Drugs in Psychiatric Disorders Practice Questions

Q: Which of the following SSRIs does NOT affect the blood levels of other drugs?

Sertraline. ### Explanation The primary reason SSRIs (Selective Serotonin Reuptake Inhibitors) affect the blood levels of other drugs is their ability to inhibit **Cytochrome P450 (CYP450)** enzymes in the liver. When these enzymes are inhibited, the metabolism of co-administered drugs (like warfarin, TCAs, or beta-blockers) decreases, leading to increased plasma concentrations and potential toxicity. **1. Why Sertraline is the Correct Answer:** **Sertraline** (along with Citalopram and Escitalopram) is known for having **minimal to no inhibitory effect** on CYP450 isoenzymes. Because it does not significantly interfere with the metabolic pathways of other medications, it has a very low potential for clinically significant drug-drug interactions. This makes it a preferred choice in elderly patients or those on multiple medications (polypharmacy). **2. Why the Other Options are Incorrect:** * **Fluoxetine:** A potent inhibitor of **CYP2D6** and **CYP3A4**. It has a very long half-life and significantly raises the levels of drugs like haloperidol and propranolol. * **Fluvoxamine:** A potent inhibitor of **CYP1A2** and **CYP2C19**. It significantly increases the levels of theophylline and warfarin. * **Paroxetine:** A highly potent inhibitor of **CYP2D6**. It can interfere with its own metabolism and significantly increase the levels of tricyclic antidepressants (TCAs). **Clinical Pearls for NEET-PG:** * **Safest SSRIs (Lowest Drug Interactions):** Sertraline, Citalopram, Escitalopram. * **Most Potent CYP2D6 Inhibitors:** Fluoxetine and Paroxetine. * **Longest Half-life:** Fluoxetine (due to its active metabolite, norfluoxetine), which requires a 5-week washout period before starting an MAOI to avoid **Serotonin Syndrome**. * **Drug of Choice (DOC):** SSRIs are the first-line treatment for Depression, OCD, Panic Disorder, and Social Phobia.

Q: Which of the following is a nonsedative anxiolytic?

Buspirone. ### Explanation **Correct Answer: A. Buspirone** **Mechanism and Rationale:** Buspirone is a unique anxiolytic that acts as a **selective partial agonist at the 5-HT1A receptors**. Unlike Benzodiazepines, it does not interact with the GABA-A receptor complex. Its primary clinical advantage is that it provides relief from anxiety **without causing sedation**, hypnosis, muscle relaxation, or anticonvulsant effects. It also lacks the potential for abuse or physical dependence, making it ideal for chronic generalized anxiety disorder (GAD). However, it has a slow onset of action (taking 1–2 weeks to show effects) and is ineffective for acute anxiety or panic attacks. **Analysis of Incorrect Options:** * **B. Hydroxyzine:** An H1-receptor antagonist (antihistamine) with significant sedative properties. It is used for acute situational anxiety but causes marked drowsiness. * **C. Chlorpromazine:** A typical antipsychotic (low potency). While it has calming effects, it is primarily used for psychosis and is highly sedative due to its alpha-1 and H1 blocking actions. * **D. Alprazolam:** A Benzodiazepine. While highly effective for anxiety and panic disorders, its primary side effect is **sedation** and psychomotor impairment. It also carries a high risk of dependence. **High-Yield Clinical Pearls for NEET-PG:** * **"Driving Safety":** Buspirone is the preferred anxiolytic for patients whose occupations require mental alertness (e.g., pilots, drivers). * **No Interaction with Alcohol:** Unlike Benzodiazepines, Buspirone does not potentiate the CNS depressant effects of alcohol. * **Metabolism:** It is metabolized by **CYP3A4**; its levels can increase significantly if taken with grapefruit juice or erythromycin. * **Rule Out:** Buspirone is **not** effective in treating Benzodiazepine withdrawal.

Q: Which of the following is a tricyclic antidepressant?

