Psychopharmacology Practice Questions

Q: What is the drug of choice for social phobia?

SSRIs. **Explanation:** **Social Anxiety Disorder (Social Phobia)** is characterized by an intense, persistent fear of being scrutinized or judged by others in social or performance situations. **1. Why SSRIs are the Correct Choice:** Selective Serotonin Reuptake Inhibitors (SSRIs) like **Paroxetine, Sertraline, and Escitalopram** are the first-line treatment (Drug of Choice) for generalized social phobia. They work by modulating serotonin levels in the amygdala and prefrontal cortex, addressing both the psychological distress and the long-term anxiety symptoms. Venlafaxine (an SNRI) is also considered first-line. **2. Why Other Options are Incorrect:** * **Beta-blockers (e.g., Propranolol):** These are only indicated for **"Performance-only" social anxiety** (e.g., stage fright). They help manage peripheral autonomic symptoms like tremors, palpitations, and sweating but do not treat the underlying cognitive anxiety of generalized social phobia. * **Gabapentin:** While it has some evidence in refractory cases due to its effect on GABAergic neurotransmission, it is a second or third-line agent and never the drug of choice. * **Tiagabine:** This is an anticonvulsant that inhibits GABA reuptake. It is not a standard treatment for social phobia and lacks robust clinical evidence for this indication. **Clinical Pearls for NEET-PG:** * **First-line:** SSRIs/SNRIs. * **Performance Anxiety:** Propranolol (taken 30–60 minutes before the event). * **Psychotherapy:** Cognitive Behavioral Therapy (CBT) is the most effective non-pharmacological treatment. * **Duration of treatment:** Once a response is achieved, medication should be continued for 6–12 months to prevent relapse.

Q: A patient on a typical antipsychotic develops restlessness, typically of the lower limbs. Which drug is used to treat this side effect?

Propranolol. **Explanation:** The patient is presenting with **Akathisia**, a common extrapyramidal side effect (EPS) of typical antipsychotics. It is characterized by subjective feelings of inner restlessness and an objective inability to sit still, often manifesting as constant pacing or leg movements. **1. Why Propranolol is correct:** **Propranolol**, a non-selective beta-blocker, is the **first-line treatment** for drug-induced akathisia. While the exact pathophysiology is debated, it is believed that beta-adrenergic receptors in the peripheral and central nervous systems play a role in the motor manifestations of restlessness. Propranolol effectively crosses the blood-brain barrier to alleviate these symptoms. **2. Why other options are incorrect:** * **Trihexyphenidyl:** This is an anticholinergic used primarily for *Drug-Induced Parkinsonism* and *Acute Dystonia*. It is generally ineffective for akathisia. * **Quetiapine:** This is an atypical antipsychotic. While switching to an atypical agent may reduce the risk of EPS, it is not the acute treatment for existing akathisia. * **Dantrolene:** This is a muscle relaxant used specifically for **Neuroleptic Malignant Syndrome (NMS)** and Malignant Hyperthermia. **Clinical Pearls for NEET-PG:** * **Akathisia Timing:** Usually occurs within days to weeks of starting or increasing the dose of an antipsychotic. * **Suicidality Link:** Severe akathisia is high-yield because it is associated with increased agitation and potential suicidality if left untreated. * **Second-line treatments:** If beta-blockers are contraindicated (e.g., in asthma), **Benzodiazepines** (like Lorazepam) or **Cyproheptadine** can be used. * **Rule of Thumb:** For *Dystonia/Parkinsonism* → Think Anticholinergics; for *Akathisia* → Think Beta-blockers.

Q: Malignant neuroleptic syndrome is caused by:

