Questions
Abnormalities in the brain structure of the patients with bipolar disorder have been reported as following, (60%) Review the PPT 1. No vascular disease found in brain 2. No significant brain structural abnormalities found 3. Enlarged Ventricular and Glial density reduction in prefrontal cortex 4. Reduced Ventricular and increased Glial density in prefrontal cortex
3. Enlarged Ventricular and Glial density reduction in prefrontal cortex
A patient is initially prescribed venlafaxine (Effexor) 37.5 mg daily, and after one week the PMHNP increases the dose to 75 mg daily, while also advising the patient's family to monitor the patient for which of the following concerns EXCEPT? (60%) 1. Exacerbation of existing hypertension 2. Increased irritability and change in behaviors 3. Weight gain and increased urination 4. Significant change in the patient's mood or affect
3. Weight gain and increased urination
Which of the following medications require a slow taper prior to discontinuation, in order to prevent possible discontinuation symptoms EXCEPT? (40%) 1. sertraline (Zoloft) 2. paroxetine (Paxil) 3. desvenlafaxine (Pristiq) 4. fluoxetine (Prozac)
4. fluoxetine (Prozac)
1. A visibly pregnant 29-year-old woman presents seeking treatment for oxycodone dependence. Because of her pregnancy she wants to stop using all drugs and does not want to take any medications. She went through untreated opiate withdrawal in the past when she couldnt get any pills and although it was very uncomfortable she thinks she could do it again with intensive social support and counseling. At this point the best treatment recommendation would be to initiate: A. Methadone maintenance B. Methadone-assisted withdrawal C. Clonidine-naltrexone-assisted withdrawal D. Buprenorphine maintenance E. Daily clinic visits to provide support
A: Methadone Maintenance Notwithstanding the patients initial thoughts of avoiding medications, opioid withdrawal should be avoided in pregnancy because of the greater risk of adverse fetal outcomes compared with methadone maintenance. Withdrawing the mother completely from opioids raises the risk of relapse and that the fetus will be harmed. Nonpharmacological treatment alone will likely expose the fetus to continued illicit drug use and multiple withdrawals. Naltrexone should never be given to a pregnant woman because of the risk of spontaneous abortion, stillbirth, and other adverse events. There is a long history of the safety of methadone maintenance for both mother and fetus/neonate. Early clinical experience suggests that buprenorphine may have similar safety, but there is insufficient evidence to recommend its initiation in a known pregnancy.
The patient F.R. is a 44-year-old male, small business owner, who was initially diagnosed with major depressive disorder and was started with; venlafaxine ER 75 mg/day combined with cognitive behavioral therapy (CBT) and the dose of venlafaxine ER was titrated. Approximately 4 weeks after his venlafaxine dose was increased to 150 mg/day and his CBT was intensified, 8 weeks since his initial diagnosis, he still remains to be nonresponsive to treatment. In addition, F.R. indicates that he had been experiencing nausea, headache, and somnolence since his venlafaxine dose was increased; these side effects only began to subside about 14 days ago, when he discontinued his antidepressant therapy on his own. In the interview, he's endorsing depressed mood, anhedonia. He's also had some unplanned weight loss; his BMI now is 20, the normal range being 18.5 to 24.9. Additionally, he endorses fatigue and insomnia and began using alcohol nightly to help himself fall asleep, but has no prior history of drug or alcohol abuse or addiction and really has no pre-existing history of any comorbid psychiatric disorders. Which is the most appropriate management strategy for F.R.? a. Address side effects and continue venlafaxine at current dose. b. Increase venlafaxine dose to 300 mg/day c. Decrease venlafaxine dose to 37.5 mg/day d. Discontinue venlafaxine, and switch to another antidepressant therapy
According to the most recent APA guidelines for the treatment of MDD, switching to an SSRI, MAOI, TCI, or an atypical antidepressant is a reasonable strategy for patients who are nonresponsive or intolerant to initial therapy. So you decide to switch to sertraline with a starting dose of 50 mg/day and titrated to 150 mg/day after it was determined that his treatment was being well tolerated but that he was still symptomatic and now consideration is being given to adding a second medication.
