Drugs in Psychiatric Disorders Practice Questions

Q: Which of the following drugs is not associated with an increase in prolactin levels?

Quetiapine. **Explanation:** The regulation of prolactin secretion is primarily controlled by the **Tuberoinfundibular pathway** in the brain. In this pathway, dopamine acts as a "Prolactin Inhibiting Factor" by stimulating **D2 receptors** on lactotroph cells in the anterior pituitary. Antipsychotic drugs that block these D2 receptors remove this inhibition, leading to **hyperprolactinemia**. **Why Quetiapine is the correct answer:** Quetiapine is a **Second-Generation (Atypical) Antipsychotic**. It is characterized by "loose" binding and rapid dissociation from D2 receptors. Because it does not maintain prolonged blockade of D2 receptors in the pituitary, it is considered **prolactin-sparing**. Along with Aripiprazole and Clozapine, Quetiapine is least likely to cause prolactin elevation. **Analysis of incorrect options:** * **Haloperidol & Chlorpromazine:** These are **First-Generation (Typical) Antipsychotics**. They are potent D2 receptor antagonists with high affinity. They significantly block the tuberoinfundibular pathway, frequently causing side effects like galactorrhea, amenorrhea, and gynecomastia. * **Hydroxysulpiride (and Sulpiride/Amisulpiride):** These are substituted benzamides. Despite being classified as atypical in some contexts, they are notorious for causing the **highest** increases in prolactin levels because they do not cross the blood-brain barrier well and concentrate in the pituitary (which lies outside the BBB). **NEET-PG High-Yield Pearls:** 1. **Highest Prolactin Elevation:** Risperidone, Paliperidone, and Amisulpiride. 2. **Lowest Prolactin Elevation:** Aripiprazole (D2 partial agonist), Quetiapine, and Clozapine. 3. **Clinical Sign:** Hyperprolactinemia can lead to decreased bone mineral density (osteoporosis) due to suppressed GnRH/estrogen.

Q: All are true about Desvenlafaxine except?

It is a D2 receptor antagonist. **Explanation:** **1. Why Option A is the correct answer (The "Except"):** Desvenlafaxine is a **Selective Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)**. It is the active metabolite of Venlafaxine. Its mechanism of action involves inhibiting the reuptake of serotonin (5-HT) and norepinephrine (NE) in the synaptic cleft. It has **no significant affinity** for D2 (Dopamine), cholinergic, histaminergic, or alpha-adrenergic receptors. Therefore, stating it is a D2 receptor antagonist is pharmacologically incorrect. **2. Analysis of other options:** * **Option B (Priapism):** While rare compared to Trazodone, SNRIs and SSRIs have been associated with idiosyncratic cases of priapism due to complex downstream effects on neurotransmitters. * **Option C (Glaucoma):** SNRIs can cause pupillary dilation (mydriasis) due to increased norepinephrine levels. This can trigger an attack of **acute angle-closure glaucoma** in predisposed individuals. * **Option D (Hyperlipidemia):** Desvenlafaxine treatment is clinically associated with dose-related increases in fasting serum total cholesterol, LDL, and triglycerides. Regular lipid monitoring is recommended during therapy. **High-Yield Clinical Pearls for NEET-PG:** * **Active Metabolite:** Desvenlafaxine is the major active metabolite of Venlafaxine (formed via CYP2D6). * **Dose-Response:** Unlike Venlafaxine, which acts like an SSRI at low doses and an SNRI at high doses, Desvenlafaxine shows SNRI activity even at the starting dose (50mg). * **Side Effect Profile:** Common side effects include nausea, insomnia, sweating, and **dose-dependent hypertension** (due to increased NE). * **Discontinuation Syndrome:** SNRIs have a high risk of withdrawal symptoms; tapering is essential.

Q: Ebstein's anomaly is associated with maternal intake of which of the following substances?

