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15
PHARMACY PREP

DEPRESSIVE DISORDERS

1. A patient who has recently had a prescription filled for Sertraline phones you and
complaints that her hands are trembling, she is shivering, sweating excessively and feel
very restless. She does not think her temperature is increased. After checking her
medical history, you find that she has not received any other medication in the last 3
weeks. She told that she has been using Robitussin DM for the last three days. What do
say to her?
a) She may be getting the flu or a cold and she should stay in bed and take ASA or
acetaminophen if her temperature is elevated.
b) She should continue her sertraline and call her doctor.
c) She should immediately stop the sertraline and you will contact her doctor.
d) She should stop taking the Robitussin DM if she is no longer has a cough and contact
doctor.

2. Serotonin syndrome has occurred with:
I. Venlafaxine
II. Mirtazapine
III. Bupropion
A. I only
B. III only
C. I and II only
D. II and III only
E. All of the above

3-What optimal response time for SSRIs
A-2 to 3 wks
B-4 to 6 wks
C-4 to 5months
D-6 to 8wks
E- over 6 wks

Tc page 67

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4-After adequate trial patient is considered not to have responded to Sertraline 50mg/day.
Patient experiencing severe sexual dysfunction side effects. Which of the following
would be the best choice of treatment?
A-Venlafaxine
B-Amitriptyline
C-Increase dose of sertraline
D-Fluoxetine
E-Mirtazepine
Ans-E

5. Sertraline interact with which of the following
A-Meperidine
B-Codeine
C-Acetaminophen
D- St. Johns wort
E-A and D
Ans-

CB is a 68-year-old man recently found to have major depression. The pharmacy has
been consulted regarding new antidepressant medications and any drug disease
interactions that may exist in the patients profile.

The patient has had an increase in depressive symptoms such as irritability, in increase in
sleep, anhedonia, and pessimism over the last few months. He is now spending much of
his time in bed or watching television. The medical history includes atrial fibrillation for
8 years, hypertension for 10 years, and hypercholesterolemia. CB has not undergone any
surgical procedures. He is allergic to penicillin (rash) and cephalexin (rash).

Meds:
Warfarin sodium 2.5 mg qd
Clonidine 0.1 mg qd
Pravastatin 20 mg qd
Multivitamin 1 tab qd
Tums EX 2 tabs qd

CBs father died at 57 years of age of MI. His mother died at 69 of lung cancer. CB quit
smoking tobacco 15 years ago. He uses alcohol occasionally. He is a retired electrical
engineer and lives at home with his wife.

Physical examination:
GEN: Quiet, disheveled elderly man who looks his stated age
BP sitting R arm: 110/68, HR: 60, T: 97F, RR: 18

Labs:
Na: 141 mEq/L Cl: 98 mEq/L
K: 4.0 mEq/L CO
2
: 16 mEq/L
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BUN 24 mg/dL SCr: 1.1 mg/dL
Gluc: 130 INR: 2.4
AST: 37 U/L L ALT: 35 U/L
Alk Phos: 80 U/L

A/P CB is a 68-year-old man with a history of fibrillation, hypertension, and
hypercholesterolemia. He has recently been found to have major depression and is about
to start antidepressant medication.
6.Which antidepressant should be avoided by a patient with cardiac arrhythmias?
A. Sertraline
B. Bupropion
C. Venlafaxine
D. Amitriptyline
E. Fluoxetine

7.Which of CBs medications should be changed because of its potential to cause
depression?
A. Warfarin
B. Clonidine
C. Pravastatin
D. Multivitamin
E. Tums EX
Answer: B Clonidine has been shown to cause depression. Depression is a relative
contraindication to use of this agent.

8.Which selective serotonin reuptake inhibitor has the least effect on pharmacokinetic
drug interactions through the CYP450 enzyme system?
A. Fluoxetine
B. Paroxetine
C. Sertraline
D. Fluvoxamine
E. They all effect CYP450 equally.


9.Which selective serotonin reuptake inhibitor has the least effect on INR for a patient
whose condition is stabilized with warfarin?
A. Fluoxetine
B. Sertraline
C. Paroxetine
D. Fluvoxamine
E. They all affect INR to an equal degree.




