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PRITE PSYCHOPHARMACOLOGY EXAM WITH COMPLETE
SOLUTIONS 1 00 % VERIFIED!!
27 y/o depressed patient treated with SSRI and tranylcypromine (and with 5- hydroxytryptophan) now presents with VH, mild confusion, myoclonic jerks, diaphoretic, flushing, restless: (6x) - ANSWER SEROTONIN SYNDROME
Which antidepressant med is most likely to cause HTN? (5x) - ANSWER VENLAFAXINE
Which antidepressant med is best to minimize risk of orthostasis in an 84 y/o? (4x) - ANSWER NORTRIPTYLINE
Antidepressant preferred for >65 y/o for which blood levels are clinically useful (3x) - ANSWER DESIPRAMINE
62 y/o pt with hx chest pain has and depression, one month ago started on paroxetine, presents with new onset of lethargy and headache, low Na and BUN, normal K , and Cr of 0.4. Next test: (2x) - ANSWER URINE OSMOLALITY
38 y/o taking imipramine 300mg qday for recurrent MDD. After 3 weeks, mood is improved, but has difficulty passing urine and mild erectile dysfunction. Appropriate action? (2x) - ANSWER BETHANECHOL 25MG TID
Antidepressant less likely to cause sexual dysfunction: (3x) - ANSWER BUPROPION
Which is a muscarinic SE of antidepressants? (2x) - ANSWER URINARY RETENTION
30 y/o pt has been treated for unreasonable fear of eating in public places, feeling of embarrassment in public places, and anger over the possibility of being scrutinized. Pt has not responded to high doses of paroxetine, citalopram, buspirone, and alprazolam,
each of them administered for 4-6 wks. Which meds would be appropriate for next? (2x)
What meds could be helpful in the treatment of depression in persons over the age of 65 because it does not produce orthostatic hypotension: (2x) - ANSWER BUPROPION
What antidepressant has plasma level that correlates with therapeutic response? (3x) - ANSWER IMIPRAMINE
What antidepressant med is considered to be the most effective in the tx of premature ejaculation? (x2) - ANSWER PAROXETINE
Which opioid has a potentially lethal interaction with monoamine oxidase inhibitors (MAOIs)? (4x) - ANSWER MEPERIDINE
45 y/o F pt on phenelzine for MDD, takes OTC medication for cold sx and develops hypertensive crisis. Which OTC medication would most likely cause this? (3x) - ANSWER PSEUDOEPHEDRINE
Minimum recommended washout period for fluoxetine prior to starting MAOI (2x) - ANSWER 5 WEEKS
Treatment for patients with MAOI related hypertensive crisis in the ER may involve the administration of which of the following meds? (2x) - ANSWER PHENTOLAMINE
What drug has a curvilinear therapeutic window? (6x) - ANSWER NORTRIPTYLINE
What drug is useful in the Rx of urinary retention secondary to TCA therapy (5x) - ANSWER BETHANECHOL
Most frequent cause of death following TCA overdose: (2x) - ANSWER ARRHYTHMIA
46 y/o F pt presents w increasing dysphoria, progressively increased frequency with which she washes her hands to the point of excoriation, dose range for effective Tx: (x2)
- ANSWER FLUVOXAMINE 200-300MG DAILY
First line rx for pt with dilated cardiomyopathy who is depressed and has no relief with fluoxetine. Pt does not want side effects - ANSWER BUPROPION
Rare occurrences of priapism are most frequently associated with: - ANSWER TRAZODONE
47 yo overweight female on celexa w sexual side effects. What med to switch to? - ANSWER BUPROPION
Which SSRI is recommended for postpartum mothers breastfeeding? - ANSWER SERTRALINE
Pt w/ unipolar depression has had 3 recurrence of depression each separated by 1 yr, after successful treatment w/ imipramine 200 mg qd. Which prophylactic treatment should be recommended: - ANSWER CONTINUE IMIPRAMINE 200MG X 5YRS
Which of the following medications is most likely to precipitate a manic switch in a patient with bipolar I disorder - ANSWER DESIPRAMINE
A 34-yo pt with epilepsy has controlled seizures but develops depression. Which is the most appropriate depression med? - ANSWER SERTRALINE
Pt on 2 mg risperdal is started on Prozac 20 mg to treat comorbid depressive symptoms. Pt then develops acute systolic reaction. Which mechanism responsible? - ANSWER INHIBITION OF CYP2D
70yo w depression plus confusion x 2wk following the start of fluoxetine. An adverse
effect is suspected but neuro exam normal. What evaluation would be most useful to confirm suspicion of an adverse effect? - ANSWER UREA AND ELECTROLYTES