Lithium. **Explanation:** **Ebstein’s anomaly** is a rare congenital heart defect characterized by the downward displacement of the tricuspid valve leaflets into the right ventricle, leading to "atrialization" of the ventricle and tricuspid regurgitation. 1. **Why Lithium is Correct:** Lithium is a mood stabilizer used for Bipolar Affective Disorder. It is a known **teratogen** that crosses the placenta. Maternal intake during the first trimester (organogenesis) is classically associated with Ebstein’s anomaly. While the absolute risk is lower than previously thought (approx. 1-2 per 1,000 exposures), the **relative risk** is significantly higher compared to the general population (where it is 1 in 20,000). 2. **Why Other Options are Incorrect:** * **Mercury (A):** Organic mercury (methylmercury) exposure during pregnancy causes **Minamata disease**, characterized by severe neurological damage, microcephaly, and cerebral palsy. * **Copper (B):** Copper is not a recognized teratogen. In fact, disorders of copper metabolism like Wilson’s disease are managed during pregnancy, and copper-containing IUCDs are local contraceptives with no systemic teratogenic effect. * **Lead (D):** Lead exposure is associated with increased risks of miscarriage, intrauterine growth restriction (IUGR), and neurodevelopmental delays, but not specific cardiac structural defects like Ebstein's. **Clinical Pearls for NEET-PG:** * **Best Screening Tool:** Fetal Echocardiography (performed at 18–22 weeks) is the gold standard to detect Ebstein’s anomaly in mothers taking Lithium. * **Management:** If a bipolar patient plans pregnancy, Lithium should ideally be tapered; however, if the risk of relapse is high, it may be continued with close fetal monitoring. * **Other Lithium Side Effects:** In neonates, it can cause "Floppy Baby Syndrome" (hypotonia) and neonatal goiter.

Q: Lithium use in pregnancy is associated with which of the following fetal defects?

Cardiovascular defects. **Explanation:** **Lithium** is a gold-standard mood stabilizer used in Bipolar Disorder; however, it is a known teratogen. When used during the first trimester of pregnancy, it is specifically associated with **Cardiovascular defects**, most notably **Ebstein’s Anomaly**. This condition involves the downward displacement of the tricuspid valve into the right ventricle, leading to "atrialization" of the ventricle and severe tricuspid regurgitation. While the absolute risk is relatively low (approx. 1 in 1,000 to 2,000), it represents a 10-20 fold increase compared to the general population. **Analysis of Incorrect Options:** * **Urogenital defects:** These are not classically associated with Lithium. They are more commonly linked to maternal diabetes or specific genetic syndromes. * **Neural tube defects (NTDs):** These are the hallmark teratogenic effect of **Valproate** and **Carbamazepine** (due to interference with folate metabolism), not Lithium. * **Facial defects:** Cleft lip and palate are associated with anticonvulsants like Phenytoin (Fetal Hydantoin Syndrome) or Benzodiazepines, but are not the primary concern with Lithium. **High-Yield Clinical Pearls for NEET-PG:** * **Monitoring:** If Lithium must be used, fetal echocardiography is recommended at 18–22 weeks gestation. * **Dosage:** Lithium clearance increases during pregnancy (due to increased GFR) and drops abruptly at delivery; close serum monitoring is vital to prevent toxicity. * **Breastfeeding:** Lithium is generally discouraged during breastfeeding as it is excreted in milk and can cause "Floppy Baby Syndrome" (hypotonia, cyanosis). * **Alternative:** For NTDs (Valproate), the boards often ask about high-dose Folic acid supplementation (4mg/day).

Q: Which of the following antipsychotics is not available as a depot preparation for the treatment of psychosis?

Clozapine. **Explanation:** The correct answer is **Clozapine**. Depot preparations (Long-Acting Injectables or LAIs) are designed to improve compliance in patients with chronic schizophrenia by providing sustained drug release over weeks or months. **Why Clozapine is not available as a depot:** Clozapine is reserved for **treatment-resistant schizophrenia**. Its use is strictly regulated due to the risk of **agranulocytosis** (severe leucopenia). Patients on Clozapine require mandatory, regular blood monitoring (ANC counts). If Clozapine were administered as a long-acting depot, it would be impossible to rapidly "withdraw" the drug from the system if a patient developed life-threatening bone marrow suppression. Therefore, it is only available in oral formulations to allow for immediate cessation if toxicity occurs. **Analysis of Incorrect Options:** * **Haloperidol:** A typical (first-generation) antipsychotic available as **Haloperidol Decanoate**, usually administered every 4 weeks. * **Aripiprazole:** An atypical (second-generation) antipsychotic available as **Aripiprazole Maintena** (monthly) and **Lauroxil**. * **Olanzapine:** Available as **Olanzapine Pamoate**. Note: It carries a risk of "Post-injection Delirium Sedation Syndrome," requiring 3 hours of clinical observation after administration. **High-Yield Clinical Pearls for NEET-PG:** * **Other Depot Drugs:** Fluphenazine decanoate, Risperidone microspheres, and Paliperidone palmitate. * **Clozapine Side Effects:** Agranulocytosis (most serious), seizures (dose-dependent), myocarditis, and significant weight gain/sialorrhea. * **Monitoring:** Clozapine is the only antipsychotic proven to reduce **suicidal behavior** in schizophrenia.

