Psychopharmacology Practice Questions

Q: Which mood stabilizer is used in the management of temporal lobe epilepsy?

Carbamazepine. **Explanation:** **Carbamazepine** is the drug of choice for the management of **Temporal Lobe Epilepsy (TLE)**, also known as focal seizures with impaired awareness. While it is primarily an anticonvulsant, it is a potent mood stabilizer used in Psychiatry for the treatment of Acute Mania and Prophylaxis of Bipolar Disorder, especially in patients who are non-responsive to Lithium. Its mechanism involves blocking voltage-gated sodium channels, which stabilizes hyperexcitable neuronal membranes. **Analysis of Options:** * **Valproate (Option B):** While Valproate is a broad-spectrum antiepileptic and a first-line mood stabilizer, it is typically the drug of choice for generalized tonic-clonic seizures and myoclonic seizures rather than specifically for TLE. * **Lamotrigine (Option C):** This is used primarily for the maintenance phase of Bipolar Disorder (preventing depressive episodes) and focal seizures. However, it is not the traditional "gold standard" for TLE compared to Carbamazepine. * **Lithium (Option D):** Lithium is the "gold standard" for Bipolar Affective Disorder (BPAD) but has **no anticonvulsant properties**. In fact, Lithium can lower the seizure threshold in high doses. **High-Yield Clinical Pearls for NEET-PG:** * **DOC for TLE:** Carbamazepine. * **Side Effects:** Agranulocytosis, Aplastic anemia, and **Stevens-Johnson Syndrome** (associated with the HLA-B*1502 allele). * **Enzyme Induction:** Carbamazepine is a potent **cytochrome P450 inducer**, leading to many drug-drug interactions (e.g., reducing the efficacy of oral contraceptives). * **SIADH:** It can cause hyponatremia by increasing ADH sensitivity.

Q: Which of the following drugs requires serum level monitoring?

Lithium. **Explanation:** **Lithium** is the correct answer because it has a **narrow therapeutic index**, meaning the difference between a therapeutic dose and a toxic dose is very small. Therapeutic drug monitoring (TDM) is mandatory to ensure efficacy and prevent severe toxicity (nephrotoxicity, neurotoxicity). The standard therapeutic range for maintenance is **0.6 to 1.2 mEq/L**. Levels above 1.5 mEq/L are generally considered toxic. **Why the other options are incorrect:** * **Lorazepam (Benzodiazepine):** These drugs have a wide therapeutic window. Clinical response and side effects (sedation) are monitored clinically rather than through serum levels. * **Amitriptyline (TCA):** While TCAs can be monitored in specific refractory cases, it is not a routine clinical requirement for standard treatment, unlike Lithium. * **Haloperidol (Antipsychotic):** Dosing is guided by clinical improvement of psychotic symptoms and the emergence of extrapyramidal side effects (EPS), not by plasma concentrations. **High-Yield Clinical Pearls for NEET-PG:** * **Sampling Time:** Lithium levels should be drawn **12 hours after the last dose** (Trough level). * **Steady State:** It takes approximately **5 days** (5 half-lives) to reach a steady state before the first level should be checked. * **Monitoring Frequency:** Initially every 1–2 weeks; once stable, every 3–6 months. * **Factors increasing Lithium levels:** Dehydration, low-sodium diet, and drugs like **NSAIDs, Thiazides, and ACE inhibitors** (mnemonic: **NSA**). * **Side Effects:** Ebstein’s anomaly (teratogenic), Nephrogenic Diabetes Insipidus, and Hypothyroidism.

Q: Who introduced the antipsychotic chlorpromazine?

