Antidepressants, Antianxiety, Antipyscotics

In comparing the characteristics of thioridazine with other older antipsychotic drugs, which of the following statements is accurate? (A) Most likely to cause extrapyramidal dysfunction (B) Least likely to cause urinary retention (C) Most likely to be safe in patients with history of cardiac arrhythmias (D) Most likely to cause ocular dysfunction (E) The safest antipsychotic drug in overdose

(A) Most likely to cause extrapyramidal dysfunction

Haloperidol is not an appropriate drug for management of (A) Acute mania (B) Amenorrhea-galactorrhea syndrome (C) Schizoaffective disorders (D) Tourette's syndrome

(B) Amenorrhea-galactorrhea syndrome

A 30-year-old male patient is on drug therapy for a psychiatric problem. He complains that he feels "flat" and that he gets confused at times. He has been gaining weight and has lost his sex drive. As he moves his hands, you notice a slight tremor. He tells you that since he has been on medication he is always thirsty and frequently has to urinate. The drug he is most likely to be taking is (A) Carbamazepine (B) Clozapine (C) Lithium (D) Risperidone (E) Valproic acid

(C) Lithium

Which statement concerning the use of lithium in the treatment of bipolar affective disorder is accurate? (A) Ingestion of foods with high salt content enhances the toxicity of lithium (B) Lithium usually alleviates the manic phase of bipolar disorder within 12 h (C) Lithium dosage may need to be decreased in patients taking thiazides (D) Since lithium does not cross the placental barrier, it is safe in pregnancy (E) The elimination rate of lithium is equivalent to that of creatinine

(C) Lithium dosage may need to be decreased in patients taking thiazides

Which of the following drugs is established to be both effective and safe to use in a pregnant patient suffering from bipolar disorder? (A) Carbamazepine (B) Fluphenazine (C) Lithium (D) Olanzapine (E) Valproic acid

(D) Olanzapine

Which statement concerning the adverse effects of antipsychotic drugs is accurate? (A) Acute dystonic reactions occur commonly with olanzapine (B) Akathisias due to antipsychotic drugs are managed by increasing the drug dose (C) Blurring of vision and urinary retention are common adverse effects of haloperidol (D) Retinal pigmentation is a dose-dependent toxic effect of thioridazine

(D) Retinal pigmentation is a dose-dependent toxic effect of thioridazine

A young male patient recently diagnosed as schizophrenic develops severe muscle cramps with torticollis a short time after drug therapy is initiated with haloperidol. The best course of action would be to (A) Add risperidone to the drug regimen (B) Discontinue haloperidol and observe the patient (C) Give oral diazepam (D) benztropine (E) Switch the patient to fluphenazine

(D) benztropine

Which of the following drugs has a high affinity for 5-HT2 receptors in the brain, does not cause extrapyramidal dysfunction or hematotoxicity, but is reported to increase the risk of significant QT prolongation? (A) Clozapine (B) Haloperidol (C) Olanzapine (D) Valproic acid (E) Ziprasidone

(E) Ziprasidone

An 18-year-old has been diagnosed with obsessive-compulsive disorder. Her main obsessions involve contamination. She compulsively avoids touching doorknobs and using public restrooms. She spends a lot of time making sure that she is clean by washing her hands for 3 to 4 hours daily. Sertaline therapy was initiated, and for 3 weeks she has been receiving 100 mg daily. While her symptoms have abated somewhat, she continues to suffer significantly. At this point you should recommend that the physician: A. Add bupropion as augmentation therapy B. Discontinue fluoxetine and begin clomipramine C. Continue for 2 to 4 more weeks and reevaluate D. Add aripiprazole to help control the obsessions

A. Add bupropion as augmentation therapy

A patient under treatment for a major depressive disorder is brought to the emergency department after ingesting 30 times the normal daily therapeutic dose of imipramine. Which of the following would be least useful? A. Administer bicarbonate and potassium chloride (to correct acidosis and hypokalemia) B. Administer lidocaine (to control cardiac arrhythmias) C. Initiate hemodialysis (to hasten drug elimination) D. Maintain heart rhythm by electrical pacing E. Use intravenous diazepam to control seizures

A. Administer bicarbonate and potassium chloride (to correct acidosis and hypokalemia)

A 20-year-old female presents to the emergency department with chest pain for the last 20 minutes. She describes a 'squeezing' sensation in the chest and can feel her heart 'racing'. Worried that she might be having a heart attack, she took aspirin before coming to the hospital. 5 days ago, she had similar symptoms, but they resolved within 10 minutes. She is a college student and works part-time at a local bookstore. Her medical and family history is unremarkable. She denies drug and alcohol use. Vital signs show a temperature of 37.0°C (98.6°F), a pulse of 110/min, respirations are 28/min, and a blood pressure of 136/80 mm Hg. On examination, the patient appears fidgety and restless. An echocardiogram (ECG) shows sinus tachycardia but is otherwise normal. Which of the following drugs is most appropriate at this time? A. Alprazolam B. Nitroglycerin C. Propranolol D. Buspirone E. Setraline

A. Alprazolam

In which way does benzodiazepine interact with GABA-A receptor? A. Benzodiazepines increase the frequency of ion channel opening and allow chloride ions passage into the cell. B. Benzodiazepines increase the frequency of ion channel opening and allow all ions passage into the cell. C. Benzodiazepines increase the duration of ion channel opening and allows chloride ions passage into the cell. D. Benzodiazepines increase the frequency of ion channel opening and allows sodium ions passage out of the cell. E. Benzodiazepines decrease the frequency of ion channel opening to prevent chloride ions movement across the membrane.