Q: Which of the following is an antidepressant?

Citalopram. **Explanation:** The question asks to identify an antidepressant from the given list. While all options listed are technically used in the management of depression, this question likely focuses on the primary classification of **Selective Serotonin Reuptake Inhibitors (SSRIs)**, which are the first-line agents for depression in modern clinical practice. **1. Why Citalopram is the Correct Answer:** **Citalopram** is a prototypical SSRI. It works by specifically inhibiting the reuptake of serotonin (5-HT) at the presynaptic terminal, increasing its availability in the synaptic cleft. It is preferred due to its high selectivity, better side-effect profile, and lower toxicity in overdose compared to older classes. **2. Analysis of Other Options:** * **Amitriptyline:** This is a **Tricyclic Antidepressant (TCA)**. It inhibits the reuptake of both Norepinephrine and Serotonin but also blocks muscarinic, histaminic, and alpha-adrenergic receptors, leading to significant side effects (sedation, dry mouth, arrhythmias). * **Trazodone & Nefazodone:** These belong to the **SARI (Serotonin Antagonist and Reuptake Inhibitor)** class. They are "atypical" antidepressants. Trazodone is more commonly used today as a hypnotic for insomnia rather than a primary antidepressant due to its highly sedative nature. **Clinical Pearls for NEET-PG:** * **SSRIs (Drug of Choice):** Escitalopram is the most specific SSRI; Fluoxetine has the longest half-life (safe from withdrawal syndrome). * **Side Effects:** SSRIs commonly cause sexual dysfunction and GI upset. TCAs are notorious for the "3 Cs": Coma, Convulsions, and Cardiotoxicity (arrhythmias due to Na+ channel blockade). * **Nefazodone Warning:** It is rarely used now due to the risk of **hepatotoxicity**. * **Trazodone:** Associated with the rare but high-yield side effect of **priapism**.

Q: What is the primary abnormality to screen for when a pregnant female is prescribed lithium?

Cardiac anomaly. **Explanation:** **Lithium** is a gold-standard mood stabilizer used in Bipolar Disorder, but it is a known human teratogen. When administered during the first trimester of pregnancy, it is specifically associated with a rare but serious **cardiac anomaly** known as **Ebstein’s Anomaly**. 1. **Why Cardiac Anomaly is Correct:** Ebstein’s anomaly involves the "atrialization" of the right ventricle due to the downward displacement of the tricuspid valve leaflets. This leads to tricuspid regurgitation and right heart failure. Because of this risk, fetal echocardiography is mandatory at 18–20 weeks of gestation for women taking Lithium. 2. **Why Other Options are Incorrect:** * **Neural Tube Defects (NTDs):** These are primarily associated with **Valproate** (highest risk) and **Carbamazepine**. These drugs interfere with folate metabolism, unlike Lithium. * **Facial Defects:** Cleft lip and palate are more commonly associated with **Phenytoin** (as part of Fetal Hydantoin Syndrome) or Benzodiazepines. * **Urogenital Defects:** These are not a classic association with Lithium; however, Lithium can cause "Floppy Infant Syndrome" and neonatal hypothyroidism if used near term. **High-Yield NEET-PG Pearls:** * **Teratogenic Risk:** While the relative risk of Ebstein’s anomaly increases 10–20 fold with Lithium, the absolute risk remains low (~1 in 1,000). * **Management:** If a stable patient becomes pregnant, Lithium should not be stopped abruptly (high relapse risk). Instead, the dose should be titrated, and serum levels monitored closely due to increased GFR during pregnancy. * **Breastfeeding:** Lithium is generally **avoided** during breastfeeding as it is excreted in milk and can cause toxicity in the neonate (lethargy, cyanosis).