Medications that can cause or exacerbate insomnia are all of the following except:
Decongestants Albuterol Caffeine Atypical antipsychotics
Atypical antipsychotics cause higher incidences of extrapyramidal side effects. True/False
False
Joe had polio as a child and has always walked with a limp. He was unable to participate in sports as a child and this has always made him feel as though he missed out on a full childhood. This would be an example of psycho-social trauma. True/False
False
The exact mechanism of action of lithium is very well known. T/F
False
Lamotrigine (lamictal) can be brought up to its full maintenance dose within the first week.
False: Titrate VERY SLOWLY start 25 mg/day x 2 weeks, 50 mg/day week #3, 100 mg/day week #5, 200 mg/day week #6
Which of the following best represents the therapeutic mechanism of action for most SSRIs? a) Block serotonin reuptake pumps (SERT) b) Block norepinephrine reuptake pumps (NET) c) Block dopamine reuptake pumps (DAT) d) All of the above
a) Block serotonin reuptake pumps (SERT)
When choosing a pharmacological agent, the following do not have CYP 450 drug interactions, as neither an inducer nor inhibitor a) Celexa, lexapro, and effexor b) Haldol, elavil, celexa c) Dilantin, tegretol and topiramate d) Effexor, lexapro, and grapefruit juice
a) Celexa, lexapro, and effexor
Quinn's ECG results have come back and his Q-T interval was recorded as > 0.450 seconds. Which drug would not be recommended for him? a) Citalopram b) Imipramine c) Alprazolam d) Bupropion
a) Citalopram -- normal QT interval is <0.44 seconds
Ann was found unconscious by her neighbor and called 911. The EMT stated she was in cardiac arrest. After she was stabilized and brought into the hospital, she admitted taking 3 weeks worth of her antidepressant. Which was the most likely offending agent? a) Clomipramine b) Sertraline c) Buspirone d) Fluoxetine
a) Clomipramine
What is the benefit of using an agent that has a long half life? a) Decreased risk of breakthrough symptoms upon discontinuation b) Increased risk of breakthrough symptoms upon discontinuation c) Weight loss d) Weight gain
a) Decreased risk of breakthrough symptoms upon discontinuation
When starting either an SSRI or SNRI, there are transient and persistent effects. Which of the following are persistent effects? a) Agitation, sexual dysfunction, and insomnia b) Sexual dysfunction, nausea and headache c) Sexual dysfunction, weight increase, and insomnia d) Akathisia, agitation, and GI disturbances
c) Sexual dysfunction, weight increase, and insomnia
Some somatic symptoms that can accompany anxiety disorders include: a) Depression b) Chest pain c) Headache d) b & c
d) b & c
Which class of antidepressants is most likely to cause weight gain? a) SNRIs b) TCAs c) MAOIs d) b & c
d) b & c
Which SSRI has the longest half-life? a) Paroxetine b) Escitalopram c) Sertraline d) fluoxetine
d) fluoxetine
F.R. is seen 8 months after remission has been achieved. He indicates that he has been feeling down and has not been sleeping much for the past 3 weeks. He goes on to explain that he hass had to lay off more of his employees and is considering closing his business altogether due to decreased revenue. The patient is experiencing recurrent depressive episodes and has become nonresponsive/resistant to current treatment of Sertraline 200mg/day (Monotherapy) and Buspirone 15mg BID (1st line augmentation). Which of the following second line augmentation strategies is the most appropriate to treat F.R.'s treatment resistant depression? 1. Atypical antipsychotic agent (Rexuiti 1mg/day) 2. Anticonvulsant (Depokate 250mg bid) 3. Lithium Carbonate 300mg BID 4. Emsam patch 6 mg daily
1. Atypical antipsychotic agent (Rexuiti 1mg/day)
What is the therapeutic anxiolytic mechanism of action (MOA) for propranolol (Inderal)? 1. Blockade of Beta1 postsynaptic receptors in the pre-frontal cortex and hippocampus. 2. Blockade of Beta1 postsynaptic receptors in the raphe nucleus. 3. Alpha 2 delta ligand at voltage sensitive calcium channel (VSCC). 4. Alpha 1 blockade at voltage sensitive sodium channel (VSSC).