A. Benzodiazepines increase the frequency of ion channel opening and allow chloride ions passage into the cell.

A 45-year-old man from Portland, Oregon with history of hypertension and HL on clonidine, lisinopril, simvastatin and metformin was seen in your clinic. He complained from difficulty concentrating, remembering details, and making decision, fatigue and decreased energy. Which medication is most likely to contribute to symptoms of anxiety? A. Clonidine B. Lisinopril C. Metformin D. simvastatin

A. Clonidine

A 26-year-old man is brought to the hospital by his wife who complains that her husband has been behaving oddly for the past few hours. She has known him for only 4 months and has been married for the past 2 months. The wife is unable to give any past history of similar complaints. The patient's speech is difficult to follow and he seems very distracted. After 15 minutes, he becomes agitated and starts to bang his head to the nearby pillar. He is admitted to the psychiatric ward and is given an emergency medication after which he calms down. In the next 2 days, he continues to become agitated at times and required 2 more doses of the same drug. On the fourth day of admission, he appears very weak, confused, and does not respond to questions appropriately. He appears to sweat profusely and has a temperature of 40.0°C (104.0°F). His blood pressure is 160/95 mm Hg and pulse is 114/min. He is unable to stand upright or even get up from his bed. What is the mechanism of action of the drug used which led to the patient's current symptoms? A. Dopamine receptor blocking B. Serotonin reuptake inhibition C. Agonistic effect on the dopamine receptors D. Histamine H2 receptor blocking E. Skeletal muscle relaxation

A. Dopamine receptor blocking

A 39 year old male is brought to the emergency department after attempting to commit suicide. It was reported that two empty bottles of phenobarbital tablets were found at the scene when emergency personal arrive and they found a suicide note in his room. Which of the following options would be the LEAST effective to save this man's life? A. Flumazenil to block the GABA-A receptor from interacting with the drug. B. Intubation to protect the airway. C. Intravenous fluid and vasopressors to maintain heart rate and blood pressure. D. Gastric lavage to remove undissolved tablets. Hemodialysis to remove the drug from the peripheral blood.

A. Flumazenil to block the GABA-A receptor from interacting with the drug.

A 39-year-old male is brought to the emergency department after attempting to commit suicide. It was reported that two empty bottles of phenobarbital tablets were found at the scene when emergency personal arrived, and they found a suicide note in his room. Which of the following options would be the LEAST effective to save this man's life? A. Flumazenil to block the GABA-A receptor from interacting with the drug. B. Gastric lavage to remove undissolved tablets. C. Intubation to protect the airway. D. Intravenous fluid and vasopressors to maintain heart rate and blood pressure. E. Hemodialysis to remove the drug from the peripheral blood.

A. Flumazenil to block the GABA-A receptor from interacting with the drug.

Which of the following antidepressants would be the least likely to cause a withdrawal syndrome based on its pharmacokinetic profile? A. Fluoxetine B. Duloxetine C. Paroxetine D. Sertraline

A. Fluoxetine

You are treating a 74 year old female with Parkinson's disease. Past medical history includes chronic hepatitis C infection, breast cancer treated 10 years ago (now in full remission), and urinary urgency. She is on a high dose of Carbidopa/Levodopa and needs an additional medication to treat her symptoms. What is a contraindication to using tolcapone? A. History of breast cancer B. Old age C. Hepatitis C infection D. Dosage of Carbidopa/Levodopa is already too high E. Urinary urgency

A. Hepatitis C infection

A 50-year-old male patient with Huntington's disease comes to your office for a follow up. He asks you for a drug which could potentially cure his disease. Which of the following is the best response? A. I am sorry there is no cure for this disease. However, we have dopamine antagonists to fix the movement problem. B. We have a cure for this disease. C. There is nothing I can do to help with your symptoms. D. I am sorry there is no cure for this disease. However, we have drugs with great efficiency to treat your mood and pyschological issues. E. I am sorry there is no cure for this disease. However, we have drugs to treat your memory problems.

A. I am sorry there is no cure for this disease. However, we have dopamine antagonists to fix the movement problem.

A 7-year-old boy is having frequent episodes of blanking out or daydreaming. Each episode lasts for less than 10 seconds. During the episode, he is unaware of what is going on around him and does not respond to the calling. After the episode, he continues whatever he was doing before. EEG shows generalized 3-4 Hz spike-and-slow-wave complexes. What is the mechanism of action of the drug of choice for this condition? A. Inhibits voltage gated calcium channels B. Inhibits release of excitatory amino acid glutamate C. Inhibits neuronal GABA receptors D. Inhibits voltage gated sodium channels E. Potentiates GABA transmission

A. Inhibits voltage gated calcium channels

A young female adult presents to her family physician's office for a follow-up appointment. She is currently on an antimanic drug and says she is doing better than before especially after she became a part of a support group at her college. She recently noticed that she needs to drink a lot of water and often needs to go to the bathroom. She is concerned that these symptoms may be due to her medication. She also feels a bit confused and agitated. Her vitals are a blood pressure of 122/89 mm Hg, a temperature of 36.7°C (98.0°F), a pulse of 88/min and respirations are 18/min. Her physical exam is within normal limits. Which of the following drugs is she most likely taking? A. Lithium B. Amitriptyline C. Valproic acid D. Carbamazepine E. Chlorpromazine

A. Lithium

If lamotrigine is initiated in a patient receiving valproic acid (VPA), the starting dose of lamotrigine should be: A. Lower than if started in a patient not receiving VPA because of risk of Steven Johnson syndrome B. Higher than if started in a patient not receiving VPA to avoid hepatotoxicity C. The same as in a patient not receiving VPA D. Lamotrigine is contraindicated in patients receiving VPA because of hyponatremia

A. Lower than if started in a patient not receiving VPA because of risk of Steven Johnson syndrome

Which Dopamine Pathway is associated hallucinations? A. Mesolimbic tract B. Chemoreceptor zone C. Mesocortical tract D. Nigrostriatal tract E. Tuberoinfundibular tract