Delay and Deniker. **Explanation:** **Chlorpromazine**, the first typical antipsychotic, revolutionized psychiatry by shifting treatment from custodial care to pharmacological management. It was synthesized in 1950 by Paul Charpentier as an antihistamine. However, its profound antipsychotic properties were first recognized and introduced into clinical psychiatry in **1952** by the French psychiatrists **Jean Delay and Pierre Deniker**. They observed its "neuroleptic" effect—specifically its ability to reduce agitation and psychosis without inducing profound sedation. **Analysis of Incorrect Options:** * **John F. Cade:** An Australian psychiatrist who discovered the mood-stabilizing effects of **Lithium** in 1948 for the treatment of mania. * **Abraham Maslow:** A psychologist famous for proposing the **Hierarchy of Needs**, a theory of psychological health predicated on fulfilling innate human needs in priority. * **Erik Erikson:** A developmental psychologist known for his theory on the **Eight Stages of Psychosocial Development** (e.g., Trust vs. Mistrust). **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism of Action:** Chlorpromazine is a low-potency antipsychotic that primarily acts by blocking **D2 receptors** in the mesolimbic pathway. * **Side Effects:** Due to its low potency, it has a high affinity for H1 (sedation), Alpha-1 (orthostatic hypotension), and M1 (anticholinergic effects) receptors. * **Specific Side Effect:** It is classically associated with **pigmentary deposits** in the lens and cornea (unlike Thioridazine, which causes retinal deposits). * **Historical Note:** It was initially used by Henri Laborit to prevent surgical shock (the "lytic cocktail").

Q: What is the drug of choice for Akathisia?

Propranolol. ### Explanation **Correct Answer: B. Propranolol** **Mechanism and Rationale:** Akathisia is an Extrapyramidal Side Effect (EPS) characterized by a subjective feeling of inner restlessness and an objective inability to sit still. Unlike other EPS (like dystonia), akathisia often responds poorly to anticholinergics. **Propranolol**, a non-selective beta-blocker, is the **drug of choice**. It works by crossing the blood-brain barrier and antagonizing beta-adrenergic receptors, which modulates the catecholaminergic pathways involved in motor restlessness. **Analysis of Incorrect Options:** * **A. Dantrolene sodium:** This is a peripherally acting muscle relaxant used primarily in the management of **Neuroleptic Malignant Syndrome (NMS)** and Malignant Hyperthermia. It has no role in treating akathisia. * **C. Anticholinergics (e.g., Benztropine, Trihexyphenidyl):** These are the drugs of choice for **Acute Dystonia** and Drug-Induced Parkinsonism. While sometimes used for akathisia, they are significantly less effective than beta-blockers. * **D. Levodopa:** This is used in Parkinson’s disease. In psychiatry, dopamine agonists are generally avoided as they can exacerbate psychotic symptoms. **High-Yield Clinical Pearls for NEET-PG:** 1. **Clinical Presentation:** Patients often describe "jumping out of their skin" or constant pacing. It is the most common EPS associated with second-generation antipsychotics (especially Aripiprazole). 2. **Management Hierarchy:** First, reduce the dose of the antipsychotic. If not possible, start **Propranolol** (typical dose: 30–90 mg/day). Second-line agents include Benzodiazepines (e.g., Lorazepam). 3. **Suicide Risk:** Akathisia is uniquely associated with an increased risk of agitation and **suicidality**; therefore, prompt treatment is critical.

Q: Which of the following is NOT used in the treatment for tardive dyskinesia?

Haloperidol. **Explanation:** **Tardive Dyskinesia (TD)** is a delayed-onset extrapyramidal side effect caused by the long-term use of dopamine receptor blockers (typically first-generation antipsychotics). It is characterized by involuntary, choreoathetoid movements, most commonly involving the tongue, face, and jaw (orofacial dyskinesia). **Why Haloperidol is the correct answer:** Haloperidol is a high-potency, first-generation antipsychotic and a potent **D2 receptor antagonist**. Since TD is pathophysiologically linked to **dopamine receptor supersensitivity** resulting from chronic blockade, administering more Haloperidol may temporarily mask the symptoms but will ultimately worsen the underlying condition and increase the risk of irreversible damage. Therefore, it is contraindicated as a treatment for TD. **Analysis of incorrect options:** * **Clozapine (Option A):** This is the drug of choice for patients with TD who still require antipsychotic therapy. It has low D2 affinity and may even help suppress existing dyskinetic movements. * **Vitamin E (Option B):** Used as an antioxidant to prevent further neuronal damage. While its efficacy is modest, it is a recognized adjunct in early-stage TD management. * **Clonazepam (Option C):** Benzodiazepines can be used as an adjunctive treatment to reduce the severity of movements through GABAergic modulation. **NEET-PG High-Yield Pearls:** * **First-line treatment:** Discontinue the offending agent or switch to Clozapine/Quetiapine. * **FDA-approved treatments:** VMAT-2 inhibitors (**Valbenazine** and **Deutetrabenazine**) are now considered the gold standard for TD management. * **Risk Factors:** Old age, female gender, and presence of affective disorders. * **Important Note:** Unlike acute dystonia, **anticholinergics (like Benztropine) worsen TD** and should be avoided.