1. Blockade of Beta1 postsynaptic receptors in the pre-frontal cortex and hippocampus.
A WBC of 4,000 in a patient taking clozapine would prompt the PMHNP to take which of the following actions? (36%) 1. Institute twice-weekly complete blood count with differentials and monitor closely 2. No action is needed since the recommended cut-points for discontinuation of Clozapine are WBC of 2,000 to 3,000 for agranulocytosis. 3. Discontinue the Clozapine since WBC of 4,000 is the recommended cut-point for discontinuation. 4. Clozapine monitoring guideline is only based on the granulocytes of 1,000 to 1,500 as cut-points for discontinuation of clozapine.
1. Institute twice-weekly complete blood count with differentials and monitor closely cutoffs: WBC 3,000 and ANC 1,500
According to FDA, most effective evidence-based mood stabilizers treating both mania and depression are, (52%) 1. Lithium and Lamotrigine 2. Lithium and Valproate 3. Valproate and Lamotrigine 4. Lithium and Carbamazapine
1. Lithium and Lamotrigine Lamotrigine is only one not approved for acute mania, but approved for maintenance and mania/depression. Valporate is approved for acute mania, maintenance Carbamazepine is only approved for acute mania
A 6-year old child's inability to control impulses such as not waiting his turn, or blurting out answers in class without raising his hand is a reflection of inefficient norepinephrine (NE) transmission in which of the following areas? 1. Orbital Frontal Cortex (OFC) 2. Dorsal Lateral Pre-frontal Cortex (DLPC) - motivation/executive function 3. Dorsal Anterior Cingulate Cortex (ACC) - Selective attention 4. All of the listed answers
1. Orbital Frontal Cortex (OFC)
Which of the following description is true for drug actions targeting bipolar disorder? 1. The drugs that modify voltage-sensitive Na and Ca channels would be expected to decrease the release of neurotransmitters during an acute mania, and to stabilize the same to avoid neurotransmitter depletion. 2. The drugs that modify voltage-sensitive Na and Ca channels would be expected to increase the release of neurotransmitters during an acute mania, and to stabilize the same to avoid neurotransmitter depletion. 3. The drugs that modify pre- and post- synaptic activities would be expected to change the release of neurotransmitters during an acute mania. 4. The drugs that modify neurotransmitter pathways would be expected to decrease the release of neurotransmitters during an acute mania.
1. The drugs that modify voltage-sensitive Na and Ca channels would be expected to decrease the release of neurotransmitters during an acute mania, and to stabilize the same to avoid neurotransmitter depletion.
You are recently hired as a PMHNP in the Clozapine Treatment Clinic where many clients are smokers. You decide to educate the PMHNP nursing students about Clozapine and smoking interactions. Starting with Clozapine is Substrate CYP 1A2 and nicotine is 1A2 inducer, which of the following is the most accurate explanation of clozapine and nicotine interaction? 1. When a patient stops smoking, nicotine is no longer available with CYP 1A2 enzyme to induce Clozapine metabolism. Consequently, Clozapine level will go up and the patient present with symptoms of excessive amount of the medication (Clozapine) in his system. 2. When a patient stops smoking, Clozapine metabolism will automatically slow down and the blood level of Clozapine will go up. Therefore, it's important for a PMHNP to reduce Clozapine dose when the patient stops smoking. 3. Since Clozapine is Substrate CYP 1A2 and nicotine is 1A2 inducer, when smoking cessation is encouraged for patients, it's important to monitor the patients who are taking Clozapine.
1. When a patient stops smoking, nicotine is no longer available with CYP 1A2 enzyme to induce Clozapine metabolism. Consequently, Clozapine level will go up and the patient present with symptoms of excessive amount of the medication (Clozapine) in his system.