A. Mesolimbic tract

A 40-year-old female with carcinoma of the breast is admitted to the hospital. Her past medical history is significant for hepatitis C and major depression, as well as intravenous heroin abuse for a long period. She was in a methadone maintenance program but relapsed soon after. She underwent a mastectomy for her breast carcinoma, followed by chemotherapy. She was in remission until her cancer relapsed a month ago. Since then, she has been given oxycodone and transdermal lidocaine for analgesia, followed by oral morphine for better pain control. However, she continued using intravenous heroin because of the intense pain and opioid craving. A new analgesic drug is initiated. She is discharged on this drug. On follow-up, she reports adequate pain control along with complete abstinence from heroin, which is confirmed by the toxicology screen. Which of the following is the primary mechanism of action of the new drug? A. Mixed agonist-antagonist at opioid receptors B. Pure antagonist at opioid receptors C. Inhibits prostaglandin synthesis D. Pure agonist at the µ-opioid receptor E. Central action via blockade of serotonin reuptake

A. Mixed agonist-antagonist at opioid receptors

A 34-year-old male presents to the outpatient department with a complaint of right-sided jaw pain. Each episode of pain lasts for about 30 seconds. This has lasted for the last month but has increased in the number of episodes per day which has brought him to the clinic. Which is the correct mechanism of action for this patient's drug of choice? A. Prevention of Na+ influx B. Decrease the excitatory effects of glutamic acid C. Increase the frequency of Cl- channel opening D. Increase the time of Cl- channel opening E. Decrease in the Ca(2+) influx

A. Prevention of Na+ influx

A 17-year-old female is rushed into the emergency department by her father who found her collapsed in her bedroom 15 minutes before the arrival of the ambulance. There was an empty bottle of clomipramine in her bedroom which her mother takes for her depression. The father says that his daughter recently broke up with her boyfriend and was quite upset. Vital signs are respirations 8/min, pulse 130/min, and blood pressure 100/60 mm Hg. On examination, the patient is unresponsive to vocal and tactile stimuli. Her oral mucosa and tongue are dry, and the bladder is palpable. A bedside electrocardiogram (ECG) shows QRS widening. Which of the following would most benefit the patient at this time? A. Sodium bicarbonate B. Lidocaine C. Induced vomiting D. Norepinephrine E. Diazepam

A. Sodium bicarbonate

You treat a 40-year-old female for neurotic depression. After a few visits you prescribe amitriptyline to relieve her depression. After 4 days she calls you to say the pills are having no effect and she still feels depressed. The best course of action would be to advise her to: A. continue on the medication as prescribed, as the drug often takes up to 2-6 weeks to have its antidepressant, effect B. double the dose C. stop the pills and you will order other treatment from the pharmacist D. continue on the same dose and you will call in an order for a second drug to use in combination with it E. take the pills with an alcoholic drink to increase their effect

A. continue on the medication as prescribed, as the drug often takes up to 2-6 weeks to have its antidepressant, effect

Barbiturates interact on which subunit(s) of the GABA-A receptor? A. Gamma subunit B. Alpha and gamma subunits C. Alpha and beta subunits D. Alpha subunit E. Beta subunit

D. Alpha subunit

In the treatment of social anxiety disorder, which of the following medications is associated with the risk of dependence with chronic and prolonged use? A. Buspirone B. Alprazolam C. Venlafaxine D. Escitalopram

B. Alprazolam

What is the difference between benzodiazepines and barbiturates? A. Benzodiazepine toxicity can lead to coma and death. It is difficult to cause coma and death with barbiturates. B. Barbiturate toxicity can lead to coma and death. It is difficult to cause coma and death with benzodiazepines. C. Barbiturates are frequently used for anti-anxiety treatment. All barbiturates and benzodiazepines are metabolized in the liver

B. Barbiturate toxicity can lead to coma and death. It is difficult to cause coma and death with benzodiazepines.

In which way does benzodiazepine interact with GABA-A receptor? A. Benzodiazepines increase the frequency of ion channel opening and allows all ions passage into the cell B. Benzodiazepines increase the frequency of ion channel opening and allows chloride ions passage into the cell C. Benzodiazepines decrease the frequency of ion channel opening to prevent chloride ions movement across the membrane D. Benzodiazepines increase the duration of ion channel opening and allows chloride ions passage into the cell E. Benzodiazepines increase the frequency of ion channel opening and allows sodium ions passage out of the cell

B. Benzodiazepines increase the frequency of ion channel opening and allows chloride ions passage into the cell

A 34-year-old male patient who was prescribed citalopram for depression has decided he wants to stop taking the drug. When questioned, he said that it was affecting his sexual performance. You ascertain that he is also trying to overcome his dependency on tobacco products. If you decide to reinstitute drug therapy in this patient, the best choice would be A. Amitriptyline B. Bupropion C. Fluoxetine D. Imipramine E. Venlafaxine

B. Bupropion

A 52-years-old man presented with history of recurrent episodes of unilateral headaches. The episodes were short lived (usually lasting for a few seconds to 3-4 minutes), with a severe throbbing orbital headache, accompanied by ipsilateral conjunctival injection and lacrimation. Often, the headache seemed to be triggered by a cutaneous stimulus over face or while chewing food. Often, he used to experience countless attacks during a single day. Typically, the headache did not respond to Indomethacin and other non-steroidal anti-inflammatory drugs (NSAID). Which of the following drugs is likely to be least effective as a preventive therapy? A. Gabapentin B. Carbamazepine C. Valproic acid D. Lamotrigine E. Topiramate

B. Carbamazepine

SSRIs are much less effective than tricyclic antidepressants in the management of A. Bulimia B. Chronic pain of neuropathic origin C. Generalized anxiety disorder D. Obsessive-compulsive disorder E. Premenstrual dysphoric disorder