What is the best reason for preferring the use of SSRI antidepressants over TCAs in tx of pts w/depression who are > 65yo? - ANSWER LESS LIKELY TO CAUSE ORTHOSTATIC HYPOTENSION
A psychiatrist wished to start an inpatient on a TCA but the pt is reluctant due to hearing these drugs may cause dry mouth, constipation, blurred vision and urinary retention. What TCA would have the least side effects? - ANSWER DESIPRAMINE
25 yo CF started on desipramine 50mg Qday. SE of constipation, dry mouth, visual difficulties, tremor and agitated feeling. Not on any other medications. Blood level is 400ng/ml. Most likely cause? - ANSWER POOR METABOLISM OF CYTOCHROME P SUBSTRATES
Which side effect occurs less frequently in pts treated with mirtazapine vs SSRIs? - ANSWER DIARRHEA
29 y/o M h/o recurrent depression & 1.5 PPD smoking. Medication? - ANSWER BUPROPION
Mirtazapine is an antagonist at which receptor? - ANSWER ALPHA-2-ADRENERGIC
The risk of increased psychosis for pts with psychotic disorders who take bupropion is attributable to enhancement of: - ANSWER DOPAMINE
Which dietary supplement has demonstrated some efficacy in Tx of depression? - ANSWER S-ADENOSYL-L-METHIONINE (SAME)
The side effects of sedation and weight gain are associated with mirtazepine's antagonism of which of the following receptors? - ANSWER H
Which of the following meds has the lowest likelihood of discontinuation symptoms if the medication is abruptly stopped? - ANSWER FLUOXETINE
What med has some evidence of effectiveness in both psychotic/nonpsychotic subtypes of body dysmorphic disorder? - ANSWER FLUOXETINE
What med is most potent inhibitor of the norepinephrine transporter? - ANSWER PAROXETINE
What pharmacological treatment should be used for long-term insomnia in pts with dementia over 65 years of age? - ANSWER TRAZODONE
Mirtazepine (vs other antidepressants) has low incidence of what side effect? - ANSWER SEXUAL SIDE EFFECTS
Orthostatic hypotension is least likely to occur as a S/E with what antidepressants? - ANSWER SERTRALINE, NORTRIPTYLINE, IMIPRAMINE, AMITRIPTYLINE, TRAZODONE
Which antidepressant has active metabolites that extend its effective half-life? - ANSWER SERTRALINE
50 y/o fireman became clinically depressed after sustaining a myocardial infarction. What is an appropriate medication to prescribe? - ANSWER SERTRALINE
MDD patient with good response to venlafaxine presents with dysphoria, agitation, nausea, poor balance after running out of medication. Cause of sx? - ANSWER SEROTONIN DISCONTINUATION SYNDROME
Receptor blocked by antidepressants -> blurred vision - ANSWER MUSCARINIC
Which antidepressant has strongest histamine-R affinity? - ANSWER MIRTAZAPINE
45 y/o pt w/ first episode MDD, on Paxil and insight-oriented therapy, but depression worsens over months. Takes Paxil only occasionally, as he is worried about becoming dependent on it (a friend was addicted to Valium). Best intervention? - ANSWER EDUCATE PATIENT ON THE DIFFERENCES BETWEEN ANTIDEPRESSANTS, LIKE PAXIL, AND BENZODIAZEPINES, LIKE VALIUM.
What antidepressant increases REM sleep? - ANSWER BUPROPION
What antidepressant has an FDA pregnancy use B rating? - ANSWER BUPROPION
Antidepressant with low risk of weight gain: - ANSWER BUPROPION
40 y/o pt experienced delirium, tremor, diaphoresis, rigidity, hyperpyrexia, and myoclonus in making the transition from the use of clomipramine to phenelzine. Pt is most likely experiencing: - ANSWER SEROTONIN SYNDROME
Antidepressant that causes Parkinson's sx: - ANSWER AMOXAPINE
In pts over 65 w MDD, Bupropion has what advantage over SSRIs? - ANSWER FEWER DRUG INTERACTIONS
Trazodone requires larger doses to be used as an antidepressant due to lower potency affinity to which receptor? - ANSWER SEROTONIC TRANSPORTER
Which med is comparative safety during Tx w/ MAOI? - ANSWER FENTANYL
Pts taking MAOIs should use caution when consuming what? - ANSWER FAVA BEANS
Which med is irreversible MAO-B inhibitor? - ANSWER SELEGILINE
right bundle branch block and poorly controlled HTN. Pt w/ no SI. Next step? - ANSWER BEGIN TX WITH PHENELZINE
What inhibitor of monoamine oxidase is also useful in the treatment of Parkinson's disease? - ANSWER SELEGILINE
Blood levels for therapeutic and potentially toxic effects can routinely be assessed for which med? - ANSWER NORTRIPTYLINE
Increased PR, QRS, or QT on EKG: - ANSWER TRICYCLICS
Psychiatrist plans to add nortriptyline as adjunct to fluoxetine. He should proceed how?