Clinically significant drug-drug interactions are defined as _______________________. Fill in the blank. 1. pharmacodynamic interactions occur when concomitantly administered medications share similar target sites of actions (i.e. receptor) producing either additive (inducer) or antagonistic (inhibitor) effects that can enhance or weaken the physiologic effect of the primary drug (substrate) respectively. 2. pharmacokinetic interactions occur when concomitantly administered medications share similar neuronal pathways (i.e. dopamine, serotonin, norepinephrine) producing either additive or antagonistic effects that can enhance or weaken the physiologic effect of the primary drug respectively. 3. pharmacodynamic interactions occur when concomitantly administered medications share similar metabolizing organs (i.e. liver, kidney) that effect the efficacy of the primary drug. 4. pharmacokinetic interactions occur when concomitantly administered medications share similar genetic factors (i.e. liver, kidney) effecting each drug metabolism.
1. pharmacodynamic interactions occur when concomitantly administered medications share similar target sites of actions (i.e. receptor) producing either additive (inducer) or antagonistic (inhibitor) effects that can enhance or weaken the physiologic effect of the primary drug (substrate) respectively.
When considering a diagnosis of treatment -resistant schizophrenia if _______trials of sufficient time and duration have failed and discuss clozapine treatment. Fill in the blank. 1. 1 2. 2 3. 3 4. 4
2 trials
If switching from an SSRI to an MAOI, what is the recommended amount of time recommended for "wash-out"?
2 weeks
Which of the following mechanisms of action best describes atypical (2nd generation) antipsychotic medication?
Antagolism of partial agonism at D2 receptors plus antagonism at 5HT2A receptors. High affinity for and antagonism at D2 receptors Partial agonism at D2 and 5HT2A receptors Antagonism at 5HT1A and D2 receptors
_______________ treat both positive and negative symptoms.
Atypical agents
A 33-year old man with a 12-year history of heroin dependence and hightolerance is admitted to the hospital for IV antibiotic treatment of bacterial endocarditis. To prevent opioid withdrawal considering his opioid tolerance, he is prescribed a moderately high dose of buprenorphine. He is just beginning to experience withdrawal symptoms before the first buprenorphine dose, but shortly thereafter, his anxiety, muscle aches and rhinorrhea worsen. At this point, the best option would be to: a. Increase the dose of buprenorphine. b. Decrease the dose buprenorphine. c. Change to methadone. d. Add a benzodiazepine. e. Add a naltrexone
C. Change to methadone Because buprenorphine is only a partial agonist at the u opioid receptor, when given in high doses to someone with high tolerance in early withdrawal, it can cause withdrawal. Increasing the dose may worsen the withdrawal, whereas decreasing the dose may not provide adequate u receptor coverage. The best option is to change to the full u agonist methadone, which has a linear dose-response curve, allowing for easier dose titration and alleviation of withdrawal symptoms. Naltrexone, a full u antagonist, will worsen with the withdrawal symptoms. A benzodiazepine is likely to exhibit minimal effect, having no activity at the u receptor.
Genes likely to increase the risk of schizophrenia related to Glu transmission are? 1. Catechol-o-methyltransferase (COMT) 2. Disrupted-In-Schizophrenia1 (DISC-1) 3. Dysbindin Neuregulin 4. All of the listed answers.
Catechol-o-methyltransferase (COMT), Disrupted-In-Schizophrenia1 (DISC-1) and Dysbindin Neuregulin
Oral antipsychotic medications or neuroleptics block ____________ reaction at _____ receptor site.
Dopamine, D2
Elevations in prolactin levels can result in which of the following?
Galactorrhea
Mr. Bennett presents to his scheduled clinic visit with a sore throat and non-productive cough. You review his current medications and note that he is on clozapine, benztropine, and clonazepam. He maintains that he is compliant and reports no side effects. What is the most appropriate immediate response?
Hold the clozapine and order a stat CBC sore throat and cough are signs of infection, need to r/o neutropenia Risks: SEVERE NEUTROPENIA; ORTHOSTATIC HYPOTENSION, BRADYCARDIA, AND SYNCOPE; SEIZURE; MYOCARDITIS AND CARDIOMYOPATHY
Jeff has had a very positive therapeutic response to phenelzine, but now complains of a severe headache and vertigo. He comes to the ER and tells the nurse he has not yet taken any of his medication. What is the most appropriate immediate response?
Hold the medication and measure Jeff's blood pressure Discontinue the medication and order a CBC Continue the medication and prescribe a beta blocker Hold the medication and complete a neurological exam of the cranial nerves.
