Pharmacotherapy — MCQs
Antidepressant drug used in nocturnal enuresis is:
Drug of choice for obsessive-compulsive disorder
Which drug for ADHD has a risk of growth retardation in children?
Which of the following is the most likely explanation for the dental abnormalities in bulimia nervosa (BN)?
Which of the following drugs is used for the long term management of obesity
Fenfluramine was historically used for which condition before its withdrawal from the market?
Indoor management of anorexia nervosa is done on priority patients with:-
In obsessive-compulsive disorder, which medication is NOT used for treatment?
Best predictor of good prognosis in anorexia nervosa is:
A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?
Pharmacotherapy Indian Medical PG Practice Questions and MCQs
Question 1: Antidepressant drug used in nocturnal enuresis is:
- A. Imipramine (Correct Answer)
- B. Fluoxetine
- C. Trazodone
- D. Sertraline
Explanation: ***Imipramine*** - **Imipramine**, a **tricyclic antidepressant (TCA)**, is frequently used off-label for **nocturnal enuresis** in children [1]. - Its mechanism of action in enuresis is thought to involve a combination of anticholinergic effects (which relax the bladder detrusor muscle) and central nervous system effects (which may increase bladder capacity and arousal from sleep) [1]. *Fluoxetine* - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** and is primarily used for depression, anxiety disorders, and OCD [2]. - It is not indicated for the treatment of nocturnal enuresis and does not have the same bladder-relaxing or arousal-modulating properties as imipramine in this context. *Trazodone* - **Trazodone** is a **serotonin antagonist and reuptake inhibitor (SARI)**, commonly prescribed for depression and insomnia due to its prominent sedative effects. - It is not used for nocturnal enuresis and its mechanism of action does not confer benefits for bladder control. *Sertraline* - **Sertraline** is another **selective serotonin reuptake inhibitor (SSRI)** used for a wide range of psychiatric conditions, including depression, anxiety, and panic disorder [2]. - Like fluoxetine, it is not an appropriate treatment for nocturnal enuresis and lacks the specific known effects beneficial for this condition.
Question 2: Drug of choice for obsessive-compulsive disorder
- A. Haloperidol
- B. Buspirone
- C. Olanzapine
- D. Fluoxetine (Correct Answer)
Explanation: ***Fluoxetine*** - **Selective serotonin reuptake inhibitors (SSRIs)** like fluoxetine are considered **first-line pharmacological treatment for Obsessive-Compulsive Disorder (OCD)** due to their effectiveness in modulating serotonin pathways implicated in the disorder. - Multiple SSRIs (fluoxetine, fluvoxamine, paroxetine, sertraline) and clomipramine are equally effective first-line agents, but **SSRIs are preferred initially** due to better tolerability and safety profile. - Among the given options, fluoxetine is the appropriate choice as an established first-line SSRI for reducing the frequency and intensity of obsessions and compulsions. - **OCD typically requires higher doses and longer duration** (8-12 weeks) compared to depression treatment. *Haloperidol* - **Haloperidol** is a **first-generation antipsychotic** primarily used to treat psychotic disorders (e.g., schizophrenia) and severe behavioral disturbances. - It works by blocking **dopamine D2 receptors** and is not a first-line treatment for OCD, though it might be used as an **augmentation strategy** in severe, treatment-refractory cases, particularly when tic disorders coexist. *Buspirone* - **Buspirone** is an **anxiolytic** primarily used for generalized anxiety disorder (GAD). It acts as a **serotonin 5-HT1A receptor partial agonist**. - While it helps with generalized anxiety, it is **generally ineffective** for the specific obsessions and compulsions characteristic of OCD and is not recommended as monotherapy. *Olanzapine* - **Olanzapine** is a **second-generation antipsychotic** primarily used for schizophrenia and bipolar disorder. It blocks dopamine and serotonin receptors. - It is not a first-line treatment for OCD but can be used as an **adjunct to SSRIs** in severe, treatment-resistant cases, particularly when there is partial response to adequate SSRI trials or comorbid psychotic symptoms.