Imipramine. **Explanation:** **Imipramine** is the correct answer as it is a prototype **Tricyclic Antidepressant (TCA)**. TCAs are characterized by a three-ring chemical structure and work primarily by inhibiting the reuptake of Norepinephrine (NE) and Serotonin (5-HT) from the synaptic cleft. Imipramine is a non-selective inhibitor, often used clinically for nocturnal enuresis in children due to its anticholinergic properties. **Analysis of Incorrect Options:** * **Sertraline (A) and Fluoxetine (C):** These belong to the **Selective Serotonin Reuptake Inhibitors (SSRIs)** class. They are currently the first-line treatment for depression and anxiety disorders due to their superior safety profile and lack of significant anticholinergic or cardiotoxic side effects compared to TCAs. * **Bupropion (B):** This is an **Atypical Antidepressant** that acts as a Norepinephrine-Dopamine Reuptake Inhibitor (NDRI). It is notably used for smoking cessation and has a lower risk of causing sexual dysfunction or weight gain. **High-Yield NEET-PG Pearls:** * **Mechanism of TCA Toxicity:** TCAs block sodium channels in the heart, leading to QRS prolongation and arrhythmias. The "3 Cs" of TCA overdose are **C**oma, **C**onvulsions, and **C**ardiotoxicity. * **Antidote:** Sodium bicarbonate is used to treat TCA-induced cardiotoxicity. * **Secondary Amines vs. Tertiary Amines:** Imipramine and Amitriptyline are tertiary amines (more sedative), while Desipramine and Nortriptyline are secondary amines (more potent for NE reuptake).

Q: Which of the following drugs has anxiolytic action with the least sedation?

Buspirone. **Explanation:** **Buspirone** is the correct answer because it is a non-benzodiazepine anxiolytic that belongs to the **Azapirone** class. Unlike benzodiazepines, it acts as a **selective 5-HT1A partial agonist**. Its unique pharmacological profile allows it to relieve anxiety without causing significant sedation, hypnosis, muscle relaxation, or anticonvulsant effects. It also lacks the potential for abuse or withdrawal symptoms, making it ideal for chronic generalized anxiety disorder (GAD). **Why the other options are incorrect:** * **Triazolam (Option B):** A short-acting benzodiazepine primarily used as a hypnotic. It causes significant sedation and has a high risk of rebound insomnia. * **Alprazolam (Option C):** A potent benzodiazepine used for panic disorders and anxiety. While effective, it causes dose-dependent sedation, psychomotor impairment, and carries a risk of dependence. * **Chlordiazepoxide (Option D):** A long-acting benzodiazepine commonly used for alcohol withdrawal. It produces active metabolites that cause prolonged sedation and "hangover" effects. **High-Yield Clinical Pearls for NEET-PG:** * **Latency of Action:** Buspirone has a slow onset of action (takes **1–2 weeks** to show effects). It is NOT useful for acute anxiety or panic attacks. * **No Interaction with Alcohol:** Unlike benzodiazepines, buspirone does not potentiate the CNS depressant effects of alcohol. * **Driving Safety:** Because it lacks sedative and psychomotor-impairing properties, it is the preferred anxiolytic for patients who need to drive or operate machinery. * **Side Effects:** Most common side effects include dizziness, nausea, and headache. It does not cause weight gain or sexual dysfunction (unlike SSRIs).

Q: Which of the following is NOT a side effect of tricyclic antidepressants?

Weight loss. **Explanation:** Tricyclic Antidepressants (TCAs), such as Amitriptyline and Imipramine, are known for their broad pharmacological profile, acting on multiple receptors including muscarinic (M1), histaminergic (H1), and alpha-adrenergic (α1) receptors. **Why Weight Loss is the Correct Answer:** TCAs are notorious for causing **Weight Gain**, not weight loss. This occurs primarily due to the potent blockade of **H1 (Histamine)** receptors, which increases appetite and cravings for carbohydrates. Therefore, weight loss is not a side effect of TCAs; in fact, it is more commonly associated with certain SSRIs (like Fluoxetine) or Bupropion. **Analysis of Incorrect Options:** * **Weight Gain:** As mentioned, H1 receptor antagonism leads to significant weight gain, making it a common reason for patient non-compliance. * **Giddiness:** This is a result of **Orthostatic Hypotension** caused by the blockade of **alpha-1 (α1) adrenergic receptors**. Patients often experience dizziness or giddiness when standing up suddenly. * **Sedation:** This is another direct consequence of **H1 receptor blockade**. TCAs like Amitriptyline are highly sedative and are often administered at bedtime to aid sleep. **NEET-PG High-Yield Pearls:** 1. **Anticholinergic Side Effects:** TCAs cause the "3 Ds": Dry mouth, Dilated pupils (blurred vision), and Difficulty in micturition (due to M1 blockade). 2. **Cardiotoxicity:** The most dangerous side effect in overdose is cardiac arrhythmia due to **Sodium (Na+) channel blockade**, leading to QRS prolongation. 3. **Treatment of Overdose:** Sodium bicarbonate is the specific antidote used to manage TCA-induced arrhythmias. 4. **Drug of Choice:** Imipramine is the DOC for Nocturnal Enuresis in children (though non-pharmacological methods are preferred first).