Increases in cortisol release can lead to____________.
Hyperarousal
A possible side effect of risperidone is______________.
Hyperprolactinemia
A 27-year-old patient is taking clozapine for schizophrenia. He has been symptomatically stable for the past couple of months and as part of his follow-up, you measure the clozapine plasma level. You are alarmed to find that he has a level of 1000 ng/mL while the upper limit for the lab reference is 700 ng/mL. In this case, what would you do?
Indications for therapeutic drug monitoring of clozapine a. Poor clinical response to routine doses b. Signs of toxicity or adverse events that may be linked to serum level, such as seizures c. Use of concurrent medications that are known to interact with the CYP450 system, in particular CYP1A2 d. The patient is altering their usual consumption of nicotine or caffeine e. The patient is suspected or known to have liver disease f. Concern about non-compliance, although serum levels should be interpreted with caution in view of significant intra-individual variation
FDA approved mood stabilizers for Acute mania of Bipolar Disorder in adults are all of the following answers EXCEPT,PP 1. Lithium 2. Valproate (Depakote) 3. Lamotrigine (Lamictal) 4. Carbamazepine (Tegretol)
Lamotrigine (approved for BPD maintenance)
Which of the following are considered the most effective mood stabilizers in treating both mania and depression in bipolar disorder?
Lithium Lamotrigine (lamictal) Quetiapine (seroquel) All of the above
Low serotonin + ___________ norepinephrine = depression
Low
"I don't think I can go on like this. I can't sleep. I can't eat. I can't think straight. Sometimes I wonder if life is worth living" Haley C. Omet is a 37 year old woman who presents to your clinic with the above complaint. She has recently separated from her husband 3 months ago. She has felt down, sad, and worried for more than a year, but her symptoms have become worse over the last couple of months. Since Haley's husband left her she has become increasingly depressed. Her appetite has been poor, she has little interest in food and she has lost 15 pounds. She cries frequently and wakes up in the middle of the night, unable to go back to sleep. Medication St. John's wort 300mg TID for the last 3 months Ibuprofen 400mg prn for headache, pain as needed Loratadine 10mg prn for seasonal allergies. Diagnosis?
Major depression
Which of the following is NOT true about clozaril?
May cause agranulocytosis False: Is recommended as a first line agent for schizophrenia May cause weight gain Low risk of EPS and TD
Smoking and caffeine can affect the ________________ of psychotropic medication.
Metabolism
Melatonin is released from the brainstem.
T/F
Libby, an 18-year-old college freshman with a history of depression who has been treated with Nardil (phenelzine) 20mg bid, was admitted to the Hospital for acute appendicitis. During the intake, the patient did not mention re. her depression and treatment. In preparation of the emergency surgery to alleviate the acute pain, she was prescribed an injection of meperidine. What do you anticipate to happen?
The potential for serotonin syndrome to develop in patients receiving monoamine oxidase inhibitors who are exposed to meperidine is well known to most anesthesiologists for the potential risk of SS. Key points - • Combination of selective serotonin reuptake inhibitors and other agents capable of increasing serotonin activity (e.g., monoamine oxidase inhibitors) has been most commonly associated with the syndrome. • A case of probable serotonin syndrome in a patient who had been taking a selective serotonin reuptake inhibitor and was subsequently given meperidine, an interaction that has not been widely recognized. • Fluoxetine is unusual in that its active metabolite, norfluoxetine, has a 2-week half-life, which potentially creates a long period of risk for patients exposed to other drugs with serotonin activity.
Factors to consider when initiating therapy include cost, side effect profile, and compliance. True/False
True
Mr. Cutie comes in to see you for a regular check up and a renewal of his olanzapine. He has not been smoking cigarettes (2ppd) for the last 10 years, but after his last appointment, he received bad news and stated to smoke. He appears more agitated than usual. Most likely, this is due to the increased metabolism of his olanzapine since he started smoking . True/False
True
Steven's Johnson syndrome is a possible adverse reaction that can occur with lamotrigine.
True: Blistering Erosion of the skin and mucous membranes
Which of the following mood stabilizing drugs are also used as anticonvulsants?
