Drugs in Psychiatric Disorders Practice Questions

Q: Which of the following is true about lithium?

It can cause fine postural tremors at therapeutic dosage. ***It can cause fine postural tremors at therapeutic dosage*** - **Fine postural tremors** are a common and well-known side effect of lithium, even within its therapeutic range. - This side effect can be dose-dependent and may worsen with higher lithium concentrations. *It is also used for treatment of absence seizures* - Lithium is primarily used as a **mood stabilizer** for bipolar disorder and is not indicated for the treatment of **absence seizures**. - **Absence seizures** are typically treated with drugs like ethosuximide or valproate. *It is not teratogenic* - Lithium is known to be **teratogenic**, especially during the first trimester of pregnancy. - It is associated with an increased risk of **Ebstein's anomaly**, a congenital heart defect. *It is not absorbed from the gut* - Lithium is **rapidly and completely absorbed** from the gastrointestinal tract after oral administration. - Its absorption is not significantly affected by food, and peak plasma concentrations are usually reached within 1-3 hours.

Q: True for lithium:

Narrow therapeutic index. ***Narrow therapeutic index*** - Lithium has a **narrow therapeutic index**, meaning the difference between its effective and toxic doses is small. - This necessitates **close monitoring of serum lithium levels** to ensure efficacy and prevent toxicity. *Can be given safely in renal dysfunction* - Lithium is **primarily excreted renally**, and its clearance is directly proportional to creatinine clearance. - Therefore, it **should be used with caution** (or avoided) in patients with renal dysfunction due to increased risk of toxicity. *Protein bound* - Lithium is **not protein-bound**; it exists as a free ion in the blood. - This characteristic contributes to its rapid distribution and excretion. *Delayed absorption* - Lithium is **rapidly and almost completely absorbed** from the gastrointestinal tract. - Peak plasma concentrations are usually reached within 1-2 hours for immediate-release preparations.

Q: Venlafaxine comes under which class of drugs?

Serotonin-norepinephrine reuptake inhibitor (SNRI). ***Serotonergic noradrenergic reuptake inhibitor*** - **Venlafaxine** is an antidepressant that works by inhibiting the reuptake of both **serotonin** and **norepinephrine**, making it a **Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)**. - This dual mechanism contributes to its efficacy in treating **major depressive disorder**, **anxiety disorders**, and **neuropathic pain**. *Monoamine oxidase inhibitors* - **MAOIs** inhibit the enzyme **monoamine oxidase**, which metabolizes neurotransmitters like **serotonin**, **norepinephrine**, and **dopamine**. - They are associated with significant **food and drug interactions**, unlike venlafaxine. *Serotonin receptor antagonist* - These drugs *block* **serotonin receptors**, often used as **antiemetics** (e.g., ondansetron) or in some **antipsychotics**. - They do not primarily increase serotonin or norepinephrine levels via reuptake inhibition. *Selective serotonin reuptake inhibitor* - **SSRIs** (e.g., fluoxetine, sertraline) primarily inhibit the reuptake of **serotonin**, with minimal effect on other neurotransmitters. - While venlafaxine affects serotonin, it also significantly impacts norepinephrine, distinguishing it from SSRIs.

Q: Ebstein anomaly is due to -

Lithium. ***Correct: Lithium*** - **Lithium** exposure during the first trimester of pregnancy is a known teratogen associated with an increased risk of **Ebstein anomaly** - **Ebstein anomaly** is a congenital heart defect affecting the **tricuspid valve**, characterized by its displacement into the right ventricle - The association with lithium is well-documented, though the absolute risk remains relatively low (approximately 1-2% compared to baseline risk of 0.01%) *Incorrect: Copper (Cu)* - **Copper (Cu)** is an essential trace element required for various enzymatic functions - While both copper deficiency and toxicity can cause health issues, there is no clear evidence linking copper exposure or deficiency directly to Ebstein anomaly - Not a recognized teratogen for this specific cardiac malformation *Incorrect: Nickel (Ni)* - **Nickel (Ni)** exposure has not been established as a significant risk factor for congenital heart defects like Ebstein anomaly - While nickel can act as an allergen and cause contact dermatitis or other toxic effects in high doses, it is not a recognized cardiac teratogen - No documented association with tricuspid valve abnormalities during fetal development *Incorrect: Cobalt (Co)* - **Cobalt (Co)** is a trace element that in excessive amounts can lead to toxicity including cardiomyopathy in adults - However, cobalt is not linked to the development of **Ebstein anomaly** during fetal development - No known direct association between cobalt exposure and congenital tricuspid valve abnormalities

Q: Which of the following drugs is specifically approved for the treatment of premature ejaculation?