B. Chronic pain of neuropathic origin

A recently widowed 76-year-old female patient was treated with a benzodiazepine for several weeks after the death of her husband, but she did not like the daytime sedation it caused even at low dosage. Living independently, she has no major medical problems but appears rather infirm for her age and has poor eyesight. Because her depressive symptoms are not abating, you decide on a trial of an antidepressant medication. Which of the following drugs would be the most appropriate choice for this patient? A. Amitriptyline B. Citalopram C. Mirtazapine D. Phenelzine E. Trazodone

B. Citalopram

Which of the following antidepressants would be the most likely to help with neuopathic pain in diabetic patients? A. Fluoxetine B. Duloxetine C. Paroxetine D. Sertraline

B. Duloxetine

A 50-year-old man presents to the emergency room with a rapid onset of severe, right periorbital pain, an ipsilateral throbbing headache, and blurring of vision lasting 1 hour. He was out walking with his friend when he felt short of breath. His friend gave him a puff of his rescue inhaler because it often relives his breathlessness. Soon thereafter, the patient's eye symptoms started. He has no history of any medical condition and was only hospitalized once in his teenage years for an appendectomy. His pulse is 100/min and regular, respirations are 18/min, temperature is 36.7°C (98.0°F), and blood pressure 130/86 mm Hg. His right pupil is fixed and dilated. Fundoscopic examination of the right eye is difficult due to 'clouding' of the cornea, and tonometry reveals an increased intraocular pressure (IOP). He is in acute distress. Physical examination reveals abnormal findings. His therapy begins with ibuprofen, acetazolamide, timolol, pilocarpine, and topical prednisolone. His symptoms are only mildly reduced. What is the next best step in the management of this patient? A. Administer systemic steroids B. Get an urgent ophthalmology consultation C. Anesthetize the eye and perform corneal indentation D. Add latanoprost E. Perform emergency iridotomy

B. Get an urgent ophthalmology consultation

A 22-year-old man presents to the emergency room after an altercation with the police. The police were called because the man was acting erratically in public. On examination, he is disoriented, does not respond to questioning, and appears to be reacting to internal stimuli. Lab work is performed which is all within normal limits, including a toxicology screen. He becomes aggressive and is given a medication to address his acute psychotic episode. An hour later, the patient is found in a sustained rigid posture in his bed, with his eyes in a fixed upward gaze. What medication was this patient given? A. Citalopram B. Haloperidol C. Phenelzine D. Olanzapine E. Alprazolam

B. Haloperidol

A 35-year-old school teacher has been treated for generalized anxiety disorder for 4 weeks with paroxetine 20 mg daily. The patient has a partial response. Based on evidence-based treatment guidelines, the most appropriate action is which of the following? A. Taper the dose gradually over the next 2 weeks B. Increase paroxetine to 30 mg and reassess in 4 weeks C. Add clonazepam 1 mg 3 times daily for 2 weeks D. Switch to sertraline 50 mg daily, increase to 100 mg in a week

B. Increase paroxetine to 30 mg and reassess in 4 weeks

The preferred treatment option for a 20-year-old patient with bipolar disorder who has severe liver disease is: A. Valproic acid B. Lithium C. Carbamazepine D. Lamotrigine

B. Lithium

Which of the following laboratory test is needed prior to initiating therapy with valproic acid? A. Potassium level B. Liver function test C. Thyroid function test D. Magnesium level

B. Liver function test

You are consulted on the case of a 71-year-old patient with newly diagnosed generalized anxiety disorder who has severe anxiety requiring pharmacotherapy with a quick onset of effect. Which of the following benzodiazepines do you recommend? A. Alprazolam B. Lorazepam C. Clorazepate D. Chlordiazepoxide

B. Lorazepam

A 20-year-old female presents to the physician with a complaint of persistent sadness for the last 2 months. She says that she is always feeling tired and nothing seems to cheer her up. Previously a top student at her college, she did not register for classes this term because she does not feel like going to school anymore. Her friends complain that she does not want to 'hang out' with them anymore. She is sleeping more than usual and often does not want to leave the bed in the morning. No suicidal ideation or preoccupation with death is reported. Concerned about her weight, she has maintained a calorie-restricted diet for the last several years but admits to a junk food binge every once in a while. Her past medical history is unremarkable. She currently takes a daily multivitamin. Her pulse is 64/min, respirations are 12/min, blood pressure is 110/70 mm Hg, and temperature is 36.9°C (98.5°F). Examination reveals a pale young female with a dry oral cavity and multiple dental caries. Her body mass index (BMI) is 17.5 kg/m2. She has some calluses on the knuckles of her left hand. Which of the following medications is most likely to benefit this patient? A. Trazodone B. Mirtazapine C. Fluoxetine D. Bupropion E. Amitriptyline

B. Mirtazapine

Which of the following antidepressants is associated with the highest incidence of weight gain and sedation? A. Venlafaxine B. Mirtazapine C. Paroxetine D. Sertraline

B. Mirtazapine

A patient who experiences blushing, palpitations, and hand tremor before a public performance is best treated with which of the following medications? A. Venlafaxine B. Propranolol C. Pregabalin D. Citalopram

B. Propranolol

A 38-year-old man presents to the doctor's office with a 1-year history of resting tremor and clumsiness in his right hand. His symptoms are interfering with his work as a teacher and his colleagues are wondering if he has issues with drinking or drugs. He is increasingly embarrassed and tends to keep his hand in his pocket. He denies drinking in excess and has never taken any recreational drugs. He is losing interest in meeting friends for their weekly rounds of golf and generally feels 'down'. He has no other health concerns and takes no medications. His grandfather had a tremor and his father passed away at a young age. Neither his brother nor his sister has a tremor. Vitals are pulse of 70/min, respirations of 15/min, blood pressure of 124/70 mm Hg and temperature of 36.7°C (98.1°F). Examination reveals decreased facial expression, hypophonia, resting tremor in the right hand, rigidity in the upper limbs and normal reflexes. No abnormalities of posture are seen and gait is normal except for decreased arm swing on the right. The rest of the examination is unremarkable. Which of the following medications will help both his movement disorder and depressive symptoms? A. Benztropine B. Selegiline C. Entacapone D. Bromocriptine E. Levodopa/carbidopa

