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Nurse Practitioner:
doi: 10.1097/01.NPR.0000406470.98288.3d
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Pharmacogenetics and the pharmacological management of depression

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INSTRUCTIONS Pharmacogenetics and the pharmacological management of depression

TEST INSTRUCTIONS

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* Registration deadline is October 31, 2013.

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PROVIDER ACCREDITATION

Lippincott Williams & Wilkins, publisher of The Nurse Practitioner journal, will award 2.5 contact hours for this continuing nursing education activity.

Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.5 contact hours. Lippincott Williams & Wilkins is also an approved provider of continuing nursing education by the District of Columbia and Florida #FBN2454.

Your certificate is valid in all states. This activity has been assigned 0.5 pharmacology credits.

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Pharmacogenetics and the pharmacological management of depression

General Purpose: To provide the NP with an overview of the complexity of treating MDD, and the use of phenotypic status when prescribing antidepressants. Learning Objectives: After reading the preceding article and taking this test, you should be able to: 1. Explain the complexities of MDD treatment. 2. Explain the importance of phenotypic status when prescribing antidepressants.

1. The current success rate for the treatment of MDD is

a. 20%.

b. 33%.

c. 40%.

d. 66%.

2. Pharmacogenetics is defined as the effect of

a. drug responses to different diseases.

b. interactions and functions of genes within the genome.

c. genetic variation in drug response.

d. a patient's genetic variability on disease processes.

3. The gold standard for diagnosing MDD includes all of the following except

a. the presence of at least five symptoms.

b. impairments in daily functioning.

c. phenotype profiling.

d. symptoms presenting for at least 2 weeks.

4. MDD would most likely occur in a

a. 65-year-old Asian female.

b. 60-year-old Hispanic male.

c. 55-year-old White female.

d. 50-year-old Black female.

5. According to APA guidelines, first line pharmacologic treatment for MDD may include

a. monoamine oxidase inhibitors.

b. bupropion.

c. tricyclic antidepressants.

d. tetracyclic antidepressants.

6. One hypothesis used to explain MDD is the

a. presence of excess serotonin in the synaptic cleft.

b. deficiency of corticotrophin-releasing hormone.

c. decrease in neurogenesis.

d. overactive hippocampus.

7. The exact physiologic mechanism for MDD is

a. unknown.

b. directly caused by the serotonin reuptake mechanism.

c. explained by neurogenetic deficiencies.

d. an increase in norepinephrine uptake.

8. The current dichotomy in the management of MDD is based on

a. the use of both antidepressants and behavior modification.

b. an increase in antidepressant use with a decreasing percentage of remissions.

c. the correlation between antidepressant use and suicide rates.

d. the increased ability to diagnose MDD with little success in treatment.

9. The STAR*D study's reported trends in MDD treatment indicated all except

a. remission times can occur after many weeks across four treatment steps.

b. 30% of patients were unable to achieve remission even after treatment.

c. greater depressive burdens were associated with more medical disorders.

d. patients on SSRI's required longer times to remission.

10. The STAR*D study demonstrated that

a. some medications are clear "winners" for MDD treatment.

b. several treatment steps are needed to achieve remission in some MDD patients.

c. a well-planned study reduces the sample MDD drop-outs.

d. a four-step program contributes most to the remission of MDD.

11. In genotyping, alleles are

a. responsible for genetic variation.

b. the building blocks of chromosomes.

c. enzymes required to perform genetic profiles.

d. pathways by which the CYP450 enzymes function.

12. Which enzyme is responsible for metabolizing many antidepressants?

a. CYP2C8

b. CYP2C19

c. CYP3A4

d. CYP2D6

13. The metabolic phenotype creating the greatest risk of adverse reaction due to lack of drug inactivation is the

a. PM.

b. UM.

c. EM.

d. IM.

14. The phenotype most likely to have low effectiveness to drug therapy due to reduced drug conversion is the

a. EM.

b. IM.

c. PM.

d. UM.

15. Antidepressant serum concentration

a. is increased by PM's activity on prodrugs.

b. follows linear pharmacokinetics.

c. does not correlate with effective treatment.

d. is decreased by UM enzyme activity.

16. Genotyping a patient's CYP2D6 profile is important because

a. no other dosing algorithm exists.

b. it offers clues to a patient's response to antidepressants.

c. it determines the plasma concentration of antidepressants.

d. major insurance companies strongly recommend it.

17. Which statement about for CYP2D6 phenotype testing is accurate?

a. There is only one test available.

b. The best testing procedure relies on the number of alleles present.

c. The test should be repeated annually for safe medication dosing.

d. Testing can be done from a buccal swab.

18. The reported correlation between CYP2D6 phenotype and MDD treatment outcomes

a. is still considered controversial.

b. has been established for 90% of antidepressants.

c. indicated CYP2D6 is not helpful when prescribing tricyclic antidepressants.

d. establishes that CYP2D6 is mandatory for prescribing selective serotonin reuptake inhibitors.

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