- ANSWER START NORTRIPTYLINE AT LOWER THAN NORMAL DOSE
The best time to obtain ECG in the treatment of children with TCA: - ANSWER BEFORE TREATMENT, FOR ALL CHILDREN, TO ESTABLISH BASELINE
Which antidepressant is successfully used to treat pain syndromes? - ANSWER AMITRIPTYLINE
Nortriptyline is the active metabolite of which of the following TCAs? - ANSWER AMITRIPTYLINE
Dry mouth, blurred vision, constipation, urinary retention. S/E of what psychotropic? - ANSWER AMITRIPTYLINE
Do NOT use in pt w/ narrow-angle glaucoma - ANSWER AMITRIPTYLINE
Which tricyclic antidepressant has the most potent antihistaminic effect? - ANSWER DOXEPIN
Which TCA should be avoided in pts w/ Parkinson's? - ANSWER AMOXAPINE
85 y/o pt w/ hx of HTN and COPD reports feeling depressed. The pt has an episode of depression 20 yrs ago, which was successfully treated with nortriptyline. The pt's HTN is currently well managed with hydrocholorothiazide. The physician prescribes nortriptyline 25mg qday. After 1 wk, the pt calls and reports feeling no better. What would be an appropriate reason to obtain a nortriptyline level? - ANSWER PT'S ADVANCED AGE
32 y/o pt w/ hx of treatment resistant depression was brought to ER after overdose on imipramine. Pt reported wanting to die, but then changed her mind and then called for help. Pt's regular psych MD had recently added imipramine to the pt's partially effective regimen of fluoxetine 80mg qday. Pt is afebrile, BP is 100/58 and HR is 96 and regular. Pt is vague about the detail of the attempt, but reports no longer feeling suicidal. Medical resident recommends admission to a psych unit. Request for a TCA blood level and EKG are deferred. Medical resident asserts that the pt's combined imipramine and desipramine level of 750ng/ml is not in the cardiotoxic range. What is the best course of action for the psych MD to take? - ANSWER INSIST ON FURTHER CARDIAC MONITORING IN EITHER THE ED OR ICU
What causes the cardiac toxicity of imipramine in overdose? - ANSWER BLOCKADE OF VOLTAGE-GATED SODIUM CHANNELS
Orthostatic hypotension associated with TCA's is caused by blockade of what receptor?
- ANSWER ALPHA-1-ADRENERGIC
80yr old pt with MDD has tried SSRIs and SNRIs with no improvement, wants to start TCA, no cardiac hx and EKG is normal, which medication is most appropriate due to the side effect profile? - ANSWER DESIPRAMINE
SSRI with shortest half life - ANSWER FLUVOXAMINE
Pt w/ hx of MDD has been taking Fluoxetine 40 mg PO QDay for one year since achieving remission of third depressive episode. Pt wants to stop medication because of sexual side effects responsive to Sildenafil 100 mg PRN. What should psychiatrist recommend
concerns of perceived skin irregularity she calls "bumps." Over time increasingly more difficult for her to ignore "bumps" and picks at them. Several dermatologists have been unable to convince pt it is not a dermatological issue. Aside from this no evidence of other mood or thought d/o. First-line treatment for pt? - ANSWER FLUVOXAMINE
Urine toxicology in a pt on bupropion may produce a false-positive screening test for which substances? - ANSWER AMPHETAMINE
Increases paxil concentration: - ANSWER CIMETIDINE
What is a sleep disturbance likely to occur after initiating a trial of an SSRI? - ANSWER BRUXISM
45 y/o pt who is in good physical health reports increased fatigue, decreased appetite, and an inability to take pleasure in usual activities. Pt is begun on fluoxetine 20mg/day, and pt's mood improves over the course of 2 weeks. However, pt now notes a new onset of anxiety symptoms, including restlessness in the arms and legs. Pt is observed to fidget and seems unable to sit still for the exam. Neurological exam: unremarkable. Which courses of Tx would be most appropriate? - ANSWER BEGIN PROPRANOLOL 10MG TID
22 y/o brought to ED by roommate who found him unconscious with a suicide note. Temp 100.9, BP 100/60, P 124, RR 8, warm and dry skin, dilated pupils and reactive to light, bowel sounds decreased, EKG with sinus tachy and QTC of 589, no obvious trauma. On which did pt OD? - ANSWER TCA