Q: Which medication is known to cause reversible lens granular deposits?

chlorpromazine. **Explanation** The correct answer is **Chlorpromazine**. **1. Why Chlorpromazine is correct:** Chlorpromazine is a low-potency typical antipsychotic known for its specific ocular side effects. Long-term use or high cumulative doses (typically >800 mg/day) lead to the deposition of drug-pigment complexes in the eye. These characteristically appear as **whitish-brown granular deposits** on the **anterior lens capsule** and the posterior surface of the cornea. These deposits are usually asymptomatic and do not significantly impair vision, though they can occasionally progress to "star-shaped" cataracts. Importantly, these lens changes are often **reversible** or stabilize upon discontinuation of the drug. **2. Why the other options are incorrect:** * **Risperidone, Paliperidone, and Olanzapine:** These are Second-Generation (Atypical) Antipsychotics. While they are associated with metabolic side effects (weight gain, dyslipidemia, and diabetes), they are **not** typically associated with granular lens deposits. Risperidone and Paliperidone are more frequently linked to hyperprolactinemia. **3. High-Yield Clinical Pearls for NEET-PG:** * **Chlorpromazine (CPZ):** Remember the mnemonic *"C for Chlorpromazine, C for Corneal/Lens deposits."* It is also associated with blue-grey skin discoloration and photosensitivity. * **Thioridazine:** Another low-potency antipsychotic, but it causes **Irreversible Retinitis Pigmentosa** (Browning of vision) at doses >800 mg/day. Remember: *"T for Thioridazine, T for Total blindness (Retina)."* * **Quetiapine:** Historically required baseline slit-lamp exams due to cataract concerns in animal studies, though this is rarely seen in humans. * **Monitoring:** Patients on long-term Chlorpromazine should undergo periodic slit-lamp examinations.

Q: Which anxiolytic benzodiazepine also possesses antidepressant properties?

Alprazolam. **Explanation:** **Alprazolam** is a unique triazolo-benzodiazepine. While all benzodiazepines (BZDs) share common properties (anxiolytic, sedative-hypnotic, muscle relaxant, and anticonvulsant), Alprazolam is the only one in this list that possesses significant **antidepressant properties**. This is attributed to its ability to modulate central monoaminergic systems and its high potency at the GABA-A receptor complex. It is specifically indicated for anxiety associated with depression and is highly effective in treating **Panic Disorder**. **Analysis of Incorrect Options:** * **Oxazepam:** A short-to-intermediate acting BZD. It is a direct metabolite of Diazepam and is preferred in patients with liver failure (as it undergoes direct glucuronidation), but it lacks antidepressant efficacy. * **Lorazepam:** A high-potency BZD used primarily for status epilepticus, acute anxiety, and pre-anesthetic medication. It does not have inherent antidepressant activity. * **Chlordiazepoxide:** The first BZD discovered. It has a long half-life and active metabolites. Its primary clinical use today is in the management of **Alcohol Withdrawal Syndrome**. **High-Yield Clinical Pearls for NEET-PG:** * **DOC for Panic Disorder:** Alprazolam (along with SSRIs for long-term management). * **BZD for Liver Failure:** Remember the mnemonic **LOT** (Lorazepam, Oxazepam, Temazepam) as they do not require hepatic oxidation. * **Antidote:** Flumazenil is a competitive BZD receptor antagonist used for overdose. * **Mechanism:** BZDs increase the **frequency** of chloride channel opening (GABA-facilitatory), whereas Barbiturates increase the **duration**.

