Are these statements TRUE or FALSE?
Though the links to the relevant articles are provided, you DON’T have to re-read that article. Correct answers are given in just few sentences.
1. Since nortriptyline is somewhat more effective than tertiary amine tricyclics like imipramine and amitriptyline, it should be considered as a first-line option when a tricyclic antidepressant is indicated.
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Answer: False
Explanation: The opposite is true. The tertiary amine tricyclic antidepressants (imipramine, amitriptyline, clomipramine) appear to be slightly more effective for major depressive disorder than the secondary amine tricyclics (nortriptyline, desipramine, protriptyline). But, the difference in efficacy is small and the difference has been seen only in severely depressed inpatients. Nortriptyline is commonly used first when a tricyclic antidepressant is needed, not because it is more effective than tertiary amine tricyclics like imipramine and amitriptyline but because it has a better side effect profile.
2. Use of topiramate can lead to the formation of urinary stones in about 1 in 1000 of the patients who are on it.
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Answer: False
Explanation: Even mild, asymptomatic metabolic acidosis due to topiramate matters because the changes in urine pH and chemistry can lead to the formation of kidney stones in as many as 1 to 2% of patients. That’s 1 in 100 to 1 in 50 patients. So, the formation of urinary stones with topiramate use is commoner than is generally realized.
3. Total carbon dioxide level, which is included in the basic metabolic panel (blood chemistry), is a good measure of serum bicarbonate.
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Answer: True
Explanation: The total carbon dioxide level that we see in the laboratory test results includes serum bicarbonate, carbonic acid, and carbon dioxide (dissolved in the blood).
About 95% of this total carbon dioxide is the serum bicarbonate. That is why the total carbon dioxide is a good estimate of the serum bicarbonate level.
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