Question 3: Which drug for ADHD has a risk of growth retardation in children?
- A. Methylphenidate (Correct Answer)
- B. Modafinil
- C. Clonidine
- D. Atomoxetine
Explanation: ***Methylphenidate*** - **Methylphenidate** (a stimulant) can cause a **transient reduction in growth velocity** due to effects on appetite suppression and potentially growth hormone secretion [1]. - While this reduction is often temporary and catch-up growth typically occurs, it is a **well-documented and clinically significant risk** requiring growth monitoring in children [1, 2]. - Among ADHD medications, stimulants like methylphenidate have the **most pronounced effect on growth** [1].*Modafinil* - **Modafinil** is primarily used for narcolepsy and other sleep disorders, not a first-line treatment for ADHD. - It works through different mechanisms than traditional stimulants and is not typically associated with growth retardation in the ADHD population.*Clonidine* - **Clonidine** is an alpha-2 adrenergic agonist used to treat ADHD, particularly for hyperactivity, impulsivity, and sleep problems. - It does **not have a known risk of growth retardation** in children.*Atomoxetine* - **Atomoxetine** is a non-stimulant medication for ADHD that works by selectively inhibiting norepinephrine reuptake. - While atomoxetine can also affect growth velocity in some children (FDA labeling includes growth monitoring recommendations), the effect is **generally less pronounced than with stimulants like methylphenidate**. - Methylphenidate remains the **most recognized** for this adverse effect among ADHD medications.
Question 4: Which of the following is the most likely explanation for the dental abnormalities in bulimia nervosa (BN)?
- A. self-induced vomiting (Correct Answer)
- B. excess cortisol levels
- C. osteoporotic changes
- D. self-induced physical trauma
Explanation: ***self-induced vomiting*** - **Self-induced vomiting** leads to frequent exposure of teeth to highly acidic gastric contents, causing **dental erosion** (perimylolysis). - This erosion typically affects the **lingual surfaces** of the maxillary anterior teeth and can lead to tooth sensitivity, discoloration, and loss of tooth structure. *excess cortisol levels* - While patients with BN can have elevated cortisol due to stress, this is not directly linked to **dental erosion** or other dental abnormalities. - High cortisol primarily affects bone density, metabolism, and immune function, rather than directly damaging tooth enamel. *osteoporotic changes* - **Osteoporotic changes** can occur in BN due to nutritional deficiencies and hormonal imbalances, affecting bone density. - However, osteoporosis primarily affects bone tissue throughout the body, not directly causing the characteristic **dental erosion** seen in BN. *self-induced physical trauma* - **Self-induced physical trauma** in BN refers to injuries from non-vomiting behaviors and would not explain the widespread **dental erosion** patterns. - While some individuals might experience trauma from purging (e.g., calluses on knuckles), it does not account for the chemical damage to tooth enamel.
Question 5: Which of the following drugs is used for the long term management of obesity
- A. Fenfluramine
- B. Sibutramine
- C. Liraglutide (Correct Answer)
- D. Metformin
- E. Orlistat
Explanation: ***Liraglutide*** - **Liraglutide** is a **GLP-1 receptor agonist** approved for **long-term weight management** in adults with obesity or overweight with comorbidities. - It works by **delaying gastric emptying**, increasing satiety, and reducing appetite, leading to sustained weight loss. *Fenfluramine* - **Fenfluramine** was an **anorectic drug** that was withdrawn from the market due to its association with **pulmonary hypertension** and **cardiac valvulopathy**. - It is **not used** for the long-term management of obesity due to severe cardiovascular side effects. *Sibutramine* - **Sibutramine** is a **serotonin-norepinephrine reuptake inhibitor** previously used for weight loss, but it was withdrawn due to increased risk of **cardiovascular events** such as heart attack and stroke. - It is **not recommended** for long-term obesity management due to its significant cardiovascular risks. *Orlistat* - **Orlistat** is a **pancreatic lipase inhibitor** that is approved for long-term obesity management but works by **reducing fat absorption** in the gastrointestinal tract. - While approved for long-term use, it is **less preferred** than GLP-1 agonists due to gastrointestinal side effects (steatorrhea, fecal incontinence) and lower efficacy in weight reduction compared to newer agents like liraglutide. *Metformin* - **Metformin** is primarily an **antidiabetic drug** used for type 2 diabetes and sometimes for polycystic ovary syndrome (PCOS). - While it may cause modest weight loss as a side effect, it is **not approved or indicated** as a primary drug for the long-term management of obesity in individuals without diabetes.