B. Selegiline

Which of the following neurotransmitter systems is most likely involved in the pathophysiology of anxiety disorders? A. Dopamine B. Serotonin C. Acetylcholine D. Histamine

B. Serotonin

A patient with a history of prescription drug abuse with oxycodone presents for acute management of panic disorder. The most appropriate initial therapy for this patient is which of the following? A. Bupropion 150 mg twice daily B. Sertraline 25 mg every morning C. Alprazolam XR 1 mg twice daily D. Buspirone 5 mg 3 times daily

B. Sertraline 25 mg every morning

Which of the following antiepileptic drugs is most likely to be associated with secondary bilateral angle closure glaucoma? A. Lamotrigine B. Topiramate C. Gabapentin D. Zonisamide E. Tiagabine

B. Topiramate

Which of the following antidepressants would be the most likely to cause sexual dysfunction? A. Fluoxetine B. Venlafaxine C. Bupropion D. Sertraline

B. Venlafaxine

The pharmacologic action of monoamine oxidase inhibitors is: A. block the reuptake of monoamine neurotransmitter into the presynaptic cleft B. blocks the metabolism of monoamine neurotransmitters C. decreases 5HT and NE monoamines D. enhances REM sleep

B. blocks the metabolism of monoamine neurotransmitters

A substance which decreases or inhibits the metabolism of benzodiazepines metabolized to active metabolites in the liver is: A. ranitidine B. cimetidine C. rifampin D. carbamazepine E. phenytoin

B. cimetidine

An appropriate length of time to assess the efficacy of sertraline 150 mg daily in the treatment of PTSD is which of the following? A. 1 week B. 3 weeks C. 6 weeks D. 24 weeks

C. 6 weeks

During the lag time for onset of action of lithium, an appropriate adjunctive medication for acute mania might include drugs from all of the following classes except: A. Antihistamines B. Benzodiazepines C. Antipsychotics D. Anticonvulsants

C. Antipsychotics

Comparing Ben and Barb, and this is how we commonly call them in pharmacy practice J. Pick the correct statement. A. Both barbiturates and benzodiazepines can be reversed by flumazenil. B. Both barbiturates and benzodiazepines act by inhibiting NA ions C. Both barbiturates and benzos inhibit the actions of GABA on a GABA A receptor complex. D. D Both benzos and barbiturates have strong antiseizure activity at low doses.

C. Both barbiturates and benzos inhibit the actions of GABA on a GABA A receptor complex.

Which of the following agent should not be used in patients with history of closed head injury, truma or seizure? A. Fluoxetine B. Venlafaxine C. Bupropion D. Sertraline

C. Bupropion

Which of the following antidepressants would be the least likely to cause sexual dysfunction? A. Fluoxetine B. Venlafaxine C. Bupropion D. Sertraline

C. Bupropion

Which of the following drugs is most likely to be of value in obsessive-compulsive disorders? A. Amitriptyline B. Bupropion C. Clomipramine D. Trazodone E. Venlafaxine

C. Clomipramine

A 70-year-old male with Parkinson's disease presents to the physician's office with his daughter for a follow up visit. He is on levodopa for the last 10 days and his daughter feels that his symptoms are not improving. She asks if a different drug could be prescribed. The physician explains that levodopa is the most effective drug and the other drug which is a dopamine agonist has more side effects. Which type of side effects is he talking about? A. A potential fall. B. Hypotension. C. Cognitive and behavioral side effects. D. Dizziness. E. Motor side effects.

C. Cognitive and behavioral side effects.

A 38-year-old male presents to his primary care physician for a follow-up visit. Two weeks back, he presented with fatigue and weight loss for four months. He felt tired all the time, which he blamed on waking up early in the morning and being unable to fall back asleep. Although he is a successful web developer with lots of ongoing projects, he no longer feels interested in his work. He lost weight and says," I just don't want to eat". A diagnosis of major depression was made and sertraline started. His past medical history is unremarkable and he takes no other medications. For the last two weeks, he has been compliant with his medications and is now getting a full night's sleep with no early morning awakenings. Since starting the medication, he has had mild nausea but no other complaints. Despite regaining his appetite, he hasn't regained any lost weight and he still feels fatigued. He believes the medication is not working and asks to be started on something else. Which of the following is most appropriate for this patient? A. Replace sertraline with fluoxetine B. Discontinue sertraline C. Continue sertraline D. Add fluoxetine to sertraline E. Add amitriptyline to sertraline

C. Continue sertraline

A 28-year-old female with history of psychosis is brought to clinic by her husband. He states that her symptoms are under control with risperidone but he is concerned about her weight gain and milky white discharge from her breast. Her last menstrual period was 2 months ago. He also adds that she shows less interest in sexual life from last month. No history of a headache, nausea, and vomiting. On examination, vitals were normal, weight gain of 3 kg (6.6 lb) and bilateral breast tenderness was present. A pregnancy test was also negative. Systemic examination was normal. What could be the exact mechanism for her presentation? A. Decrease in dopamine activity in mesolimbic pathway B. Increase in dopamine activity in mesolimbic pathway C. Decrease in dopamine activity in tuberoinfundibular pathway D. Increase in dopamine activity in tuberoinfundibular pathway E. Decrease in dopamine activity in nigrostriatal pathway

C. Decrease in dopamine activity in tuberoinfundibular pathway

Trifluoperazine was prescribed for a young male patient diagnosed as suffering from schizophrenia. He complains about the side effects of his medication. Which of the following is not likely to be on his list? A. Constipation B. Decreased libido C. Excessive salivation D. Postural hypotension