Antipsychotics. **Explanation:** **Neuroleptic Malignant Syndrome (NMS)** is a rare but life-threatening idiosyncratic reaction to **Antipsychotics** (Neuroleptics). The underlying pathophysiology involves a profound **blockade of central Dopamine (D2) receptors** in the nigrostriatal pathway and hypothalamus. This leads to the classic tetrad of clinical features: hyperthermia, "lead-pipe" muscle rigidity, autonomic instability, and altered mental status. * **Why Antipsychotics are correct:** Both typical (e.g., Haloperidol) and atypical antipsychotics (e.g., Risperidone) can trigger NMS. It is most commonly associated with high-potency first-generation agents. * **Why other options are incorrect:** * **Antidepressants:** These are more commonly associated with **Serotonin Syndrome**, which presents with hyperreflexia and myoclonus rather than lead-pipe rigidity. * **Anxiolytics:** Benzodiazepines are actually used in the supportive management of NMS to control agitation and muscle spasms. * **Antiepileptics:** These do not typically cause NMS; however, certain drugs like Carbamazepine can rarely cause Stevens-Johnson Syndrome. **High-Yield Clinical Pearls for NEET-PG:** 1. **Laboratory Hallmark:** Significantly elevated **Creatine Phosphokinase (CPK)** levels due to muscle necrosis (rhabdomyolysis). 2. **Drug of Choice:** **Dantrolene** (a direct-acting muscle relaxant) or **Bromocriptine** (a dopamine agonist). 3. **Differential Diagnosis:** Unlike Serotonin Syndrome (caused by SSRIs), NMS is characterized by **"Lead-pipe" rigidity** and **bradyreflexia**, whereas Serotonin Syndrome features hyperreflexia and tremors. 4. **Non-Antipsychotic Cause:** Sudden withdrawal of anti-Parkinsonian drugs (like Levodopa) can also trigger an NMS-like state.

Q: Metabolic syndrome is most commonly associated with which of the following groups of medications as a side effect?

Antipsychotic drugs. **Explanation:** **Metabolic Syndrome** (characterized by weight gain, dyslipidemia, and insulin resistance) is a major adverse effect primarily associated with **Antipsychotic drugs**, particularly the **Second-Generation Antipsychotics (SGAs)** or Atypical Antipsychotics. **Why Antipsychotics are the correct answer:** The underlying mechanism involves the blockade of **Histamine (H1)** and **Serotonin (5-HT2C)** receptors, which leads to increased appetite, sedation, and significant weight gain. Furthermore, these drugs directly interfere with insulin signaling and lipid metabolism. Among SGAs, **Clozapine** and **Olanzapine** carry the highest risk, while Aripiprazole and Ziprasidone are considered metabolic-neutral. **Why other options are incorrect:** * **Anti-anxiety drugs (e.g., Benzodiazepines):** These primarily cause sedation, cognitive impairment, and potential dependence, but do not typically cause metabolic derangements. * **Antidepressant drugs:** While some (like Mirtazapine or TCAs) can cause weight gain, they are not as strongly or universally linked to the full cluster of metabolic syndrome as antipsychotics are. * **Anticholinergic drugs:** These cause "dry" side effects (dry mouth, blurred vision, constipation, urinary retention) and tachycardia, but do not impact glucose or lipid metabolism. **High-Yield Clinical Pearls for NEET-PG:** 1. **Highest Risk:** Clozapine > Olanzapine > Quetiapine. 2. **Lowest Risk:** Aripiprazole, Ziprasidone, Lurasidone. 3. **Monitoring:** Patients on SGAs must have regular monitoring of **BMI, Waist Circumference, Fasting Blood Sugar, and Lipid Profile** (as per ADA/APA guidelines). 4. **Drug of Choice:** If a patient develops metabolic syndrome, switching to a "metabolic-neutral" agent like **Aripiprazole** is often the next step.

Q: What is the treatment of choice for akathisia?

Propranolol. **Explanation:** **Akathisia** is the most common and distressing Extrapyramidal Side Effect (EPS) associated with antipsychotic medication. It is characterized by a subjective feeling of inner restlessness and an objective need to move (e.g., pacing, foot tapping). **1. Why Propranolol is the Correct Answer:** **Propranolol**, a non-selective beta-blocker, is the **first-line treatment of choice** for akathisia. It works by crossing the blood-brain barrier and blocking beta-adrenergic receptors in the central nervous system, effectively reducing the physiological symptoms of restlessness. Unlike other EPS (like dystonia), akathisia often responds poorly to anticholinergics alone, making beta-blockers the gold standard. **2. Why the Other Options are Incorrect:** * **A. Phenytoin:** This is an antiepileptic drug used for generalized tonic-clonic seizures. it has no role in treating movement disorders induced by antipsychotics. * **C. Dantrolene:** This is a muscle relaxant used specifically for **Neuroleptic Malignant Syndrome (NMS)** and Malignant Hyperthermia. It acts on ryanodine receptors to inhibit calcium release. * **D. Lithium:** This is a mood stabilizer used for Bipolar Disorder. It does not treat EPS and can actually cause a fine tremor as a side effect. **Clinical Pearls for NEET-PG:** * **First-line:** Propranolol (40–120 mg/day). * **Second-line:** Benzodiazepines (e.g., Lorazepam) or anticholinergics (e.g., Benztropine). * **Differentiate:** Do not confuse akathisia with psychotic agitation; increasing the antipsychotic dose will worsen akathisia but improve agitation. * **NMS Treatment:** Bromocriptine (Dopamine agonist) and Dantrolene. * **Acute Dystonia Treatment:** Promethazine or Benztropine (IV/IM).