Question 6: Fenfluramine was historically used for which condition before its withdrawal from the market?
- A. Malignancy
- B. Obesity (Correct Answer)
- C. Diabetes mellitus
- D. Hypertension
Explanation: ***Obesity*** - Fenfluramine was notably used as an **anorectic agent** (appetite suppressant) for the treatment of **obesity** - Often prescribed in combination with phentermine, known as **"fen-phen"** - The drug was effective in promoting **weight loss** through its mechanism as a **serotonergic agent** that enhanced satiety - It was **withdrawn from the market in 1997** due to associations with **valvular heart disease** and **pulmonary hypertension**, not due to lack of efficacy *Malignancy* - Fenfluramine has **never been approved** or used for the treatment of **malignancy** or cancer - There is no historical or clinical data supporting its use as an anticancer agent - Its mechanism of action is related to appetite suppression, not cancer treatment *Hypertension* - Fenfluramine was **not used to treat hypertension** - Ironically, it was associated with **causing pulmonary hypertension** as a serious adverse effect - Its mechanism as a serotonergic agent for appetite suppression is unrelated to systemic blood pressure control *Diabetes mellitus* - Fenfluramine was not indicated for **diabetes mellitus** treatment - While weight loss can improve glycemic control, fenfluramine was specifically marketed as an **anti-obesity medication**, not an antidiabetic drug
Question 7: Indoor management of anorexia nervosa is done on priority patients with:-
- A. Depression
- B. Amenorrhea
- C. Binging episodes
- D. Weight for height less than 75% of normal (Correct Answer)
Explanation: ***Weight for height less than 75% of normal*** - A **weight for height less than 75% of normal** (or **BMI <15 kg/m²**) indicates severe **malnutrition** and a high risk of medical complications, necessitating urgent inpatient care. - This level of **underweight** is a critical indicator for hospital admission in **anorexia nervosa** to prevent severe organ dysfunction, refeeding syndrome, and even death. *Depression* - While **depression** is a common comorbidity with **anorexia nervosa** and often requires treatment, it does not, by itself, warrant immediate inpatient management unless there are acute **suicidal risks**. - **Depression** is usually managed in an outpatient setting initially, with hospitalization being reserved for severe cases where safety is compromised. *Amenorrhea* - **Amenorrhea** (absence of menstruation) is a common symptom of **anorexia nervosa** due to hormonal imbalances caused by low body weight. - Though an indicator of significant caloric restriction, **amenorrhea** alone is not typically an immediate criterion for inpatient admission unless accompanied by other severe physical complications. *Binging episodes* - While **binging episodes** can occur in **anorexia nervosa** (specifically the binge-purging subtype) and can lead to electrolyte imbalances or medical complications, they are not the primary, stand-alone trigger for immediate inpatient admission. - The severity of **binging** and associated **purging behaviors** must be evaluated in the context of overall medical stability and weight to determine the appropriate level of care.
Question 8: In obsessive-compulsive disorder, which medication is NOT used for treatment?