Valproate, carbamazepine, lamotrigine
Please order the following antipsychotics from lowest risk of weight gain to highest. olanzapine quetiapine Ziprasidone clozapine
Ziprasidone quetiapine olanzapine clozapine
Sam is a 23 year old make who presents with complaints of difficulty in social situations due to "worrying too much". He does not like to go out because he is worried that he will let his friends down and that he will be alone forever. He will not go on job interviews for fear of failure. Since graduating from college, he has had difficulty sleeping because he is worried he will not get a job and he continually worries about this. What should be in Sam's differential diagnosis? a) GAD b) PUD c) PTSD d) OCD
a) GAD
A serious side effect of citalopram to consider when prescribing is: a) Increased risk of suicidal ideation b) ST wave changes c) Increased risk of cerebrovascular accident d) QT prolongation risk
a) Increased risk of suicidal ideation
Augie was started on buspirone 2 days ago and he is calling your office to ask why he is not feeling better yet. You explain that: a) It takes up to 2 weeks to become effective b) A dose adjustment is needed now c) He will feel better tomorrow d) None of the above
a) It takes up to 2 weeks to become effective
Benzodiazepines may be useful in certain anxiety disorders, but are less beneficial in: a) PTSD b) Panic disorder c) Generalized anxiety disorder d) Social anxiety disorder
a) PTSD
Mr. M. Physema has a history of asthma and has been using a rescue inhaler as needed for shortness of breath. He hasn't had to use his albuterol inhaler for about 6 months, so he didn't think to mention it to his provider when they asked him about his current medication. His first line antidepressants were not helping his mood, so he was started on a different medication. At this time, he was at a BBQ where there were several smokers. He experienced an asthma attack and used his albuterol inhaler for relief. After about 15 minutes, he experienced palpitations. What could have caused this reaction? a) Phenelzine b) Trazodone c) Buspirone d) Amitriptyline
a) Phenelzine
Which of the following anticonvulsants are NOT used in anxiety disorders? a) Phenytoin b) Lamotrigene c) Neurontin d) Gabapentin
a) Phenytoin
Stu Dent comes to your office upon referral for initiating drug therapy for depression and anxiety. You notice that he has not showered and he mentions that the world would be a better place without him. Which agents would you avoid in Stu? a) SNRIs b) SSRIs c) Bupropion d) Buspar
a) SNRIs
Sonia is a 70 year old female who has a history of Type II diabetes and breast cancer. She complains of pain, but cannot specify where the pain is nor can she describe it. She has lost the desire to get up in the morning and reports low energy for the past 9 months. Which agents would you prescribe? a) Duloxetine 150mg bid b) Venlafaxine 5mg tid c) Duloxetine 20mg bid d) Effexor 225mg daily
c) Duloxetine 20mg bid
Mrs. T, a 39-year-old state hospital resident with schizoaffective disorder, bipolar type, has been treated with clozapine, 250 mg bid for 6 months; her most recent trough serum level was 492 ng/mL. She smokes 15 cigarettes/d. Two weeks after the hospital institutes a no-smoking policy, Mrs. T complains of excessive drooling and lightheadedness. Her trough clozapine level is now 875 ng/mL. A PMHNP who is treating this patient understands that Clozapine is a CYP 1A2 enzyme substrate and nicotine is CYP 1A2 enzyme_____, and decides to ______ the dosage of Clozapine. Fill in the blank. a. Inducer/decrease b. Inhibitor/increase c. Substrate/maintain d. None of the listed answers
a. Inducer/decrease
Bruce is a 65 year old male who weighs 420lbs. His only complaint is that he has difficulty walking due to pain in his knees. He has difficulty driving over the past year and is becoming increasingly depressed about this situation. His daughter is unable to visit him with the grandchildren since she does not drive. What would you prescribe to treat his depression? a) Amitriptyline b) Mirtazapine c) Fluoxetine d) Selegiline
c) Fluoxetine
Sally is a 27-year-old attorney who recently moved to your area. Sally presents with social anxiety disorder, specifically symptoms of performance anxiety and also has been sober for the last 5 years from drinking. Sally's only other medical condition is exercise-induced asthma, and she is treated on Albuterol. Sally states she was in cognitive behavioral therapy, without relief, and would like to try a medication. Which is the most suitable initial treatment for Sally? a. Zoloft (SSRI) b. Inderal (beta blocker) c. Klonopin (benzodiazepine) d. Seroquel (atypical antipsychotic)
a. Zoloft (SSRI) Explanation: Zoloft is used to treat social anxiety disorder and the patient is on albuterol; therefore, the beta blocker is contraindicated with Albuterol due to the risk of increased CNS stimulation.