Q: Which one of the following medications is used to aid in smoking cessation?

Bupropion. **Explanation:** **Bupropion** (specifically the sustained-release formulation) is an FDA-approved first-line non-nicotine pharmacotherapy for smoking cessation. Its mechanism involves the inhibition of neuronal reuptake of **Dopamine and Norepinephrine**. By increasing dopamine levels in the nucleus accumbens, it mimics the reward pathway of nicotine, thereby reducing withdrawal symptoms and the urge to smoke. **Analysis of Incorrect Options:** * **Buspirone (A):** An anxiolytic and partial $5-HT_{1A}$ agonist used primarily for Generalized Anxiety Disorder (GAD). It has no proven efficacy in smoking cessation. * **Naltrexone (C):** An opioid antagonist used primarily in the management of **Alcohol dependence** (to reduce cravings) and **Opioid use disorder** (to prevent relapse). * **Fluoxetine (D):** An SSRI used for Depression, OCD, and Bulimia. While depression is often comorbid with smoking, SSRIs are not standard treatments for nicotine withdrawal. **High-Yield Clinical Pearls for NEET-PG:** * **Varenicline** is another first-line agent; it is a **partial agonist** at the $\alpha_4\beta_2$ nicotinic acetylcholine receptors. * **Contraindication:** Bupropion is strictly contraindicated in patients with **Seizure disorders** or **Eating disorders** (Bulimia/Anorexia) as it lowers the seizure threshold. * **Timing:** Patients should start Bupropion 1–2 weeks *before* their target "quit date" to reach steady-state plasma levels. * **Weight Gain:** Bupropion is often preferred for smokers concerned about post-cessation weight gain.

Q: Which is the most widely used antidepressant?

Fluoxetine. **Explanation:** **Fluoxetine** is the correct answer because it belongs to the **Selective Serotonin Reuptake Inhibitors (SSRIs)** class, which is currently the first-line pharmacological treatment for major depressive disorder, anxiety disorders, and OCD. Fluoxetine was the first SSRI to gain widespread clinical use due to its favorable safety profile, lack of anticholinergic side effects compared to older drugs, and long half-life (reducing withdrawal symptoms). **Analysis of Options:** * **A. Duloxetine:** This is an SNRI (Serotonin-Norepinephrine Reuptake Inhibitor). While effective, it is generally considered second-line or used specifically when depression is comorbid with chronic pain (e.g., diabetic neuropathy or fibromyalgia). * **B. Trazodone:** A Serotonin Antagonist and Reuptake Inhibitor (SARI). It is highly sedating and is now more commonly used off-label as a hypnotic for insomnia rather than as a primary antidepressant. * **C. Phenelzine:** A non-selective MAO Inhibitor (MAOI). These are rarely used today due to dangerous dietary interactions (tyramine/cheese reaction) and the risk of hypertensive crisis. **High-Yield Clinical Pearls for NEET-PG:** * **SSRIs** are the drug of choice (DOC) for most psychiatric conditions including Depression, OCD, Panic Disorder, and Bulimia. * **Fluoxetine** has the longest half-life among SSRIs (due to its active metabolite, norfluoxetine), making it the safest choice if a patient occasionally misses a dose. * **Side Effects:** Common SSRI side effects include GI upset and sexual dysfunction (most common long-term reason for non-compliance). * **Drug Holiday:** Fluoxetine requires a 5-week washout period before starting an MAOI to avoid **Serotonin Syndrome**.

Q: What is the treatment of choice for bipolar mood disorder?

Lithium. **Explanation:** **Lithium** is the established **gold standard** and treatment of choice for Bipolar Mood Disorder (BMD). It is a mood stabilizer effective in treating acute manic episodes and, more importantly, serves as the mainstay for long-term maintenance therapy to prevent the recurrence of both mania and depression. Its unique clinical value lies in its proven **anti-suicidal properties**, a high-yield fact for NEET-PG. **Analysis of Incorrect Options:** * **Fluoxetine (SSRI) & Imipramine (TCA):** These are antidepressants. Using them as monotherapy in BMD is contraindicated because they can trigger a **"manic switch"** (precipitating a manic episode) or lead to rapid cycling. They are only used in bipolar depression when combined with a mood stabilizer. * **Chlorpromazine:** This is a typical antipsychotic. While it may be used to manage acute agitation in severe mania, it does not stabilize mood or prevent future episodes, making it a secondary or adjunctive treatment rather than the primary choice. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Index:** Lithium has a narrow therapeutic index. Target serum levels are **0.8–1.2 mEq/L** for acute mania and **0.6–1.0 mEq/L** for maintenance. * **Monitoring:** Before starting Lithium, check **Thyroid Function Tests (TFT)** and **Renal Function Tests (RFT)**, as it can cause hypothyroidism and nephrogenic diabetes insipidus. * **Teratogenicity:** Use in pregnancy is associated with **Ebstein’s Anomaly** (atrialization of the right ventricle). * **Drug of Choice for Rapid Cyclers:** Valproate is preferred over Lithium for patients with rapid-cycling BMD (>4 episodes/year).