- A. Sertraline
- B. Clomipramine
- C. Carbamazepine (Correct Answer)
- D. Haloperidol
Explanation: ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for **epilepsy** and **bipolar disorder**. - It does not have a primary role in the treatment of **obsessive-compulsive disorder (OCD)**. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** approved for **OCD** treatment. - SSRIs are considered **first-line pharmacological agents** for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that is a potent **serotonin reuptake inhibitor**. - It is one of the **most effective medications for OCD** and has been historically used as a first-line treatment. *Haloperidol* - **Haloperidol**, an **antipsychotic**, can be used as an **augmentation strategy** for OCD that is **resistant to SSRI treatment**. - It may be particularly helpful in OCD presentations with **comorbid tic disorders** or significant behavioral disinhibition.
Question 9: Best predictor of good prognosis in anorexia nervosa is:
- A. Early treatment
- B. Higher BMI at diagnosis
- C. Shorter duration (Correct Answer)
- D. Supportive family
Explanation: ***Shorter duration*** - **Shorter duration of illness** before treatment is consistently identified as one of the strongest predictors of good prognosis in anorexia nervosa. - Duration encompasses the total time the illness has existed, capturing the chronicity and entrenchment of maladaptive eating behaviors, psychological patterns, and physiological complications. - Patients with **brief illness duration** before intervention have higher rates of **full recovery** (up to 50-70% in some studies) compared to those with chronic illness (20-30% recovery rates). - Shorter duration indicates less time for the development of severe medical complications (osteoporosis, cardiac abnormalities) and entrenched psychological patterns that are harder to reverse. *Early treatment* - While **early treatment initiation** is extremely important and strongly correlated with better outcomes, it is typically a function of recognizing and intervening in an illness of short duration. - The benefit of early treatment is largely because it prevents the illness from becoming chronic; thus, duration remains the more fundamental prognostic indicator. - Both concepts overlap significantly, but duration captures the complete timeframe of illness pathology. *Higher BMI at diagnosis* - A **higher BMI at diagnosis** suggests less severe weight loss and may indicate less severe restriction, but it is not as strong a predictor as duration. - Patients can have relatively higher BMI but still have chronic illness with poor prognosis if the duration has been extended. *Supportive family* - A **supportive family** is crucial for treatment adherence, recovery, and relapse prevention, and is indeed a positive prognostic factor. - However, family support alone cannot overcome the physiological and psychological damage of prolonged illness duration. - In pediatric/adolescent populations, family-based therapy (FBT) outcomes are best when the **illness duration is short** at treatment onset.
Question 10: A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?
- A. Ideas of reference
- B. Tingling of extremities (Correct Answer)
- C. Hallucination
- D. Neologism
Explanation: ***Tingling of extremities*** - The patient's presentation of "feeling tense," **stomach upset, heartburn, and diarrhea** for many years, alongside a family history of similar issues, suggests significant **anxiety**. - **Peripheral neurological symptoms** such as **tingling of extremities (paresthesia)** are common manifestations of anxiety and panic attacks due to **hyperventilation** (causing respiratory alkalosis and decreased ionized calcium) and **physiological arousal**. *Ideas of reference* - **Ideas of reference** are typically seen in **psychotic disorders** (e.g., schizophrenia) where a person believes that unrelated, external events have a special, personal meaning. - While anxiety can sometimes lead to misinterpretations, **ideas of reference** at a delusional level are not characteristic of generalized anxiety. *Hallucination* - **Hallucinations** are perceptual disturbances where an individual experiences sensory perceptions (e.g., hearing voices, seeing things) in the absence of an external stimulus. - These are core symptoms of **psychotic disorders** and are not typical findings in anxiety disorders without comorbid conditions. *Neologism* - A **neologism** is the coining of new words or phrases, often without clear meaning, which is a hallmark feature of disorganized thought in **psychotic disorders** (e.g., schizophrenia). - This symptom is related to severe thought disorganization and is not associated with anxiety disorders.
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