Q: Which of the following pharmacologic agents has the highest potential to cause metabolic syndrome?

Clozapine. **Explanation:** The risk of **Metabolic Syndrome** (weight gain, dyslipidemia, and hyperglycemia/Type 2 Diabetes) is a significant side effect of Second-Generation Antipsychotics (SGAs). This is primarily due to their antagonistic action at **H1 (histamine)** and **5-HT2C (serotonin)** receptors, which increases appetite and disrupts insulin sensitivity. **Why Clozapine is Correct:** Among all antipsychotics, **Clozapine** and **Olanzapine** carry the **highest risk** for metabolic syndrome. Clozapine causes profound weight gain and has a direct effect on insulin resistance, often independent of weight gain. Because of this, patients on Clozapine require mandatory monitoring of BMI, waist circumference, fasting blood glucose, and lipid profiles. **Analysis of Incorrect Options:** * **Risperidone:** Carries a **moderate risk**. While it is associated with weight gain and significant prolactin elevation, its metabolic impact is less severe than Clozapine or Olanzapine. * **Quetiapine:** Also carries a **moderate risk**. It is more metabolically offending than Risperidone but generally less so than Clozapine. * **Aripiprazole:** This is a **metabolically neutral** drug (along with Ziprasidone and Lurasidone). As a partial D2 agonist, it has a very low potential for weight gain or glucose dysregulation. **High-Yield NEET-PG Pearls:** * **Highest Metabolic Risk:** Clozapine > Olanzapine. * **Lowest Metabolic Risk:** Aripiprazole, Ziprasidone, Lurasidone. * **Clozapine Monitoring:** Apart from metabolic parameters, remember the mandatory **ANC (Absolute Neutrophil Count)** monitoring due to the risk of **Agranulocytosis**. * **Drug of Choice:** Clozapine remains the gold standard for **Treatment-Resistant Schizophrenia**.

Q: Which of the following is the drug of choice for medication-resistant schizophrenia?

Clozapine. **Explanation:** **Clozapine** is the gold-standard treatment and the **drug of choice for treatment-resistant schizophrenia (TRS)**. TRS is clinically defined as schizophrenia that fails to respond to adequate trials (at least 4–6 weeks) of at least two different antipsychotics at therapeutic doses. Clozapine is a Dibenzodiazepine derivative and an "atypical" (second-generation) antipsychotic. Its superior efficacy is attributed to its unique receptor profile, characterized by a high affinity for D4 and 5-HT2A receptors and a relatively low affinity for D2 receptors. It is also the only antipsychotic proven to reduce suicidal behavior in schizophrenic patients. **Why the other options are incorrect:** * **Haloperidol (A) & Chlorpromazine (B):** These are first-generation (typical) antipsychotics. While effective for positive symptoms, they are not indicated for resistant cases and carry a high risk of Extrapyramidal Side Effects (EPS) and Tardive Dyskinesia. * **Flupentixol (D):** A thioxanthene derivative often used as a long-acting injectable (depot). While useful for maintenance and compliance, it has no specific role in medication-resistant schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Agranulocytosis:** The most dreaded side effect of Clozapine (occurs in ~1%). Mandatory **Absolute Neutrophil Count (ANC)** monitoring is required. * **Seizures:** Clozapine significantly lowers the seizure threshold in a dose-dependent manner. * **Sialorrhea:** Paradoxical hypersalivation (especially at night) is a common, bothersome side effect. * **Metabolic Syndrome:** Clozapine carries the highest risk of weight gain and diabetes among antipsychotics. * **No EPS:** Clozapine has the lowest risk of Extrapyramidal Side Effects and does not cause Tardive Dyskinesia.