What is the neurotransmitter, dopamine, responsible for? a. pleasure and motor activities b. mood and anxiety c. sedation and weight gain d. dementia and anxiety disorders
a. pleasure and motor activities
Foods rich in tyramine should be avoided with which medication(s)? a) Paroxetine b) Phenelzine c) Acetaminophen d) All of the above
b) Phenelzine
Mike is a 53 year old with past medical history of MI. He has always been very active and his recent physical limitations have made him very depressed. After 6 months, he has gained weight due to his significantly decreased physical activity and you decide to start him on an antidepressant. Which agent is best for Mike? a) Amitriptyline b) Sertraline c) Paroxetine d) Citalopram
b) Sertraline
Peter is a 78 year old gentleman who has benign prostate hypertrophy and hypertension. He currently takes tamsulosin for his BPH and amlodipine or his HTN. He lost his wife in January and has been depressed ever since. You prescribe: a) Alprazolam b) Sertraline c) Selegiline d) Trazodone
b) Sertraline
It has been one week and Haley returns to you and tells you that she still cannot sleep. In fact, her insomnia has gotten worse. You let her know that there is a medication you can prescribe to help, and she states that she would like to give it a trial. Which medication would you suggest? a) Nyquil b) Trazodone c) Bupropion d) Haloperidol
b) Trazodone
______________ can cause priapism, which may require surgical intervention, in a subset of males. a) Triazolam b) Trazodone c) Triamterene d) Timolol
b) Trazodone
Metabolic syndrome includes monitoring of; a) Vaccines b) Weight c) Vision d) a and c
b) Weight
F.R. is seen 8 months after remission has been achieved. He indicates that he has been feeling down and has not been sleeping much for the past 3 weeks. He goes on to explain that he's had to lay off more of his employees and is considering closing his business altogether due to decreased revenue. The patient is experiencing recurrent depressive episodes and has become nonresponsive/resistant to current treatment of Sertraline 200mg/day and Buspirone 15mg BID. Q. Which of the following management strategies is most appropriate for F.R.'s apparent treatment-refractory MDD, given his recent history of multiple lines of therapy? a. Switching b. Augmentation c. Combination d. Optimization
b. Augmentation
Follow up to determine if the medication prescribed is working should be scheduled in _____ weeks from initial visit. a) 1 week b) 2 weeks c) 4 weeks d) 12 weeks
c) 4 weeks
What is the best first line drug therapy option for Haley? a) Amitriptyline 25mg daily b) Buspirone 10mg three times daily c) Citalopram 20mg daily d) Doxepin 50mg daily
c) Citalopram 20mg daily
Mr. John is a 38-year-old white male who has been successfully treated on Selegline for over 4 years. Ms. Joh is going in for an elective surgical procedure. Which medication is strictly contraindicated with Selegline? a. Codeine b. Meperidine c. Morphine d. Non-steroidal anti-inflammatory drugs (NSAIDS)
b. Meperidine
Rae has recently been started on sertraline for her depression. She calls you the next day to report that she feels the medication is not working and she is very worried that nothing will help her. You explain that the medication will take a week or so to take effect. She still expresses a great deal of anxiety. What would you prescribe as a "bridge" to help with her anxiety during this time? a) Triazolam 0.125mg daily b) Diazepam 1mg tid c) Clonazepam 0.25mg bid d) Temazepam 30mg daily
c) Clonazepam 0.25mg bid
Difficulty concentrating, anhedonia, and blunted affect are all examples of a. positive symptoms of schizophrenia b. negative and cognitive symptoms of schizophrenia c. increased dopamine levels d. excessive transmission of dopamine
b. negative and cognitive symptoms of schizophrenia
Mary Jane is being started on pharmacotherapy for the treatment of major depressive disorder. Which is the most likely starting dose? a) Citalopram 60mg daily b) Escitalopram 40mg daily c) Fluoxetine 80mg daily d) Sertraline 50mg daily