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10.What are the most common symptoms associated with abrupt cessation of a selective
serotonin reuptake inhibitor?
A. Fatigue, nausea, dizziness, tremor, chill and diaphoresis
B. Tonic-clonic seizure, coma, death
C. Hypertensive emergency, stroke
D. A and B
E. A, B, and C

Next 2 Questions refer to the following case
R.F is a 30-year-old female who has been on amitriptyline 70 mg bedtime for four weeks.
She come to pharmacy today, and an interview reveals that she started amitriptyline
because she is often teary and depressed and cannot sleep at night. However, she is not
feeling better. Instead she is experiencing dry mouth, constipation, and sleepiness in
daytime. Which all seems quite problematic to her. Her medication profile indicates she
is taking acetaminophen 325 mg as needed for headache.

11.Which of the following drug related problem she is experiencing?
A-Not taking medication as prescribed
B-Experiencing drug interactions
C-Experiencing side effects
D-Taking medication at wrong dose
1-C

12.What would be your response to patient concern?
A. Advise her that antidepressants take time to work. Recommend that wait two to three
weeks before expecting an improvement. Recommend saliva substitute for dry mouth.
B. Call her physician to recommend another agent since she is not getting benefit from
this drug and is experiencing side effect.
C. Recommend combination therapy with SSRI.
D. Recommend psychotherapy, as drug therapy failed to improve her symptoms
Ans-A

13.In what situation might you prefer using amitriptyline or another TCA over SSRI in
this patient?
A-She is diagnosed with major depressive disorder
B-She is diagnosed with mild depression and insomnia
C-She is diagnosed with major depressive disorder or hospitalized. She has responded to
TCA in the past.
D-She has sulfonamide allergy
Ans-C

14.Which of the following antidepressants are associated with lower incidence of sexual
dysfunction.
A.SSRI
B.TCA
C-Bupropion
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D-Venlafaxine
Ans-C
Comments: TC p 44

15.Which of the following agent would you recommend for the patient suffering from
atypical depression?
A.Fluxotine
B.Amitriptyline
C. Venlafaxine
D. mirtazapine
E-Moclobemide
5-E

16.About Sedatives, the correct statement:
I. Sedatives can be "habit forming."
II. Ideally, sedatives should be taken only for short periods depending on the medication
(2-4 weeks)
III. Expect 2-3 nights of poor sleep when stopped. One suggestion is to decrease sleep
time by 20mins 2 nights before stopping the medication.
A.I only
B.III only
C.I and II only
D.II and III only
E.All of the above
6-E

Next 3 Questions refer to the following case
FF is a 45-year-old woman who comes for more information on prescription for which
she had recently filled fluoxetine at your pharmacy.
Medical history: Previous depression episodes she received antidepressants treatment.
17. Which of the following is/are the correct statements on fluoxetine
I- Must be taken with food
II- Side effects are insomnia
III-Taken in the morning
A. I only
B. III only
C. I and II only
D. II and III only
E. All of the above
Ans. D

18. You were told by the patient that she was once on antidepressant that caused her
limbs to jerk at night. Which antidepressant is most likely to cause this problem?
a) Mirtazapine
b) Venlafaxine
c) Bupropion
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d) Moclobemide
e) Fluoxetine

19. The dosage forms available for fluoxetine hydrochloride are:
I. Capsule
II. Liquid
III. Intravenous
a) I only
b) III only
c) I and II only
d) II and III only
e) All of the above
Ans-C

20. What is the dosage strength available for fluoxetine tablets?
a) 20 mg
b) 10 mg
c) 5 mg
d) 15 mg
Ans-B

21. Which of the statements are correct about Ondansteron and fluoxetine:
I-Ondansetron is a selective antagonist of the serotonin receptor subtype, 5-HT
3
, while
fluoxetine Selective serotonin reuptake inhibitor
II-Fluoxetine and ondansteron interact with each other
III-Fluoxetine and ondansteron counter with each other
A. I only
B. III only
C. I and II only
D. II and III only
E. All of the above
Ans-C
Tips: Ondansetron is a selective antagonist of the serotonin receptor subtype, 5-HT
3
. Its
precise mode of action in the control of chemotherapy-induced nausea and vomiting is
not known.
Ondansetron does not itself appear to induce or inhibit the cytochrome P450 drug-
metabolizing enzyme system of the liver. Because ondansetron is metabolized by hepatic
cytochrome P450 drug-metabolizing enzymes, inducers or inhibitors of these enzymes
may change the clearance and, hence, the half-life of ondansetron. On the basis of
available data no dosage adjustment is recommended for patients on these drugs.

