Final Exam Review Questions Chapters 7-11

Marie is a young mother who is worried that her 3-year-old son may have ADHD because he often loses focus when he is performing simple tasks. Inattentive symptoms become noticeable at what age?

5-6 years old

A 48-year-old patient with depression was recently started on 20 mg/day fluoxetine to combat his presenting symptoms of apathy, fatigue, problems concentrating, and hypersomnia. The patient reports that he is feeling much more energized and can see improvements in his cognition and attention within a day or two of starting fluoxetine. Which of the following properties of fluoxetine is theoretically most likely responsible for this patient's positive response?

5HT2C antagonism

As a conscientious clinician you often request that plasma drug levels be determined for your patients not responding to psychopharmacological treatments. Pharmacokinetics play a substantial role in the therapeutic profiles of:

A. Alpha 1 selective GABA A positive allosteric modulators B. Benzodiazepine hypnotics

Jamie, a 42-year-old patient, suffers from chronic back pain secondary to a car accident 5 years ago. She was also recently diagnosed with fibromyalgia and is currently reporting increasing forgetfulness and worsening ability to follow conversations—a condition known as "fibrofog." "Fibrofog" may be explained by the association of chronic back pain with reduced gray matter in which brain area?

A. Dorsolateral prefrontal cortex B. Anterior thalamus

A high school student with a family history of Alzheimer's disease is curious about what kind of treatments for Alzheimer's disease may be available when he is older. Which of the following are potential future treatments for Alzheimer's disease?

A. Gamma secretase inhibitors B. Beta secretase inhibitors

A 24-year-old woman has been taking lithium to treat her bipolar disorder for 6 years. Lithium's hypothesized mechanism of action is:

A. Inhibition of second messenger enzymes B. Interaction with downstream signal transduction cascades

A partial agonist has what effect on neurotransmission?

A. Net agonism when neurotransmission is deficient B. Net antagonism when neurotransmission is excessive

Neuroimaging data show that neuronal activity in the amygdala of depressed patients is:

A. Overactive to induced sadness B. Underreactive to induced happiness

George is an 81-year-old patient with Alzheimer's dementia. He is currently taking rivastigmine 4 mg/day but is experiencing treatment-induced nausea and diarrhea. These gastrointestinal side effects may be due to which action of rivastigmine?

A. Peripheral inhibition of acetylcholinesterase B. Peripheral inhibition of butyrylcholinesterase

Which of the following are involved in regulating neurotransmission via excitation-secretion coupling?

A. Voltage-sensitive sodium channels B. Voltage-sensitive calcium channels

PET imaging of a 69-year-old patient with mild cognitive impairment (MCI) has shown some beta amyloid brain deposition. Which apolipoprotein E (APOE) genotype would predict a faster progression from MCI to Alzheimer's dementia?

APOE4

Rick is a 52-year-old truck driver who consumes large quantities of caffeine in order to stay awake. Caffeine likely promotes wakefulness and opposes homeostatic drive through its actions as an antagonist of:

Adenosine

A female patient of yours is having difficulty falling asleep and is curious about the melatonergic agent, ramelteon. Melatonergic agents may be expected to improve sleep onset through:

Agonism of melatonin 1 receptors

A 15-year-old patient with ADHD has a rare mutation in the gene for the dopamine transporter (DAT). In deciding which treatment to initiate for this patient's ADHD, you know it will be important to avoid treatments that depend on normally functioning DAT. Which of the following drugs are transported into neurons via the dopamine transporte

Amphetamine

A 19-year-old female requires a hospital consultation, after she was admitted following an attempted suicide. Her family reports that she has been suffering from severe depression for the last 3 years. What area of the brain may best be described as hypothetically involved in her feelings of worthlessness and suicidality?

Amygdala

A 22-year-old man exhibits a fear response in reaction to unexpectedly encountering a bear while hiking. The various expressions of fear are hypothetically regulated by circuitry centered around the:

Amygdala

A 45-year-old female patient continues to maintain the re-experiencing of her fear of the opposite sex, which began one year ago when she was raped on her way to a parking garage. Which two brain regions are involved in the reciprocal relationship resulting in this symptom?