Q: Which of the following statements is not true regarding Tardive Dyskinesia (TD)?

Combining anticholinergics with antipsychotics prevents TD.. **Explanation:** **Tardive Dyskinesia (TD)** is a delayed-onset extrapyramidal side effect (EPS) resulting from long-term blockade of dopamine (D2) receptors. **Why Option D is the correct answer (False Statement):** Anticholinergics (like Trihexyphenidyl) are effective for treating *acute* EPS, such as dystonia or parkinsonism. However, they **do not prevent** TD. In fact, anticholinergics can **exacerbate or unmask** TD symptoms by further upsetting the dopamine-acetylcholine balance in the nigrostriatal pathway. Prophylactic use of anticholinergics is generally discouraged for this reason. **Analysis of other options:** * **Option A (True):** Clozapine is the drug of choice for patients with severe TD who still require antipsychotic medication. It has low D2 affinity and may even help suppress existing dyskinetic movements. * **Option B (True):** The most widely accepted pathophysiology is **dopamine receptor supersensitivity**. Chronic blockade leads to an upregulation (increase in number and sensitivity) of D2 receptors in the striatum. * **Option C (True):** TD characteristically involves involuntary, choreoathetoid movements of the **perioral region** (tongue protrusion, lip-smacking, puckering), though it can affect the trunk and extremities. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Old age, female gender, and presence of mood disorders. * **AIMS Scale:** The Abnormal Involuntary Movement Scale (AIMS) is used for screening and monitoring TD. * **Management:** First, reduce the dose or switch to a second-generation antipsychotic (Quetiapine or Clozapine). * **FDA Approved Treatments:** VMAT2 inhibitors like **Valbenazine** and **Deutetrabenazine** are now first-line for TD management.

Question 1

What is the drug of choice for social phobia?

Accepted Answer

SSRIs

Answer

Beta-blockers

Answer

Gabapentin

Answer

Tiagabine

Question 2

A patient on a typical antipsychotic develops restlessness, typically of the lower limbs. Which drug is used to treat this side effect?

Accepted Answer

Propranolol

Answer

Trihexyphenidyl

Answer

Quetiapine

Answer

Dantrolene

Question 3

Which condition is Methylphenidate the drug of choice for?

Accepted Answer

Attention deficit hyperkinetic disorder

Answer

Obsessive compulsive disorder

Answer

Enuresis

Answer

Autism

Question 4

Malignant neuroleptic syndrome is caused by:

Accepted Answer

Antipsychotics

Answer

Antidepressants

Answer

Anxiolytics

Answer

Antiepileptics

Question 5

Metabolic syndrome is most commonly associated with which of the following groups of medications as a side effect?

Accepted Answer

Antipsychotic drugs

Answer

Anti-anxiety drugs

Answer

Antidepressant drugs

Answer

Anticholinergic drugs

Question 6

What is the treatment of choice for akathisia?

Accepted Answer

Propranolol

Answer

Phenytoin

Answer

Dantrolene

Answer

Lithium

Question 7

Which one of the following medications is used to aid in smoking cessation?

Accepted Answer

Bupropion

Answer

Buspirone

Answer

Naltrexone

Answer

Fluoxetine

Question 8

Which is the most widely used antidepressant?

Accepted Answer

Fluoxetine

Answer

Duloxetine

Answer

Trazadone

Answer

Phenelezine

Question 9

What is the treatment of choice for bipolar mood disorder?

Accepted Answer

Lithium

Answer

Fluoxetine

Answer

Imipramine

Answer

Chlorpromazine

Question 10

Which of the following statements is not true regarding Tardive Dyskinesia (TD)?

Accepted Answer

Combining anticholinergics with antipsychotics prevents TD.

Answer

Clozapine is useful in its treatment.

Answer

Dopaminergic supersensitivity is believed to be the cause.

Answer

It is usually observed in the perioral area.

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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