Pt who responded in the past to SSRIs requests a drug from this class when subsequently seen for another episode of depression. However, pt reports concerns that when the previous medication was tapered, pt experienced fatigue, insomnia, abdominal distress, flu-like symptoms, and dizziness. What meds would be appropriate for this pt? - ANSWER FLUOXETINE
36 y/o pt c/o dysphoria, insomnia, fatigue, poor concentration. Pt is started on sertraline 50mg, increased to 100mg in 2 weeks. 2 months after dose increase, pt reports mood greatly improved. However, pt notes new onset of sx of delayed ejaculation, frequently
to point of anorgasmia. He believes this began almost immediately after dose increase. First step in management of problem would be? - ANSWER DECREASE THE SERTRALINE DOSAGE TO 50MG/DAY
Cytochrome P450 (CYP450) subenzyme, inhibited by ______, increases TCA levels ____ - ANSWER FLUOXETINE, 2D
SSRIs with the greatest potential for slowing or blocking metabolism of other medications? - ANSWER LUVOX
45 y/o pt w/ hx of MDD recently had Citalopram twofold, with addition of Trazodone 100 mg/night for sleep. Ten days later, pt presents to ED with severe restlessness, nausea, vomiting, and diarrhea. Serum tox negative. On exam, pt confused, mildly agitated, febrile to 100.8, and tachy to 108. Neuro exam = nystagmus, B/L hyperreflexia, and ankle clonus. Tone without rigidity. In addition to stopping all meds & starting supportive care, what med should be given? - ANSWER LORAZEPAM
Two antidepressants are tested alone and as a combo treatment against a waitlist control group in pts with treatment resistant MDD. Both meds are found to have a significant therapeutic effect individually, and the combo treatment is more efficacious than the summed effects of each med given alone. What has been demonstrated? (2x) - ANSWER TWO TREATMENTS MAIN EFFECTS AND AN INTERACTION EFFECT
First pass effect refers to which of the following aspects of a med's metabolism? (2x) - ANSWER PRESYSTEMIC ELIMINATION
Which is an NMDA receptor antagonist? (2x) - ANSWER MEMANTINE
Psychiatrist is called to eval a pt on a medical floor who has developed acute dysarthria w/ protruding tongue and torticollis. Which med is suspect? (2x) - ANSWER METOCLOPRAMIDE
Pt with flashbacks, nightmares, and insomnia r/t sexual trauma is improving slightly with Zoloft but still having nightmares, next step in mgmt.? - ANSWER PRAZOSIN
22 y/o pt suffers a traumatic brain injury following a skiing accident, and is admitted to an inpatient rehabilitation facility. There, pt has frequent episodes of sudden anger and aggression directed toward staff. On psychiatric evaluation, pt is aware of these episodes, saying, "I can't help it, I just see red." Pt denies symptoms of depression or anxiety, and there is no evidence of acute confusion on examination. The rehabilitation staff report that all behavioral strategies have failed, and that pt's outbursts are intimidating the staff. Which of the following medications has the best evidence for efficacy? - ANSWER PROPRANOLOL
Treatment of catatonia (hallucinations with mutism and unusual posturing) - ANSWER ATIVAN
In addition to life support, which class of meds to consider for the treatment of neuroleptic malignant syndrome? (2x) - ANSWER DOPAMINE AGONISTS (bromocriptine)
FDA requires that generics not be significantly different from the parent compounds in what way? (5x) - ANSWER BIOEQUIVALENCE
Hepatitis C treatment with interferon can cause what psychiatric symptom? (3x) - ANSWER DEPRESSION
What medication may cause mood d/o in pts being treated for melanoma? Also worsens fatigue and cognitive inefficiency: (2x) - ANSWER INTERFERON
What med is effective in tx of motor/vocal tics associated w Tourette syndrome refractory to tx with antipsychotics and alpha adrenergic agonists? (x2) - ANSWER TETRABENAZINE
After OD, pt has fever, confusion, tachycardia, dry mouth, urinary retention, dilated and unresponsive pupils. Which medication would treat this? (Anticholinergic toxicity) (4x) - ANSWER PHYSOSTIGMINE
Pt presents to ED c/o ringing in ears, abdominal pain, and is found to have mild