Dapoxetine. ***Dapoxetine*** - **Dapoxetine** is a **short-acting selective serotonin reuptake inhibitor (SSRI)** specifically approved for the on-demand treatment of **premature ejaculation (PE)**. - It works by delaying the ejaculatory reflex through its effect on serotonin transporters in the brain, thereby increasing the **intravaginal ejaculatory latency time (IELT)**. *Escitalopram* - **Escitalopram** is a **long-acting SSRI** primarily used for the treatment of **depression and anxiety disorders**. - While other SSRIs can be used off-label for PE, escitalopram's long half-life makes it less suitable for on-demand use, and it is not specifically approved for this indication. *Citalopram* - **Citalopram** is another **long-acting SSRI** used mainly for **depression and anxiety**, similar to escitalopram. - Its pharmacokinetic profile is not ideal for on-demand treatment of PE, and it carries a risk of QT prolongation, which further limits its use in this context. *Chlorpromazine* - **Chlorpromazine** is a **first-generation antipsychotic** used to treat **psychotic disorders** like schizophrenia, as well as severe nausea and vomiting. - It has no role in the direct treatment of premature ejaculation and its side effect profile, including sedation and extrapyramidal symptoms, makes it inappropriate for this condition.

Q: A patient with nocturnal enuresis and depressive symptoms was started on an antidepressant. What is the drug?

imipramine. ***Imipramine*** - **Imipramine (Tofranil)** is a **tricyclic antidepressant (TCA)** [1] historically used for **nocturnal enuresis** due to its anticholinergic and alpha-adrenergic effects, which increase bladder capacity and sphincter tone. While it treats **depressive symptoms** [2], its use in enuresis has declined due to newer therapies with fewer side effects. *Clomipramine* - **Clomipramine (Anafranil)** is primarily used for **obsessive-compulsive disorder (OCD)** but also has antidepressant effects. While it shares some properties with imipramine as a TCA, it is **not the primary choice for nocturnal enuresis** and is more known for its serotonin reuptake inhibition. *Sertraline* - **Sertraline (Zoloft)** is a **selective serotonin reuptake inhibitor (SSRI)** commonly used for depression, anxiety disorders, and OCD. It **does not have a recognized role in treating nocturnal enuresis** and can sometimes even worsen urinary symptoms or cause nocturnal polyuria. *Amitriptyline* - **Amitriptyline (Elavil)** is a TCA effective for **depression**, **neuropathic pain**, and **migraine prophylaxis**. While it has strong anticholinergic properties that could theoretically affect bladder function, it is **not the preferred TCA for nocturnal enuresis**; imipramine has a more established history for this indication.

Q: Which of the following is excreted in saliva?

Lithium. ***Lithium*** - **Lithium** is actively excreted in saliva, making salivary lithium levels a potential, though not routinely used, indicator of serum levels. - The salivary glands can concentrate lithium, leading to concentrations in saliva that are typically **2 to 3 times higher** than in plasma (saliva/plasma ratio of approximately 2-3:1). - This property makes saliva a useful non-invasive medium for therapeutic drug monitoring of lithium. *Chloramphenicol* - **Chloramphenicol** is primarily metabolized in the liver by glucuronidation and excreted in the urine. - While small amounts may be found in various body fluids, it is not a significant component of salivary excretion. *Ampicillin* - **Ampicillin**, a penicillin antibiotic, is mainly eliminated unchanged via renal excretion. - Salivary excretion is not a primary route of elimination for ampicillin. *Tetracycline* - **Tetracycline** antibiotics are primarily excreted unchanged by the kidneys and, to a lesser extent, in bile. - While some drugs can be detected in saliva, tetracycline is not notably excreted through this route in clinically significant amounts.

Q: Nocturnal enuresis is commonly treated with:

Imipramine. **Imipramine** - **Imipramine**, a tricyclic antidepressant, is known to reduce the depth of sleep, decrease the volume of urine produced at night, and increase bladder capacity, making it an effective treatment for **nocturnal enuresis**. - Its mechanism involves both anticholinergic effects on the bladder and direct effects on the central nervous system to reduce arousal threshold. *Haloperidol* - **Haloperidol** is a typical antipsychotic primarily used to treat psychotic disorders like schizophrenia and acute delirium. - It is not indicated for the management of nocturnal enuresis and could potentially have severe neurological side effects. *Chlordiazepoxide* - **Chlordiazepoxide** is a benzodiazepine used for anxiety, alcohol withdrawal, and muscle spasms. - It acts as a central nervous system depressant and would likely worsen enuresis by further relaxing bladder control and increasing sleep depth. *Chlorpromazine* - **Chlorpromazine** is another typical antipsychotic, also used as an antiemetic and for severe behavioral problems. - It has no role in the treatment of nocturnal enuresis and can cause significant side effects such as sedation and extrapyramidal symptoms.