Amygdala and hippocampus

Patricia is a 17-year-old high school student with ADHD. She often has difficulty paying attention in class and completing assignments. Problems with selective attention associated with ADHD are hypothetically regulated by the:

Anterior cingulate cortex

A patient with schizophrenia has been stabilized on medication but is complaining that he is so tired and sleepy all the time that he no longer wants to take it. Which of the following switching options might be the least likely to cause sedation?

Aripiprazole

Marcus is a 19-year-old patient who was diagnosed with ADHD when he was 9. He has recently graduated high school and is scheduled to start his first semester at college next month. As individuals with ADHD progress into adulthood, they generally experience a decline in:

B. Impulsive symptoms. C. Hyperactive symptoms

A 24-year-old man with moderate depression achieves remission after 16 weeks on a therapeutic dose of an antidepressant. According to the neurotrophic hypothesis of depression, which of the following is most likely true of his BDNF expression before and after his successful treatment?

BDNF expression was abnormally low while he was depressed, and increased during antidepressant treatment

Rita is a 28-year-old patient with untreated ADHD. You are currently deciding between guanfacine and clonidine as potential treatments for this patient. The selective alpha 2A agonist guanfacine appears to be:

Better tolerated than the alpha 2 agonist clonidine

A 26-year-old man is being prescribed an atypical antipsychotic for first-episode schizophrenia. What measures should be taken by the mental health professional prior to prescribing and during treatment with the antipsychotic?

Blood pressure, BMI, fasting triglycerides, and fasting glucose.

The known receptor sites for ligand-gated ion channels are

Both inside and outside the channel

Which of the following is true?

Both positive and negative allosteric modulations are possible only in the presence of a neurotransmitter

A young man arrives at the emergency room in great pain after receiving a chemical burn during an accident at work. Which primary afferent neurons would have responded to the chemical stimulus to produce nociceptive neuronal activity?

C fiber neurons

A 25-year-old patient with first-episode major depressive disorder is being prescribed an antidepressant. The time course for therapeutic effects of antidepressants correlates with:

Change in receptor sensitivity

Communication between human CNS neurons at synapses is:

Chemical

The age class with the worst risk/benefit ratio for suicidality with use of antidepressants is:

Children under age 12

A serotonin molecule binds to a 5HT2A receptor causing electrical impulses to be sent down a GABA neuron's axon terminal, eventually releasing GABA to the GABA-A receptor of its postsynaptic neuron. Which type of neurotransmission does this describe?

Classic synaptic neurotransmission

A 26-year-old patient with ADHD has recently entered a drug rehabilitation center following arrest for possession of cocaine. The cocaine use in this patient may be an attempt at self-medication for ADHD symptoms because:

Cocaine has the same actions at the dopamine transporter as methylphenidate

What role does the amygdala play in substance abuse?

Communicates to the ventral tegmental area when cues related to drugs of abuse are present

A 25-year-old woman with longstanding anxiety is currently experiencing debilitating concerns that her children will be harmed whenever they are aware from her. Such worry is associated with activity in:

Cortico-striatal-thalamic-cortical circuits

A 21-year-old man with first-episode psychosis is prescribed an antipsychotic that has serotonin 2A antagonism. According to a leading hypothesis, blockade of serotonin 2A receptors in the cortex can ultimately increase dopamine in the striatum through what initial mechanism?

Decreased glutamate and thus decreased GABA in the brainstem

Which of the following is true about depression and reproductive hormones?

Depression is linked to estrogen levels in women across their life cycles

A 34-year-old patient with schizophrenia is not responding to a standard dose of an antipsychotic. Which of the following might you suspect?

Dopamine 2 receptor occupancy less than 60%

1. An example of volume neurotransmission is:

Dopamine in the prefrontal cortex

A 27-year-old male who has been treated with risperidone for the last eight weeks is now having his medication changed to quetiapine. What is the recommended switching method in this situation, assuming the need to do this expeditiously, but not urgently, as an outpatient?