C. Excessive salivation

10.To be effective in breast cancer, tamoxifen must be converted to an active form by CYP2D6. Cases of inadequate treatment of breast cancer have occurred when tamoxifen was administered to patients who were being treated with A. Amitriptyline B. Bupropion C. Fluoxetine D. Mirtazapine E. Phenelzine

C. Fluoxetine

A 20-year-old female presents to the physician with the complaint of persistent sadness for the last 2 months. She says she is always feeling tired and nothing seems to cheer her up. Previously a top student at her college, she did not register for classes this term because she does not feel like going to school anymore. Her friends complain that she does not want to 'hang out' with them anymore. She is sleeping more than usual and often does not want to leave the bed in morning. No suicidal ideation or preoccupation with death is reported. Concerned about her weight, she has maintained a calorie restricted diet for the last several years but admits to a junk food binge every once in a while. Her past medical history is unremarkable. She currently takes a daily multivitamin. Her pulse is 64/min, respirations are 12/min, blood pressure is 110/70 mm Hg, and temperature is 36.9°C (98.5°F). Examination reveals a pale young female with a dry oral cavity and multiple dental caries. Her body mass index (BMI) is 17.5 kg/m2. She has some calluses on the knuckles of her left hand. Which of the following medications is most likely to benefit this patient? Which of the following medication should be avoided? A. Trazodone- B. Mirtazapine C. Fluoxetine- D. Bupropion E. Amitriptyline

C. Fluoxetine- benefit D. Bupropion- don't give with bulimia

Patients with panic disorder should be started at ¼ to ½ of the dose of fluoxetine used to treat depression in order to decrease the risk for which of the following? A. Weight gain B. Sedative effects C. Increased anxiety D. Sexual dysfunction

C. Increased anxiety

Blood pressure of pregnant patient is 148/110 mm Hg today. On her last visit at 24 weeks of gestation, her blood pressure was 146/96 mm Hg. Fundus measures 28 cm above the pubic symphysis. Labs show: Serum Glucose (fasting) 88 mg/dL Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum Creatinine 0.9 mg/dL Blood Urea Nitrogen 10 mg/dL Alanine aminotransferase (ALT) 18 U/L Aspartate aminotransferase (AST) 16 U/L Hemoglobin (Hb%) 85 fL Mean Corpuscular Volume (MCV) 4,200/mm3 Reticulocyte count 1% Erythrocyte count 5.1 million/mm3 Platelet count 95,000mm3 Urinalysis show: Proteins 2+ Glucose negative Ketones negative Leucocytes negative Nitrites negative Red Blood Cells (RBC) negative Casts negative Which of the following medications should she be started on? A. Diazepam B. Ethosuximide C. Magnesium sulfate D. Valproic acid E. Phenobarbital

C. Magnesium sulfate

Which of the following antidepressants would be the most likely to cause a withdrawal syndrome based on its pharmacokinetic profile? A. Fluoxetine B. Duloxetine C. Paroxetine D. Sertraline

C. Paroxetine

A 35-year-old female presents to the psychiatrist for a follow-up of her depression. She was diagnosed with major depression 16 months ago and has tried multiple medications namely bupropion, fluoxetine, sertraline, venlafaxine and imipramine to no avail. Upon inquiry, she assures the psychiatrist that she has been fully compliant with her medications so far but stopped her current medications a few weeks back as they did not help either. Her husband suggested her to try a herbal preparation for improving her mood. She also noted that she felt temporarily better while attending her sister's wedding last weekend but her she still remains to be depressed most of the times. Which of the following could be tried next for her depression? A. St John's Wort B. Selegiline C. Phenelzine D. Electroconvulsive therapy E. Getting regular exercise

C. Phenelzine

A 45-year-old cashier was shot during a robbery at the convenience store where he works 5 months ago. He presents for management of intrusive images of the event, has missed work, feels that someone is following him, and cannot envision the rest of his life as being happy. He complains of recurring nightmares with restless sleep. He is diagnosed with posttraumatic stress disorder. What is the most appropriate pharmacologic management of this patient? A. Imipramine 100 mg twice daily B. Haldol 20 mg every day C. Prazosin 5 at bedtime D. Quetiapine 50 mg at bedtime

C. Prazosin 5 at bedtime

Choose a benefit to the COMT inhibitor, tolcapone. A. Reduced depression B. Reduced psychosis C. Prolonged 'on time' D. Prolonged 'off time' E. Improved exercise tolerance

C. Prolonged 'on time'

Which of the following is NOT a use for benzodiazepines? A. Alcohol withdrawal B. Anxiety (panic disorder) C. Psychosis D. Anxiety (generalized anxiety disorder) E. Muscle spasticity

C. Psychosis

The antidepressant of choice for an elderly patient with narrow-angle glaucoma and major depressive disorder is: A. Imipramine B. Mirtazapine C. Sertraline D. Amitriptyline

C. Sertraline

A 63-year-old patient with asthma, hypertension, and ulcers presents with symptoms of anxiety including palpitations, diaphoresis, and abdominal pain. The patient's medication regimen includes tiotropium, theophylline, lisinopril, and esomeprazole. Which medication is most likely to contribute to symptoms of anxiety? A. Lisinopril B. Tiotropium C. Theophylline D. Esomeprazole

C. Theophylline

Which of the following laboratory test is needed prior to initiating lithium therapy? A. Potassium level B. Platelet count C. Thyroid function test D. Magnesium level

C. Thyroid function test

Which drug is an antagonist at 5-HT2 receptors and widely used for the management of insomnia? A. Estazolam B. Flurazepam C. Trazodone D. Triazolam E. Zolpidem

C. Trazodone

A patient on medication develops severe hypertension after eating some cheese. The combination of substances found in the cheese and medication, respectively, which is the most likely cause of this reaction is: A. ergotamine and amphetamine B. acetylcholine and reserpine C. tyramine and phenelzine D. angiotensin and propranolol E. dopamine and phentolamine