22. If fluoxetine is added to the treatment regimen of a patient already receiving a drug
metabolized by P4502D6 the need for decreased dose of the original medication should
be considered. The aforementioned drugs with a narrow therapeutic index represent the
greatest concern.
Which of the following is/are the correct statements on fluoxetine
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I-Must be taken with food
II- Side effects are insomnia
III-Taken in the morning
a) I only
b) III only
c) I and II only
d) II and III only
e) All of the above
Ans-D

23. Which of the following medications/herbals may be responsible for diminish sexual
desire, delay climax in Mr. X.
I-Gingko
II-St. John wort
III-Venlafaxine
a) I only
b) III only
c) I and II only
d) II and III only
E-All of the above
Ans-D

24. Which of the following are the appropriate actions for Mr. X sexual dysfunction
problems:
I-Refer physician for possible treatment options
II-Possible treatment option may include switching to bupropion
III- Possible treatment options may include Sildenafil (Viagra) for diminish sexual desire
and delay in climax.
A. I only
B. III only
C. I and II only
D. II and III only
E. All of the above
Ans-C
Comments:
Sexual dysfunction distinguish etiology (drug vs. illness); switch to: (bupropion,
Mirtazapine, moclobemide, venlafaxine, { dose}); adjust dose;
Other:
libidoneostigmine 7.5-15 mg 30 min prior to intercourse
Impaired erection bethanechol 10 mg po tid
anorgasmiacyproheptadine (Periactin) 4 mg po qam
Antidepressant induced erectile dysfunction sildenafil may help

Next 4 Questions refer to the following case

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25-A 40 year old patient taking MAOI (moclobemide) got cold and nasal congestion and
cough. What OTC drugs he cannot use:
A. Tylenol
B. Pseudoephridine topical
C. Dextromethorphan syrup
D. Dextromethorphan + Pseudoephridine
E. C and D
Ans-E

26. All of the following statements are correct, EXCEPT:
a) Non-compliance with antidepressant is higher in the geriatric population
b) Depressed people with more severe depression are more likely to take their
antidepressant
c) Social stigma associated with depression is a major reason for non-compliance
d) People who have suffered from more than 2 episodes of depression may have to stay
on antidepressant indefinitely
Ans-B
Tips: depressed patients refuse to take more antidepressants

27. A person who is taking moclobemide
a. Should not start an SSRI for 2 weeks after discontinuing moclobemide
b. Should not eat any aged cheese because of its possibility to increase the blood
pressure
c. May experience headaches and sedation
d. May experience headaches and insomnia
Ans-D

28- Serotonin syndrome may occur with:
A. Venlafaxine
B. Mirtazapine
C. Bupropion
A. I only
B. III only
C. I and II only
D. II and III only
E. All of the above
Ans: C

29. Moclobemide: (antidepressant used in depression illness)
A-Reversible MAOA-Inhibitor
B-May interact with MAOI or SSRI so not used
C-Used with caution in thyrotoxicosis or pheochromocytoma
D-Wash period of 4-5 weeks after SSRI should be considered before starting
Moclobemide
E-Side effects are nausea, vomiting, diarrhea, Palpitation, Crisis hypotension, dry mouth

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30. MAOI interact with all EXCEPT:
a. SSRI
b. TCA
c. Meperidine
d. Phenytoin
E-Other MAOI
Ans-D

Next 5 Questions refer to the following case
31-DD is a 20-year-old woman who comes to pick her prescription for Amitriptyline
(elavil). While talking to the patient you have noticed that the patient is prone to have
suicidal attempts. What will you do?
a. Do not fill prescription
b. Refer to physician
c. Recommend other pharmacy
d. Make part fill for weekly
e. Dispense and counsel about relaxation techniques
Ans-D

32- Doctor wants to switch patient medication from amitriptyline to fluoxetine, how long
is the patient has to wait before she starts fluoxetine:
a. 2 weeks
b. 4 weeks
c. 10 days
d. 5 weeks
e. 6 weeks
Ans-A
Comments: TCASSRI washout period is two weeks
Fluoxetine TCA washout period is five weeks

33. Amitriptyline is not used in some cases because it:
a. Causes coronary vasomotor
b. Causes heart problems
c. Affect the blood vessels
d. Right bundle branch and AV blockade
Ans-D

Next 6 Questions refer to the following case
CB is a 68-year-old white man recently found to have major depression. The pharmacy
has been consulted regarding new antidepressant medications and any drug disease
interactions that may exist in the patients profile.

