with Bupropion.
Bupropion lowers the seizure threshold. This risk is heavily magnified in patients with electrolyte shifts from purging behaviors.

Key Concept

Adverse effect profiles of atypical and SNRI antidepressants
Estimated Time:1m 30s
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Topics

Psychopharmacology and Psychological Therapies

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