Down-titrate risperidone over at least 1 week while uptitrating quetiapine over at least 2 weeks

Marty is a 71-year-old patient in with a family history of Alzheimer's disease. He has been participating in an Alzheimer's disease research study for the past 5 years. In the study, he has been categorized as ""prodromal"" based on biomarker results and neuropsychiatric testing. Which of the following biomarker results are indicative of Alzheimer's disease?

Elevated CSF tau and decreased CSF beta amyloid

A middle-aged male is having difficulty getting up in time for work because he is unable to fall asleep until after 2 am and has difficulty waking up before noon. Individuals who are phase delayed may benefit from:

Evening melatonin and morning light

A 26-year-old patient with untreated ADHD has recently been arrested for possession of both cocaine and marijuana. In individuals with comorbid substance abuse and ADHD, it is generally advisable to treat ADHD first before addressing substance abuse. True or False

False

A mother whose daughter has just been diagnosed with major depressive disorder wants to know more about the underlying cause. Recent research largely supports the hypothesis that depression is due to a measurable deficiency of monoamines in the brain. True or False

False

Schizophrenia and psychosis are synonymous. True or False

False

A patient presents to a new clinician with a major depressive episode. In addition to taking a patient's history, the two factors most useful for helping to determine if a presenting depressive episode is part of a unipolar or bipolar illness include:

Family history and input from someone close to the patient

Which of the following has the secondary property of positive allosteric modulation at nicotinic receptors?

Galantamine

The activation of N-methyl-d-aspartate (NMDA) receptors requires the presence of:

Glutamate and glycine

The activation of AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid) receptors requires the presence of:

Glutamate only

The syndrome of bipolar disorder:

Has many varied presentations

The majority of atypical antipsychotics:

Have higher affinity for serotonin 2A receptors than for dopamine 2 receptors

What is epigenetics?

Heritable trait resulting from a change in gene expression.

A leading hypothesis of schizophrenia is:

Hypofunctioning NDMA receptors

A 34-year-old woman with posttraumatic stress disorder has been treated with exposure therapy, with partial success. Her clinician is considering an adjunct medication. The agent d-cycloserine could be efficacious for reducing symptoms in anxiety disorders because it has been shown to:

Increase glutamate neurotransmission during fear extinction

A patient with generalized anxiety disorder is taking a benzodiazepine. What role do benzodiazepines play in GABA neurotransmission?

Increase it via positive allosteric modulation

Agents that block reuptake of norepinephrine have what effect on dopamine in the prefrontal cortex?

Increase its synaptic availability

A clinician has decided to administer an alpha 2 antagonist to his patient. Alpha 2 antagonists have what effect on neurotransmission?

Increase norepinephrine and increase serotonin

A 45-year old man with schizophrenia has been maintained on clozapine. He now presents with depressive symptoms and his clinician is considering adding fluvoxamine. If fluvoxamine is added to clozapine, which of the following laboratory test results would you most likely expect for this patient?

Increased plasma levels of clozapine

A 44-year-old patient has schizophrenia and comorbid alcohol abuse disorder. Alcohol has what effect on GABA and glutamate in the ventral tegmental area?

Increases GABA and decreases glutamate

The direct role of transcription factors is to:

Influence gene expression

A 75-year-old patient with Alzheimer's disease is currently being treated with donepezil. Donepezil increases acetylcholine by:

Inhibiting acetylcholinesterase

A patient with bipolar II disorder responds well to monotherapy with lamotrigine. Lamotrigine's unique therapeutic profile in bipolar depression compared to other anticonvulsants appears to be hypothetically linked to its:

Inhibition of glutamate release

A 34-year-old man presents with a major depressive episode characterized by depressed mood, insomnia, problems concentrating, weight loss, and suicidal ideation. Which of the following symptoms is the most likely to be residual following otherwise successful treatment?

Insomnia

When voltage-sensitive sodium channels are open and activated, the flow of sodium is

Into the neuron

A 25-year-old patient who was diagnosed with ADHD at age 11 has previously been on immediate-release methylphenidate and the methylphenidate patch. She is a heavy drinker and has a history of drug abuse. You decide to put her on 80 mg/day of atomoxetine, one of the non-stimulant medications effective in ADHD. Why does atomoxetine lack abuse potential?