Q: Risperidone increases the risk of which of the following?

Extrapyramidal symptoms. **Explanation:** Risperidone is a **Second-Generation (Atypical) Antipsychotic**. While atypical antipsychotics generally have a lower risk of Extrapyramidal Symptoms (EPS) compared to first-generation drugs (like Haloperidol), **Risperidone is unique** because it exhibits dose-dependent EPS. At higher therapeutic doses (>6 mg/day), its potent D2 receptor antagonism outweighs its 5-HT2A antagonism, significantly increasing the risk of akathisia, dystonia, and parkinsonism. **Analysis of Options:** * **Extrapyramidal Symptoms (Correct):** Risperidone has the highest propensity for EPS among all atypical antipsychotics. It also frequently causes hyperprolactinemia due to D2 blockade in the tuberoinfundibular pathway. * **Cerebrovascular accidents:** While there is an increased risk of stroke in elderly patients with dementia-related psychosis taking atypicals, it is a "Black Box Warning" for the class rather than the primary side effect associated with Risperidone in general pharmacology. * **Agranulocytosis:** This is a classic, life-threatening side effect specifically associated with **Clozapine**, requiring mandatory WBC monitoring. * **Diabetes insipidus:** Nephrogenic Diabetes Insipidus is a classic side effect of **Lithium**, not antipsychotics. **High-Yield NEET-PG Pearls:** 1. **"The Typical Atypical":** Risperidone is the atypical antipsychotic most likely to cause EPS and prolactin elevation (amenorrhea, galactorrhea). 2. **Metabolic Syndrome:** Atypicals (especially Clozapine and Olanzapine) are high-risk for weight gain, dyslipidemia, and Type 2 Diabetes. 3. **Ziprasidone:** Notable for causing QT interval prolongation but has the least weight gain. 4. **Aripiprazole:** A D2 partial agonist, often called a "dopamine stabilizer."

Question 1

Which of the following drugs is not associated with an increase in prolactin levels?

Accepted Answer

Quetiapine

Answer

Haloperidol

Answer

Chlorpromazine

Answer

Hydroxysulpiride

Question 2

All are true about Desvenlafaxine except?

Accepted Answer

It is a D2 receptor antagonist

Answer

Can cause priapism

Answer

Can cause glaucoma

Answer

Can cause hyperlipidemia

Question 3

Ebstein's anomaly is associated with maternal intake of which of the following substances?

Accepted Answer

Lithium

Answer

Mercury

Answer

Copper

Answer

Lead

Question 4

Lithium use in pregnancy is associated with which of the following fetal defects?

Accepted Answer

Cardiovascular defects

Answer

Urogenital defects

Answer

Neural tube defects

Answer

Facial defects

Question 5

Agranulocytosis is a known side effect of which of the following medications?

Accepted Answer

Carbamazepine

Answer

Risperidone

Answer

Clonazepam

Answer

Olanzapine

Question 6

Which of the following is the most common side effect seen with fluoxetine therapy?

Accepted Answer

Anxiety

Answer

Seizure

Answer

Hypotension

Answer

Loose stools

Question 7

Which of the following antipsychotics is not available as a depot preparation for the treatment of psychosis?

Accepted Answer

Clozapine

Answer

Aripiprazole

Answer

Olanzapine

Answer

Haloperidol

Question 8

Which of the following is an antidepressant?

Accepted Answer

Citalopram

Answer

Amitriptyline

Answer

Trazodone

Answer

Nefazodone

Question 9

What is the primary abnormality to screen for when a pregnant female is prescribed lithium?

Accepted Answer

Cardiac anomaly

Answer

Neural tube defect

Answer

Facial defect

Answer

Urogenital defect

Question 10

Risperidone increases the risk of which of the following?

Accepted Answer

Extrapyramidal symptoms

Answer

Cerebrovascular accidents

Answer

Agranulocytosis

Answer

Diabetes insipidus

Drugs in Psychiatric Disorders — MCQs

Drugs in Psychiatric Disorders — MCQs

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