Q: Which of the following is a non-selective serotonin and noradrenaline reuptake inhibitor?

Venlafaxine. The question tests the classification of antidepressant drugs based on their mechanism of action. **Correct Option: C. Venlafaxine** Venlafaxine belongs to the class of **Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)** [1]. These drugs are "non-selective" because they inhibit the reuptake of both serotonin (5-HT) and noradrenaline (NE) by binding to their respective transporters (SERT and NET) [1]. This dual action increases the synaptic concentration of both neurotransmitters. Other drugs in this class include Duloxetine, Milnacipran, and Desvenlafaxine [1, 2]. **Incorrect Options:** * **A, B, and D (Sertraline, Citalopram, Paroxetine):** These drugs belong to the **Selective Serotonin Reuptake Inhibitors (SSRIs)** class [1]. As the name suggests, they selectively inhibit the reuptake of serotonin (5-HT) with minimal to no effect on noradrenaline or dopamine reuptake [1]. SSRIs are currently the first-line treatment for most anxiety and depressive disorders due to their better safety profile. **High-Yield Clinical Pearls for NEET-PG:** * **Dose-Dependent Action:** At low doses, Venlafaxine acts primarily as an SSRI; its noradrenergic effect becomes significant only at higher doses (>150 mg/day) [2]. * **Side Effects:** Due to its noradrenergic activity, Venlafaxine can cause a **dose-dependent increase in blood pressure** (diastolic hypertension). * **Duloxetine:** Another SNRI frequently asked about; it is the drug of choice for **diabetic neuropathy** and fibromyalgia. * **Discontinuation Syndrome:** Venlafaxine has a short half-life, making it more likely to cause severe withdrawal symptoms if stopped abruptly compared to SSRIs like Fluoxetine.

Question 1

All of the following are true about Clozapine EXCEPT?

Accepted Answer

It has a lesser potency in blocking 5-HT2 than the D2 receptor.

Answer

It can cause agranulocytosis.

Answer

It has more affinity to D4 receptors compared to D2 receptors.

Answer

It is an atypical antipsychotic agent.

Question 2

Which of the following SSRIs does NOT affect the blood levels of other drugs?

Accepted Answer

Sertraline

Answer

Fluoxetine

Answer

Fluvoxamine

Answer

Paroxetine

Question 3

Which of the following is a nonsedative anxiolytic?

Accepted Answer

Buspirone

Answer

Hydroxyzine

Answer

Chlorpromazine

Answer

Alprazolam

Question 4

What is the mechanism of action of Mianserin?

Accepted Answer

Inhibits alpha-adrenergic, H1, and some types of 5-HT receptors

Answer

Inhibits alpha-adrenergic, H2, and some types of 5-HT receptors

Answer

Inhibits beta-adrenergic, H1, and some types of 5-HT receptors

Answer

Inhibits alpha-adrenergic and H1 receptors

Question 5

Which of the following is a tricyclic antidepressant?

Accepted Answer

Imipramine

Answer

Sertraline

Answer

Bupropion

Answer

Fluoxetine

Question 6

Which of the following drugs has anxiolytic action with the least sedation?

Accepted Answer

Buspirone

Answer

Triazolam

Answer

Alprazolam

Answer

Chlordiazepoxide

Question 7

Which of the following is NOT a side effect of tricyclic antidepressants?

Accepted Answer

Weight loss

Answer

Weight gain

Answer

Giddiness

Answer

Sedation

Question 8

Which medication is known to cause reversible lens granular deposits?

Accepted Answer

chlorpromazine

Answer

risperidone

Answer

paliperidone

Answer

olanzapine

Question 9

Which anxiolytic benzodiazepine also possesses antidepressant properties?

Accepted Answer

Alprazolam

Answer

Oxazepam

Answer

Lorazepam

Answer

Chlordiazepoxide

Question 10

Which of the following is a non-selective serotonin and noradrenaline reuptake inhibitor?

Accepted Answer

Venlafaxine

Answer

Sertraline

Answer

Citalopram

Answer

Paroxetine

Drugs in Psychiatric Disorders — MCQs

Drugs in Psychiatric Disorders — MCQs

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