You are evaluating five different patients who have recently initiated psychotropic medications. Each patient is now presenting with a specific adverse effect based on their history and examination findings. Which primary pharmacological mechanism best corresponds to the responsible medication for each patient's clinical presentation?
- A 32-year-old woman with bulimia nervosa and normal vital signs presents with postictal confusion following a generalized tonic-clonic seizure shortly after starting a new antidepressant.Inhibition of presynaptic reuptake of norepinephrine and dopamine
- A 45-year-old man with depression and severe insomnia presents in acute distress with a painful, sustained penile erection lasting 6 hours after taking a newly prescribed sleep aid.Serotonin reuptake inhibition combined with prominent alpha-1 adrenergic receptor antagonism
- A 29-year-old woman with treatment-resistant depression presents with diaphoresis, severe anxiety on mental status exam, and a blood pressure of 220/115 mm Hg after attending a wine and aged cheese tasting.Irreversible inhibition of monoamine oxidase A and B enzymes
- A 55-year-old man with major depressive disorder and diabetic neuropathy presents with a euthymic mood but new-onset resting hypertension (155/95 mm Hg) following a dose increase of his medication.Serotonin reuptake inhibition with dose-dependent presynaptic norepinephrine reuptake inhibition
- A 24-year-old man treated for depression presents with significant recent weight gain (5 kg) and complains of profound daytime sedation and dizziness upon standing (orthostatic hypotension).Central alpha-2 adrenergic receptor antagonism and potent histamine H1 receptor blockade
Cevap
Match each clinical presentation to the underlying mechanism of action of the responsible psychotropic medication: 1-Bupropion, 2-Trazodone, 3-MAOI, 4-SNRI, 5-Mirtazapine.
Bupropion causes seizures in patients with eating disorders due to NE/DA reuptake inhibition. Trazodone causes priapism via alpha-1 antagonism. MAOIs cause tyramine hypertensive crisis by inhibiting monoamine oxidase. SNRIs like venlafaxine cause dose-dependent hypertension via NE reuptake inhibition. Mirtazapine causes sedation, weight gain, and orthostasis via H1 and alpha-1/alpha-2 antagonism.
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Anahtar Kavram
The mechanisms of action of psychotropic medications directly correlate with their unique and potentially dangerous adverse effect profiles.