Q: Ebstein's anomaly is seen with intake of –

Lithium. ***Lithium*** - **Lithium** exposure during the first trimester of pregnancy is associated with an increased risk of **Ebstein's anomaly**, a congenital heart defect. - This defect involves the **tricuspid valve** being displaced into the right ventricle, leading to tricuspid regurgitation and right heart failure. - The risk is approximately **1-2%** with first-trimester lithium exposure compared to baseline risk of 1 in 20,000. *Mercury* - **Mercury poisoning**, especially in utero, can lead to neurological developmental issues, such as **Minamata disease**, characterized by sensory disturbances, ataxia, and cognitive impairment. - It is not directly linked to cardiac malformations like Ebstein's anomaly. *Lead* - **Lead exposure** during pregnancy is associated with adverse outcomes such as preterm birth, low birth weight, and neurodevelopmental delays in the child. - It is not a known cause of specific cardiac anomalies like Ebstein's anomaly. *Copper* - While **copper excess** (e.g., in Wilson's disease) or deficiency can lead to various health problems, there is no established direct link between maternal copper intake and Ebstein's anomaly. - **Genetic factors** or other teratogens are more commonly implicated in congenital heart defects.

Q: Which of the following drug treatment increases thirst and causes dilute diuresis ?

Lithium. ***Lithium*** - **Lithium** can cause **nephrogenic diabetes insipidus**, leading to impaired water reabsorption in the kidneys. - This results in increased thirst (polydipsia) and the excretion of a large volume of dilute urine (polyuria). *Chlorpromazine* - **Chlorpromazine** is a typical antipsychotic that can cause **anticholinergic side effects** such as dry mouth, but typically not polyuria or polydipsia directly via renal mechanisms. - It primarily acts on dopamine receptors and can cause **sedation** and **extrapyramidal symptoms**. *Clozapine* - **Clozapine**, an atypical antipsychotic, is associated with a risk of **sialorrhea** (excessive salivation) and **metabolic syndrome**, but not primarily with dilute diuresis. - It is used for refractory schizophrenia but carries risks like **agranulocytosis** and **myocarditis**. *Phenobarbitone* - **Phenobarbitone** is a barbiturate used as an anticonvulsant and sedative, acting on GABA-A receptors. - Its side effects include **sedation** and **respiratory depression**, but it does not typically cause increased thirst or dilute diuresis.

Question 1

Which of the following is true about lithium?

Accepted Answer

It can cause fine postural tremors at therapeutic dosage

Answer

It is also used for treatment of absence seizures

Answer

It is not teratogenic

Answer

It is not absorbed from the gut

Question 2

True for lithium:

Accepted Answer

Narrow therapeutic index

Answer

Can be given safely in renal dysfunction

Answer

Protein bound

Answer

Delayed absorption

Question 3

Venlafaxine comes under which class of drugs?

Accepted Answer

Serotonin-norepinephrine reuptake inhibitor (SNRI)

Answer

Monoamine oxidase inhibitors

Answer

Serotonin receptor antagonist

Answer

Selective serotonin reuptake inhibitor

Question 4

Ebstein anomaly is due to -

Accepted Answer

Lithium

Answer

Cu

Answer

Ni

Answer

Co

Question 5

Which of the following drugs is specifically approved for the treatment of premature ejaculation?

Accepted Answer

Dapoxetine

Answer

Escitalopram

Answer

Citalopram

Answer

Chlorpromazine

Question 6

A patient with nocturnal enuresis and depressive symptoms was started on an antidepressant. What is the drug?

Accepted Answer

imipramine

Answer

clomipramine

Answer

sertraline

Answer

amitriptyline

Question 7

Which of the following is excreted in saliva?

Accepted Answer

Lithium

Answer

Chloramphenicol

Answer

Ampicillin

Answer

Tetracycline

Question 8

Nocturnal enuresis is commonly treated with:

Accepted Answer

Imipramine

Answer

Haloperidol

Answer

Chlordiazepoxide

Answer

Chlorpromazine

Question 9

Ebstein's anomaly is seen with intake of –

Accepted Answer

Lithium

Answer

Mercury

Answer

Lead

Answer

Copper

Question 10

Which of the following drug treatment increases thirst and causes dilute diuresis ?

Accepted Answer

Lithium

Answer

Chlorpromazine

Answer

Clozapine

Answer

Phenobarbitone

Drugs in Psychiatric Disorders — MCQs

Drugs in Psychiatric Disorders — MCQs

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