The patient has had an increase in depressive symptoms such as irritability, increase in
sleep, anhedonia, and pessimism over the last few months. He is now spending much of
his time in bed or watching television. The medical history includes atrial fibrillation for
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34 years, hypertension for 10 years, and hypercholesterolemia. CB has not undergone
any surgical procedures. He is allergic to penicillin (rash) and cephalexin (rash).

Meds:
Warfarin sodium 2.5 mg qd
Clonidine 0.1 mg qd
Pravastatin 20 mg qd
Multivitamin 1 tab qd
Tums EX 2 tabs qd

CBs father died at 57 years of age of MI. His mother died at 69 of lung cancer. CB quit
smoking tobacco 15 years ago. He uses alcohol occasionally. He is a retired electrical
engineer and lives at home with his wife.

Physical examination:
GEN: Quiet, disheveled elderly man who looks his stated age
BP sitting R arm: 110/68, HR: 60, T: 97F, RR: 18

Labs:
Na: 141 mEq/L Cl: 98 mEq/L
K: 4.0 mEq/L CO
2
: 16 mEq/L
BUN 24 mg/dL SCr: 1.1 mg/dL
Gluc: 130 INR: 2.4
AST: 37 U/L L ALT: 35 U/L
Alk Phos: 80 U/L

A/P CB is a 68-year-old man with a history of fibrillation, hypertension, and
hypercholesterolemia. He has recently been found to have major depression and is about
to start antidepressant medication.

35-Which antidepressant a patient with cardiac arrhythmias should avoid?
a. Sertraline
b. Bupropion
c. Venlafaxine
d. Amitriptyline
e. Fluoxetine
Answer: D All TCA antidepressants have proarrythmic effects and should be avoided
in the treatment of patients with preexisting arrhythmias.

36-Which of CBs medications should be changed because of its potential to cause
depression?
a. Warfarin
b. Clonidine
c. Pravastatin
d. Multivitamins
e. Tums EX
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Answer: B Clonidine has been shown to cause depression. Depression is a relative
contraindication to use of this agent.

37-Which selective serotonin reuptake inhibitor has the least effect on pharmacokinetic
drug interactions through the CYP450 enzyme system?
a. Fluoxetine
b. Paroxetine
c. Sertraline
d. Fluvoxamine
e. They all effect CYP450 equally
Answer: C Sertraline has the least amount of enzymatic inhibition on the CYP450
system.

38-Which selective serotonin reuptake inhibitor has the least effect on INR for a patient
whose condition is stabilized with warfarin?
a. Fluoxetine
b. Sertraline
c. Paroxetine
d. Fluvoxamine
e. They all affect INR to an equal degree.
Answer: B Sertraline has a minimal effect on the ability of warfarin to produce
anticoagulation. Dosage adjustment of warfarin usually is not necessary.

39-What are the most common symptoms associated with abrupt cessation of a selective
serotonin reuptake inhibitor?
I-Fatigue, nausea, dizziness, tremor, chill and diaphoresis
II-Tonic-clonic seizure, coma, death
III-Hypertensive emergency, stroke
a. I only
b. III only
c. I and II only
d. II and III only
e. All of the above
Answer: C Fatigue, nausea, dizziness, and lightheadedness, tremors, chills, insomnia,
anxiety and diaphoresis are the most common effects of abrupt discontinuation of SSRIs.
Fluoxetine, because of its long half-life and active metabolite, is the least likely agent to
cause the

40.Which of the following medications cause least nausea/vomiting
a) Sertraline
b) Effexor
c) Prozac
d) Fluvoxamine
e) Fluoxetine
Ans-A

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Next 7 Questions refer to the following case
41. A patient is on Moclobemide, he got severe sinus and cough, what do you
recommend?
I-Pseudoephedrine
II-Dextromethorphan
III- Xylometazoline
A. I only
B. III only
C. I and II only
D. II and III only
E. All of the above
Ans-B

42. Which of the following a patient can take with MAO-inhibitor?
a. Milk
b. Red wine
c. Grape juice
d. Aged cheese
e. Tyramine food
Ans: A