It increases dopamine levels in the prefrontal cortex but not in the nucleus accumbens

A 39-year-old patient with major depressive disorder presents to your office after several months of trying various antidepressant drugs. It is suggested that he try augmenting his current regimen with L-methylfolate. Why might L-methylfolate hypothetically boost the therapeutic efficacy of antidepressants?

It increases synthesis of monoamines

A 28-year-old woman presents with a depressive episode. She has previously been hospitalized and treated for a manic episode, but is not currently taking any medication. Which of the following have the best evidence of efficacy to treat bipolar depression?

Lamotrigine, quetiapine

Tricyclic antidepressants, compared to newer antidepressants such as serotonin selective reuptake inhibitors or serotonin norepinephrine reuptake inhibitors, have:

Less favorable tolerability profile

A receptor with four transmembrane regions changes conformation as GABA binds. Which system is this process describing?

Ligand-gated ion channel

A 35-year-old patient with bipolar disorder is currently experiencing a depressive episode that involves suicidal ideation. Which of the following mood stabilizers has shown efficacy for the prevention of suicide?

Lithium

A 32-year-old woman with bipolar I disorder has just found out that she is 6 weeks pregnant. Her mania has been stable on a combination of lithium, valproate, and olanzapine, but she is unsure about the safety of maintaining her medications during her pregnancy. Which of the following is true regarding medication use for bipolar disorder during pregnancy?

Lithium and valproate are associate with known risk for various fetal toxicities

Symptoms of schizophrenia are hypothetically attributable to malfunctioning in the:

Mesocortical and mesolimbic pathways

Conventional antipsychotics may worsen negative symptoms, presumably through their actions in the:

Mesolimbic and mesocortical pathways

Which of the following is considered the pleasure center of the brain?

Mesolimbic dopamine pathway

A 73-year-old Alzheimer's patient has been on donepezil 10 mg/day for approximately 10 months to aid in improving her cognitive functioning. Her husband has begun to notice a loss of effectiveness over the past month. You decide to augment donepezil with 5 mg/day of memantine. Which of the following properties of memantine may be useful in treating Alzheimer's disease?

NMDA antagonism at the magnesium site

Examples of neurotransmitters produced specifically as retrograde neurotransmitters (i.e., those that communicate from postsynaptic neuron to presynaptic neuron) include:

Nitric oxide

The known receptor sites for ligand-gated ion channels are:

Open more frequently

A 24-year-old woman is hospitalized after an altercation in which she screamed at and attacked her neighbor when he knocked on her door. Her mother reports that she has been increasingly erratic recently, with emotional outbursts and impulsive behavior. Which of the following brain regions is theoretically most closely associated with these symptoms?

Orbital frontal cortex

Jackson is a 10-year-old patient with ADHD. He often exhibits impulsive behaviors in the classroom such as not raising his hand and waiting to be called upon. According to the model of prefrontal cortex functioning presented in this chapter, impulsivity associated with ADHD is hypothetically regulated by the:

Orbital frontal cortex

A 51-year-old male veteran with chronic PTSD has agreed to begin pharmacotherapy for his debilitating symptoms of arousal and anxiety associated with his experiences in Iraq two years ago. Which of the following would be appropriate as first-line pharmacologic treatment?

Paroxetine

A 22-year-old woman presents with schizophrenia characterized by the presence of positive, negative, cognitive, and affective symptoms. The symptom dimension of schizophrenia most effectively treated with antipsychotics is:

Positive symtpoms

A 23-year-old female college student has gotten in significant trouble for her risky and impulsive behavior, stealing a fire extinguisher, driving on the common area lawn, and hostilely addressing a professor. Which of the following monoamine projections may account for her recent behavior? Projections to the:

Prefrontal cortex

A 34-year-old man with schizophrenia has a history of side effects and/or partial response with antipsychotics, including agitation with ziprasidone, sedation with quetiapine, orthostatic hypotension with risperidone, and gastrointestinal problems with aripiprazole. His clinician elects to prescribe iloperidone and begins treatment according to the dosing schedule in the label. What is the rationale for the slow dosing schedule with iloperidone?