C. tyramine and phenelzine

A 36-year-old woman presents with symptoms of major depression that are unrelated to a general medical condition, bereavement, or substance abuse. She is not currently taking any prescription or over-the-counter medications. Drug treatment is to be initiated with sertraline. In your information to the patient, you would tell her that A. Sertraline may take 2 wk or more to become effective B. It is preferable that she take the drug in the morning C. She should notify you if she anticipates using other prescription drugs D. All of the above

D. All of the above

The following neurotransmitters have been implicated in the pathophysiology of depression: A. Norepinephrine B. Serotonin C. Dopamine D. All of the above

D. All of the above

A 50-year-old female presents to the emergency department accompanied by her husband for a severe headache and vomiting after attending a wine tasting at the local brewery. She tells you that her headache is mostly at the back of her head. Her husband adds that she vomited twice today. She is complaining of nausea. Her past medical history is significant for depression diagnosed 20 years but is now well-controlled with medication. She also has significant vitamin D deficiency. Currently, she takes phenelzine and a vitamin D supplement. She is a non-smoker and denies the use of recreational drugs. Her pupils are dilated and she is sweating profusely in the ER which is air-conditioned. Which of the following is most likely to be raised? A. Serum creatinine B. Temperature C. Creatine phosphokinase D. Blood pressure E. Aspartate aminotransferase

D. Blood pressure

The neurotransmitter through which benzodiazepines exert their action is: A. norepinephrine B. B epinephrine C. dopamine D. GABA E. Serotonin

D. GABA

Which adverse effect is more frequently associated with oxcarbazepine than carbamazepine? A. Ataxia B. Nausea and vomiting C. Stevens-Johnson syndrome D. Hyponatremia

D. Hyponatremia

A 75-years-old female presents to the emergency department with a sudden onset of weakness and difficulty walking. She also complains of nausea and palpitations. She was working in her garden about an hour ago when her problems started. The patient is feeling warm even though the ER is airconditioned. She was diagnosed with depression 5 years ago and after failing to respond to various antidepressants, was started on venlafaxine to which she responded well. Since then she has had no depressive symptoms. Besides her psychiatric conditions, her medical history is significant for hypertension and osteoporosis. Her current medications are aspirin, lisinopril, alendronate, calcium and vitamin D supplements, and venlafaxine. She is a retired school teacher and recently celebrated 50th marriage anniversary. Her pulse is 110/min, respirations are 22/min, and blood pressure is 160/100 mm Hg. On examination, the patient is irritable but no findings are elicited. A CT scan of the head, electrocardiogram (ECG), and blood tests are all normal. Which of the following most likely accounts for this patient's symptoms? A. Ischemic stroke B. Dehydration due to physical activity C. Aspirin overdose D. Missed dose of venlafaxine E. Missed dose of Lisinopril

D. Missed dose of venlafaxine

A 20-year-old man presents to the physician complaining of a tremor involving his upper limbs for the past 3 weeks. His past medical history is significant for 2 episodes of undiagnosed jaundice over the last 1 year. His temperature is 36.9°C (98.4°F), pulse is 82/min, blood pressure is 116/78 mm Hg, and respiratory rate is 12/min. On physical examination, there is excessive salivation and he has an expressionless face. He has an ataxic gait accompanied by asymmetric resting and kinetic tremors. Hepatomegaly is evident. There is a greenish-gold limbal ring in both corneas. After necessary laboratory workup, the physician prescribes a drug with a warning to the patient that it may worsen his tremors. The physician also mentions that it is important to assess complete blood counts and monitor for the presence of urinary protein during initial drug therapy, as the drug is known to cause kidney problem and low blood cell counts. Which of the following additional adverse effects may be expected? A. Pulmonary fibrosis B. Constipation C. Weight gain D. Myasthenia gravis E. Sensorineural deafness

D. Myasthenia gravis

A 58-year-old African-American male is brought to the emergency room by his wife with a sudden severe headache and vomiting for the past couple of hours. She mentions that he has poorly controlled hypertension and is taking several medications currently. His blood pressure is 188/87 mm Hg and pulse is 110/min. A head CT scan is negative for any pathology, and a cerebrospinal fluid analysis is within normal limits except for an RBC count of 558/mm3. IV labetalol is prescribed. Which of the following medications should be added to this patient's management? A. Nifedipine B. Verapamil C. Furosemide D. Nimodipine E. Ecosprin

D. Nimodipine

Lamotrigine appears to be useful for the maintenance phase of bipolar disorder. However, which of the following adverse effects has limited its use? A. Anxiety B. Tremor C. Sedation D. Rash and SJS

D. Rash and SJS

In a patient currently receiving a selective serotonin reuptake inhibitor (SSRI) and linezolid, which of the following should be closely monitored for? A. Neuroleptic malignant syndrome B. Antibiotic resistance C. Reduced SSRI effectiveness D. Serotonergic syndrome

D. Serotonergic syndrome

A 50-year-old woman is brought to the ER by her husband for shivering and fever that started an hour ago. She is sweating profusely and is irritable when asked questions. Her other medications include captopril, metformin, and fluoxetine for her hypertension, diabetes, and depression. Earlier in the day, she took St. John's wort because she was told by a friend that it helps in depression. She has no history of allergies. On examination, pulse rate is 130/min, respirations are 18/min, blood pressure is 176/92 mm Hg, and temperature is 38.5°C (101.3°F). Increased bowel sounds are heard in the abdomen. Hyperreflexia is noted, clonus is elicited, and sensations are decreased in the feet. Mydriasis is seen, and she is diaphoretic. She is well-oriented but irritable throughout the examination. Fingerstick glucose is 140 mg/dL. An ECG shows sinus tachycardia but is otherwise normal. What is the likely cause of this patient's condition? A. Neuroleptic malignant syndrome B. Diabetic ketoacidosis C. Anaphylactic reaction D. Serotonin syndrome E. Sepsis