Next 8 Questions refer to the following case
43. A 60 year old male patient has insomnia, depression and no other medical condition.
Which medication can be used? Allergies are not known.
a. Amitriptyline
b. Fluoxetine
c. MAO inhibitor
d. Sertraline
e. Moclobemide
Ans-A

44. All of the following drugs cause dry mouth, EXCEPT:
a) Clonidine
b) Amitriptyline
c) Pilocarpine
d) Nortriptyline
e) Doxamine
Ans: C

45. Why Amitriptyline is not recommended in-patient with cardiac problem? (Options
exactly cardiac effects of TCA)
a) AV node blockade
b) SA- node blockage
c) Arrhythmias
d) Anticholinergic side effects
Ans-A
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46. If there is urinary retention, which anti-depressant drug cannot be used?
a) Amitriptyline
b) Desipramine
c) Fluoxetine
d) MAOI
e) Sertraline
Ans: A

Next 9 Questions refer to the following case
47. A 20-year-old female depressed patient on antidepressant treatment (amitriptyline).
While talking to the patient pharmacist noticed that the patient is prone to have suicidal
attempts, what will you do?
a. Do not fill Rx
b. Send to other pharmacy
c. Partly fill Rx (weekly)
Ans: C

48. A 33-year-old female came to pharmacy with complaining too much pressure at
work, insomnia, reduce of appetite tidiness. She is smoker for long time, she tried to quit
but failed. In the past, she has history of major depressive disorder her depression was
treated with clomipramine, Venlafaxine, and the combination of paroxetine and lithium,
each with little or no effect. She has been somewhat controlled for the past one year with
escitalopram 10 mg daily. In her family her aunt also have suffered with depression. Her
current medications include oral contraceptive pills. Which is the main reason to send her
to doctor?
a) She has been a heavy smoker for a long time
b) Her aunt has depression
c) She takes oral contraceptive pill
d) She had depression 2 years ago
e) She complaining for too much pressure at work
Ans:

49. She came back to pharmacy with prescription on sertraline. Which is the MOST
important warning pharmacist has to tell?
a. Take with food to reduce gastrointestinal side effects
b. Take in the morning, to prevent for insomnia side effects.
c. It takes 4 to 6 weeks for optimal benefit of drug.
d. If depression symptoms not reduced in 2-4 weeks, contact your physician
e. Initially sexual dysfunction may be seen in some patient
Ans:

Next 10 Questions refer to the Bupropion
50. A 35 year old traveling agent is currently taking Bupropion 150 mg- bid for MD,
suppose to take 9 am and 5 pm (now 12 noon) missed the dose. When take next dose:
a. Take now (12 noon) then follow schedule NB! (Doses should be 8 hrs. apart)
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b. Skip now, next dose take at 5 pm
c. Double the dose at 5 pm
d. Take now (12 noon) then 8 pm
Ans: D

51- Which of the following statement is incorrect about Zyban (Bupropion).
A-High dose may result in seizure
B-Used for 3-6 weeks
C-Not for pregnant or breast feeding
D-Used with or without Nicotine Replacement Therapy, and increases BP
Ans-B
Tips: monitor BP for bupropion, used for 7-12 weeks. g/L

Next 11 Questions refer to the following case
52-AZ is a 42-year old female who has a five-year history of major depressive disorder
(MDD) without psychotic features. In the past, her depression was treated with
clomipramine, Venlafaxine, and the combination of paroxetine and lithium, each with
little or no effect. She has been somewhat controlled for the past six months with
escitalopram (Lexapro) 10 mg daily, but went to her doctor because she still has no
interest in doing things she used to enjoy, has trouble sleeping, and continuous to lose
weight. She presents with a prescription for olanzapine 5 mg daily, and tells you her
doctor is giving her another antidepressant. When she reads in the patient information
leaflet that the medication is used for schizophrenia, she becomes concerned that she is
not receiving the correct medication. Which of the following appropriate counselling
olanzapine:
I. Explain that increased appetite and weight gain may be beneficial side effects.
II. Suggest that she let her doctor know if she is gaining too much weight.
III. Olanzapine may cause extrapyramidal symptoms
a. I only
b. III only
c. I and II
d. II and III
e. I, II and III
Ans-E