Prevent orthostatic hypotension

A 35-year-old cigarette smoker would like to quit but is nervous because she typically craves a cigarette approximately every 2 hrs. The craving and withdrawal are due to:

Resensitization of nicotinic receptors

A 34-year-old patient with bipolar disorder has been taking lithium with some success, but is now experiencing a depressive episode that is not responding to treatment. Her clinician is considering adding an atypical antipsychotic. What shared mechanism of some atypical antipsychotics may be partially responsible for antidepressant effects?

Serotonin 1A partial agonism and serotonin 7 antagonism

A 24-year-old schizophrenia patient with prominent cognitive symptoms and social impairment is being evaluated for treatment. Her care provider is considering initiating ziprasidone, quetiapine, or aripiprazole, all of which share the property of serotonin 1A agonism. This receptor binding property is expected to have clinical effects in schizophrenia most similar to

Serotonin 2A antagonism

Which of the following is the most potent property of trazodone?

Serotonin 2A antagonism

Patrick is a 22-year-old male who recently experienced a psychotic-like episode after trying MDMA (""ecstasy"") while at a party. A key binding site for hallucinogens is the:

Serotonin 2A receptor

A patient who has been taking an atypical antipsychotic for six months has experienced a 22-pound weight gain since baseline. Which of the following pharmacologic properties most likely underlies this patient's weight change?

Serotonin 2C antagonism and histamine 1 antagonism

Presynaptic reuptake transporters are a major method of inactivation for which of the following?

Serotonin and GABA

A 40-year-old woman presents with a major depressive episode. Her clinician is considering prescribing the antidepressant vilazodone, which has what two major mechanisms of action?

Serotonin reuptake inhibition and serotonin 1A partial agonism

A 45-year-old female presents with a hand-washing compulsion and an obsession with air fresheners. Based on these symptoms, which of the following is most likely to be true?

She may have been born with the catechol-O-methyltransferase (COMT) Met genotype, leading to an increased risk of susceptibility to worry and anxiety disorders

Transport of monoamines requires energy, which is supplied by a:

Sodium pump

A 13-year-old middle school student has trouble finishing exams within the allotted time because he gets easily distracted. His pediatrician suggests testing his selective attention using the ____________ to see if his ____________ is aberrantly activated on an fMRI.

Stroop Task; anterior cingulate cortex

Which of the following statements regarding mood symptoms is true?

Symptoms related to increased negative affect are hypothetically linked to serotonergic (and noradrenergic) dysfunction

The alpha 2 delta sub-unit of voltage-sensitive calcium channels is believed to help regulate opening and closing of the voltage-sensitive calcium channel. True or False

TRUE

Based on thorough evaluation of a patient and his history, his care provider intends to begin treatment with a conventional antipsychotic but has not selected a particular agent yet. Which of the following is most true about conventional antipsychotics?

They are very similar in therapeutic profile but differ in side-effect profile

A patient has been taking an atypical antipsychotic for 6 months. At his current appointment, his weight is unchanged since he began taking the antipsychotic. What can be predicted regarding his fasting triglyceride levels?

They cannot be predicted based on his weight

Dopamine 2 partial agonists cause receptor output that is less than that caused by dopamine but more than that caused by a conventional anti psychotic. True or False

True

The reactive reward system signals the immediate prospect of pleasure or pain and triggers drug-seeking behavior. True or False

True

A 44-year-old male with schizophrenia has been taking an antipsychotic medication since initial diagnosis twelve years ago. He has recently begun experiencing difficulty with fluid movement of his arms as well as involuntary facial grimaces. Which of the following likely underlies these symptoms?

Upregulation of dopamine 2 receptors

A patient with bipolar disorder responds to treatment with a mood stabilizing anticonvulsant agent. Which of the following has the strongest evidence of direct involvement in the mechanism of action of these agents?

Voltage-sensitive sodium channels