Q: Which of the following medications is NOT used for schizophrenia?

Venlafaxine. **Explanation:** The correct answer is **Venlafaxine** because it is a **Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)**, primarily used as an antidepressant and for anxiety disorders. It does not possess the dopamine (D2) receptor antagonism required to treat the core psychotic symptoms of schizophrenia. **Analysis of Options:** * **Chlorpromazine (Option A):** A prototypical **Typical (First-generation) Antipsychotic**. It works by blocking D2 receptors in the mesolimbic pathway. It is also known for its low potency and side effects like sedation and orthostatic hypotension. * **Clozapine (Option B):** An **Atypical (Second-generation) Antipsychotic**. It is the "gold standard" for **treatment-resistant schizophrenia**. It has a unique profile with high affinity for D4 and 5-HT2 receptors but carries a risk of agranulocytosis. * **Risperidone (Option C):** A commonly used **Atypical Antipsychotic**. It blocks both D2 and 5-HT2A receptors. It is notable for having a higher risk of extrapyramidal symptoms (EPS) and hyperprolactinemia compared to other atypicals at higher doses. **High-Yield Clinical Pearls for NEET-PG:** * **Dopamine Hypothesis:** Schizophrenia is primarily linked to overactivity of dopamine in the mesolimbic pathway (positive symptoms) and underactivity in the mesocortical pathway (negative symptoms). * **Clozapine Monitoring:** Requires mandatory WBC and ANC monitoring due to the risk of **agranulocytosis** (occurs in ~1%). It is also the only antipsychotic proven to reduce suicide risk in schizophrenia. * **Drug of Choice:** For a first episode of schizophrenia, atypical antipsychotics (like Risperidone or Olanzapine) are generally preferred over typicals due to a lower risk of tardive dyskinesia.

Question 1

Which mood stabilizer is used in the management of temporal lobe epilepsy?

Accepted Answer

Carbamazepine

Answer

Valproate

Answer

Lamotrigine

Answer

Lithium

Question 2

Which of the following drugs requires serum level monitoring?

Accepted Answer

Lithium

Answer

Lorazepam

Answer

Amitriptyline

Answer

Haloperidol

Question 3

Schizophrenia drugs mainly act on which receptors?

Accepted Answer

D2 dopamine receptors

Answer

D1 dopamine receptors

Answer

D3 dopamine receptors

Answer

Acetylcholine receptors

Question 4

Who introduced the antipsychotic chlorpromazine?

Accepted Answer

Delay and Deniker

Answer

John F. Cade

Answer

Maslow

Answer

Erik Erikson

Question 5

What is the drug of choice for Akathisia?

Accepted Answer

Propranolol

Answer

Dantrolene sodium

Answer

Anticholinergics

Answer

Levodopa

Question 6

Lithium is the treatment of choice for which condition?

Accepted Answer

Bipolar major depressive disorder prophylaxis

Answer

Unipolar major depressive disorder prophylaxis

Answer

Schizophrenia

Answer

Acute mania

Question 7

Which of the following is NOT used in the treatment for tardive dyskinesia?

Accepted Answer

Haloperidol

Answer

Clozapine

Answer

Vitamin E

Answer

Clonazepam

Question 8

Which of the following pharmacologic agents has the highest potential to cause metabolic syndrome?

Accepted Answer

Clozapine

Answer

Risperidone

Answer

Quetiapine

Answer

Aripiprazole

Question 9

Which of the following is the drug of choice for medication-resistant schizophrenia?

Accepted Answer

Clozapine

Answer

Haloperidol

Answer

Chlorpromazine

Answer

Flupentixol

Question 10

Which of the following medications is NOT used for schizophrenia?

Accepted Answer

Venlafaxine

Answer

Chlorpromazine

Answer

Clozapine

Answer

Risperidone

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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