metabolic acidosis. Overdose of what substance? (4x) - ANSWER ASPIRIN
Pt confused, disoriented, dry mouth, dilated unresponsive pupils. Likely ingested: (2x) - ANSWER BENZTROPINE
Flumazenil is used to treat: (2x) - ANSWER BENZO INTOXICATION
This is a relative contraindication for interferon treatment in pt's with Hepatitis C: (2x) - ANSWER DEPRESSION WITH SUICIDAL IDEATION
The effects of caffeine on which of the following results in increased dopaminergic activity? (x2) - ANSWER ADENOSINE RECEPTOR
84 yo pt goes to ED with fever, dry mouth, visual hallucinations. Is found tachycardia, restless, toxicity of what medication most likely caused symptoms? - ANSWER BENZTROPINE
Prolonged ingestion of high doses pyridoxine causes: - ANSWER SUBACUTE SENSORY NEUROPATHY
Physostigmine is useful in treating toxic syndrome from overdose with: - ANSWER SCOPOLAMINE
Pt in ED for treatment of OD - was found 4 hrs ago after ingesting 10 cold med packs of 650mg Tylenol, antihistamine, and alpha 1 agonist decongestant. Pt is pale and vomiting. How do you decide whether to use N-acetylcysteine as an antidote? - ANSWER PT'S SERUM N-ACETYL-P-AMINOPHENOL (APAP) LEVEL OVER TIME
Tx of pts w/ substance abuse who have acute pain - ANSWER PATIENT-CONTROLLED ANALGESIA
offending agent is: - ANSWER SUPPORTING VITAL FUNCTIONS
Restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, and confusion are compatible with which diagnosis? - ANSWER SEROTONIN SYNDROME
Research on the use of psychostimulants to treat pts w/ secondary depressive symptoms in medical setting suggest: - ANSWER WHEN TREATED WITH THESE AGENTS, PT MAY ENGAGE IN REHABILITATION SOONER.
A psychiatry consult is placed regarding a patient with SI. History of Bipolar disorder and admitted for VRE bacteremia. BP of 171/95, temp of 100.9. Has tremors, hyperreflexia, myoclonic jerks, not oriented at all, has visual hallucinations. Meds include linezolid, lithium, sertraline, Risperdal. What is diagnosis? - ANSWER SEROTONIN SYNDROME
What drug has been known to cause hypertensive crisis? - ANSWER PHENELZINE
African americans tend to have higher activity of which of the following cytochrome p450 enzymes? - ANSWER 3A
Sudden death in children taking which medication? - ANSWER TRICYCLICS
47 yo pt presents with fever, confusion, and tremor and found to be tachy and diaphoretic. Clonus easily elicited on exam. Pt suspected to have serotonin syndrome, is taking Celexa and Lithium. What additional medication may have contributed to syndrome? - ANSWER ST. JOHN'S WORT
Autonomic instability, nonfocal neurological signs, and elevated temp associated with which elevated lab value? - ANSWER CREATININE PHOSPHOKINASE (CPK)
Drug-drug interactions in pts taking HIV meds are particularly problematic with which medication: - ANSWER METHADONE
In addition to benzos, which class of meds is assoc with falls in pts older than 60? - ANSWER ANTIDEPRESSANTS
The potency of medication refers to which of the following properties of a medication? - ANSWER RELATIVE DOSE REQUIRED TO ACHIEVE A CERTAIN EFFECT
60 yo pt with chronic schizophrenia takes cogentin for neuroleptic induced parkinson now has increased urine retention and confusion. What medication would be the best alternative for treating this patient's condition? - ANSWER AMANTADINE
Most of the body's serotonin is located where? - ANSWER GI TRACT
Common side effect of acetylcholinesterase inhibitors - ANSWER DIARRHEA
Diphenhydramine's ability to treat acute dystonia is due to action on which receptor? - ANSWER MUSCARINIC-
28 y/o with BMDII wants to use phototherapy for depressive Sx treatment in winter. What should you advise? - ANSWER CAN BE USED BUT REQUIRES VIGILANCE AND CAREFUL TITRATION OF DOSE
Which med is used to treat hep C viral infection and is associated with depression, anxiety, and cognitive impairment? - ANSWER INTERFERON-ALPHA
In pts who surreptitiously use excess sulfonylurea, which of the following substances can be administered to r/o possible insulinoma? - ANSWER TOLBUTAMIDE
Which of the following medications inhibits the enzyme ETOH acetaldehyde dehydrogenase? - ANSWER DISULFIRAM