d) Sertraline 50mg daily
Mr. Fox has recently been diagnosed with schizophrenia. He is a Type 2 diabetic who has been controlled on insulin. Which of the following would you recommend for Mr. Fox ? a. clozapine b. olanzapine c. aripiprazole d. risperidone
c. aripiprazole
Norepinephrine deficiency syndrome includes which symptom? a. focus b. increased athletic performance c. slowness of information processing d. energetic mood
c. slowness of information processing
Quinn is a 70 year old gentleman who was a past medical history of atrial fibrillation, hypertension, hyperlipidemia and newly diagnosed anxiety. What baseline information is needed to determine the best anxiolytic for Quinn? a) What is his current medication list b) Baseline QTc c) Diet d) All of the above
d) All of the above
Venlafaxine should be used cautiously in patients with: a) Hyperthyroidism, glaucoma b) CHF, recent MI c) HTN, glaucoma d) All of the above
d) All of the above
Quinn's active medication list includes coumadin 5mg daily, aspirin 81 mg daily, atorvastatin 10mg daily, hydrochlorothiazide 25mg daily and propranolol 40mg daily. One of his active medications is known to cause depression in some individuals. What is the mechanism? a) Alpha agonist b) Alpha antagonist c) Beta agonist d) Beta antagonist
d) Beta antagonist
All of the following are examples of SSRIs except: a) Fluvoxamine b) Escitalopram c) Paroxetine d) Duloxetine
d) Duloxetine
Benzodiazepines bind to which receptor complex? a) Alpha b) Beta c) Norepinephrine d) GABA
d) GABA
Paroxetine should be avoided with: a) Thiazide diuretics b) Swiss cheese c) White wine d) Linezolid
d) Linezolid
Which of the following agents can be used for hypertension due to tyramine induced hypertension? a) Amlodipine 5mg b) Toprol 50mg c) Nifedipine XL 90mg d) Nifedipine 10mg
d) Nifedipine 10mg
Which beta blocker has the most potential to cause depression? a) Atenolol b) Metoprolol c) Nadolol d) Propranolol
d) Propranolol
When studying pharmacodynamics involving receptors, an inverse agonist produces the following effect: a. Blocks the agonist from opening the channel, and does not activate a biological response. b. Does not fully activate the receptor and causes only limited actions. c. Activates a biological response, and opens the ion channel. d. Causes the opposite effect of agonist, and causes the receptor to close the ion channel.
d. Causes the opposite effect of agonist, and causes the receptor to close the ion channel.
First-line treatment for generalized anxiety may include: a) Antidepressants and cognitive behavioural therapy b) Antidepressants and anti-anxiolytics c) Benzodiazepines d) All of the above e) Both A & B
e) Both A & B
Please list the following from least to most sedative Aripiprazole chlorpromazine risperidone haloperidol
haloperidol Aripiprazole risperidone chlorpromazine
Which of the following is the only drug known to reduce suicidality in bipolar disorder?
lithium
Which of the following can reduce both positive and negative symptoms of schizophrenia without increasing extrapyramidal effects? May choose more than one correct answer. lurasidone ziprasidone haloperidol fluphenazine
lurasidone ziprasidone
Anticonvulsant medications stabilize behavior and __________________
mood symptoms
Which of the statements are false? a) SSRIs and SNRIs are recommended first line agents as anxiolytics in treatment naive patients b) If one SSRI is ineffective for a particular patient, the whole class of SSRIs should be excluded c) SSRIs inhibit the reuptake of serotonin d) SSRIs are not likely to cause dependence
true a) SSRIs and SNRIs are recommended first line agents as anxiolytics in treatment naive patients true c) SSRIs inhibit the reuptake of serotonin true d) SSRIs are not likely to cause dependence False -- b) If one SSRI is ineffective for a particular patient, the whole class of SSRIs should be excluded