D. Serotonin syndrome

A 32-year-old mechanic from New Jersey who witnessed death of number of children during Hurricane Sandy. He assisted in transporting two children to the hospital. Afterward he had an extreme reaction of hopelessness. Each time he sees children in his neighborhood this reminds him of Sandy. He describes flashbacks of the trauma, avoids going outside of his house, has no interests in former hobbies or even work, he is hypervigilant to any unusual noises, and prone to angry outbursts. He suffered one bout of depression 5 years ago after a divorce and was treated with desipramine. The Medical Student prescribed lorazepam 1 mg 3 times a day 2 weeks ago, but he continues to suffer from symptoms of posttraumatic stress disorder. The most appropriate suggestion at this time is which of the following? A. Initiate muscle relaxation therapy B. Add phenelzine 15 mg twice a day C. Increase lorazepam to 2 mg 3 times a day D. Switch to sertraline 50 mg once a day

D. Switch to sertraline 50 mg once a day

A 26-year-old female presents to the physician's clinic due to increased anxiety for the last couple of weeks despite taking her medication. She previously presented 1 month ago with an 8-month history of insomnia and feeling of impending doom due to her precarious financial situation. At that time, she was started on an anxiolytic medication and advised to follow-up after 8 weeks. She came a couple of weeks early for her follow-up appointment as she ran out of her anti-anxiety medication. Due to ever increasing anxiety levels she started taking extra doses of her medication in her accord to achieve a similar anxiolytic effect. Which medication was she most likely prescribed? A. Hydroxyzine B. Buspirone C. Propranolol D. Triazolam E. Thiopental

D. Triazolam

A 13-year-old boy diagnosed with schizophrenia is brought to the psychiatrist by his mother due to intolerable side effects of a traditional antipsychotic medication that the boy has been experiencing for the past few months. His uncle also suffers from schizophrenia but when his mother compares her son to his uncle, she says that her son's symptoms are worse with poor attention and school performance. Last month, the boy witnessed his best friend get bullied at school, and since then, his mother struggles to get him ready for school every day. He also started to hallucinate more than usual, some of which are very bizarre. When asked about the bullying incident, the boy responds by completely diverting off topic. The psychiatrist decides to switch his medication to one that will help reduce his symptoms and at the same time decrease his anxiety. Which of the following medications is the patient most likely to be switched to? A. Chlorpromazine B. Fluoxetine C. Buspirone D. Ziprasidone E. Alprazolam

D. Ziprasidone

Which is the preferred medication for sleep aid? A. Diazepam B. Flurazepam C. Phenobarbital D. Zopiclone Lorazepam

D. Zopiclone

All of the following benzodiazepines are metabolized to active products EXCEPT: A. alprazolam B. chlordiazepoxide C. midazolam D. lorazepam E. diazepam

D. lorazepam

A 30-year-old male comes to the physician complaining of restlessness and inability to sit or lie down for the 2 days. He was diagnosed with schizophrenia 3 weeks ago and mentions that after he has started treatment he doesn't hear any voice ordering him. On examination patient is fidgety, anxious but well oriented, his blood pressure is 140/90 mm Hg and pulse rate is 96/min. What is the likely diagnosis of his presentation? A. Psychotic agitation B. Essential tremor C. Acute muscular dystonia D. Drug-induced parkinsonism E. Akathisia

E. Akathisia

A 56-year-old man is brought to the urgent care clinic by his wife because he has not urinated for a day. She says that he also has constipation for which he tried drinking a lot of water but that did not help. She adds that he is sleepy all the time and does not respond to her promptly. A review of past medical records reveals that the patient was diagnosed with schizophrenia and was started on an antipsychotic medication 3 months ago. His current medication also includes sildenafil. His wife found the bottle of his antipsychotics empty this morning. His blood pressure is 80/45 mm Hg, respirations are 23/min, pulse is 86/min and temperature is 38.7°C (101.7°F). On examination, he appears agitated and confused. Which of the following medications is the most probable cause of this patient's presentation? A. Lithium B. Haloperidol C. Ziprasidone D. Aripiprazole E. Chlorpromazine

E. Chlorpromazine

A 28-year-old woman presents to the physician's office concerned about her facial hair. She has noticed a marked growth and darkening of hair on her face and feels embarrassed. Occasionally, she reports seeing objects as two but believes that is just because she is fatigued. She has asthma that is well-controlled by medication and was recently diagnosed with epilepsy. She had a seizure 6 months back and was started on phenytoin. Her other medications include albuterol and beclomethasone. She also takes a daily multivitamin and a garlic supplement. She does not smoke, drink, or use recreational drugs. She works in the marketing department of a local firm. Her father has asthma. Her pulse is 75/min, respirations are 15 /min, and blood pressure is 110/76 mm Hg. Examination reveals a healthy female with excessive facial hair growth and enlarged gums. Her body mass index (BMI) is 24 kg/m2. The rest of the examination is unremarkable. Which of her medications is most likely responsible for her symptoms? A. Beclomethasone B. Albuterol C. Garlic supplement D. Multivitamin E. Phenytoin

E. Phenytoin

Which is the preferred medication for sleep aid? A. Lorazepam B. Diazepam C. Phenobarbital D. Flurazepam E. Zopiclone

E. Zopiclone

Effects of benzodiazepines include all of the following EXCEPT: A. paradoxical stimulation B. tolerance C. dependence and withdrawal D. respiratory depression in patients with obstructive lung disease E. lower seizure threshold

E. lower seizure threshold

Pharmacologic effects of cyclic antidepressants include all of the following EXCEPT: A. sedation B. flattened or inverted T waves on EKG C. C urinary retention and mydriasis D. mood elevation E. raise the seizure threshold

E. raise the seizure threshold- lowers the threshold