53-A 30-year-old patient, is currently on antidepressant treatment, wants to stop taking
fluoxetine because she continues to have trouble sleeping and does not wish to use a
sedative. Which is the best option to improve sleep?
a) Add lorazepam at bedtime
b) Switch to bupropion
c) Switch to moclobemide
d) Switch to mirtazapine
Ans: D

Next 12 questions refer to Depression in Alzheimers Patient:
54. The most appropriate antidepressant therapy for the patient with Alzheimer is
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a) Trazodone
b) Venlafaxine
c) Amitriptyline
d) Citalopram
Ans: D
Tips: SSRIs are the best, citalopram have low drug interactions

Case 2
A 25-year-old female with Crohns disease presented to her DOCTOR complaining of
insomnia mainly due to her painful condition. She was taking venlafaxine 75 mg b.d. in
addition to her immunosuppressant therapy. She felt that her prednisolone treatment was
aggravating her low mood and her Crohns symptoms were still not controlled.

What course of action could the DOCTOR take?
The patient should be referred back to her specialist to review her Crohns
medication, as this is likely to be the main cause of her insomnia. However, the
DOCTOR may consider changing the antidepressant to a more sedating agent
such as trazodone and reviewing her medication for pain. General counselling
about sleep may also be beneficial, as outlined above.

55-Patient has hyperlipidemia and he is on atorvastatin and he has a depression. The
doctor wants to prescribe an SSRI. The best SSRI typical for these patients:
A-Fluoxetine
B-Paroxetine
C-Citalopram
D-Sertraline
E-Fluvoxetine
Ans-A

56-Patient taking Codeine for his severe ankle pain. He is starting to get depressed. The
best antidepressant should be considered:
A-Fluoxetine
B-Amitriptyline
C-Moclebamide
D-Buprapione
E-Citalopram
Ans-E

57-A patient using Amitriptyline for the treatment of major depression and morphine for
chronic pain reports the pinpoint pupil. This symptoms may be associated with overdose
of ?
A-Amitriptyline
B-Morphine

A patient using Phenelzine, complains about high blood pressure. His lunch menu
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include, pizza and milk, coke.
58-Which of the following may not be cause of his blood pressure?
A-Pizza
B-Phenelzine
C-Milk
D-Cheeze
E-None of the above

59-Patient comes with symptoms of cold intolerance, constipated, fatigue, which of the
following drugs may be using?
A-Fluoxetine
B-Paroxetine
C-Buprapione
D-Lithium
E-Lorazepam

60-A maniac patient currently using, Lithium carbonate treatment. He is seeking some
help for antidiarrheal medications, he also have severe watery diarrhea for the last two
days?
Reports dizziness, confused. Which of the following is the appropriate action:
A-Loperamide
B-Peptobismol
C-Refer to Dr
D-Recommend to change diet
E-Recommend Oral rehydration solution

61-Antidepressant that should be taken with food?
I-sertraline
II-Venlafaxine

62-A patient was taking flexetin for about 4 months. She is bringing a new RX for
moclobomide. What should you do about this new RX?

a) Call the Dr. and say this new RX will not work because it has the same effect
as fluxetin
b) Fluxetin should be stopped 2 weeks before starting moclobomide
c) Ask Dr. to prescribe a MAOin instead of moclobomide
d) Fill the RX and tell pt. to stop fluxetin

63-A patient has heart condition. Why amitripiline is not suitable in this pt.?

a) Amitriptiline is proarrithmic agent
b) Amitriptiline is anticholinergic
c) Amitriptiline might cause AV block

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15-17
64-Which anti-depressant has the least chance to be prescribed in this pt.?
a.) Fluoxetine b.) Fluoxamine c.) Sertraline d.) Paroxetine

65. A 50-year old patient, he is on Moclobemide. He developed common cold
requesting an OTC:
(A) Dextromethorphan syrup
(B) Pseudophed
(C) Tylenol cough and cold
(D) Strepsills lozenges
(E) Otrivine nasal drop
Answer: (D)
TIPS: They are only soothing agent and doesnt interact with moclobemide

66. Auxiliary labels to be put on all CNS antidepressants and antipsychotics is/are:
I Avoid sunlight
II Avoid alcohol
III They cause drowsiness
(A) I only
(B) III only
(C) I and II
(D) II and III
(E) All of the above
Answer: (B)