Psychopharmacology Practice Questions

Q: What is the classical drug of choice for Tourette syndrome?

Haloperidol. ***Haloperidol*** - **Haloperidol**, a **first-generation antipsychotic**, is highly effective in blocking dopamine receptors and reducing the frequency and severity of tics in Tourette syndrome. - Its efficacy in managing severe tics makes it a **classical drug of choice**, particularly for individuals who do not respond to less potent interventions. *Amantadine* - **Amantadine** is primarily used as an **antiviral agent** against influenza A and as an antiparkinsonian drug, enhancing dopamine release. - It is not indicated for the treatment of Tourette syndrome as its mechanism of action is related to increasing dopamine, which would worsen tics. *Propranolol* - **Propranolol** is a **beta-blocker** primarily used to treat conditions like hypertension, angina, and essential tremor by reducing adrenergic activity. - While it can help with anxiety and some motor symptoms in specific conditions, it is not a primary treatment for the motor and vocal tics characteristic of Tourette syndrome. *Diazepam* - **Diazepam** is a **benzodiazepine** that acts as a central nervous system depressant, used primarily for anxiety, insomnia, and muscle spasms. - While it can help with associated anxiety, it does not directly address the underlying mechanism of tics in Tourette syndrome and is not a drug of choice for tic management.

Q: What is the treatment of choice for akathisia?

Propranolol. ***Propranolol*** - **Beta-blockers** like propranolol are considered first-line treatment for akathisia due to their ability to reduce central as well as peripheral noradrenergic hyperactivity and anxiety. - They are particularly effective in alleviating the subjective feeling of **inner restlessness** and the objective motor symptoms, especially when the akathisia is induced by antipsychotics. *Benztropine* - This is an **anticholinergic** medication primarily used to treat other extrapyramidal symptoms like **dystonia** and **pseudoparkinsonism**. - While it might provide some relief for certain motor aspects, it is generally less effective for the subjective feeling of restlessness in akathisia and can have significant side effects. *Dantrolene* - **Dantrolene** is a direct-acting **skeletal muscle relaxant** used primarily in the treatment of **neuroleptic malignant syndrome (NMS)** and malignant hyperthermia. - It is not indicated for the management of extrapyramidal symptoms like akathisia. *Lithium* - **Lithium** is a mood stabilizer used predominantly in the treatment of **bipolar disorder**. - It has no role in the direct treatment of akathisia; however, it can ironically sometimes induce or worsen akathisia as a side effect itself.

Q: What is a therapeutic indication for the use of liothyronine?

Resistant depression. ***Resistant depression*** - Liothyronine (T3) can be used as an **adjunctive therapy** for patients with major depressive disorder who have not responded adequately to antidepressant monotherapy. - While the exact mechanism is not fully understood, it's thought to improve antidepressant response by modulating **neurotransmitter systems** and receptor sensitivity in the brain. *Social phobia* - **Social phobia**, or social anxiety disorder, is primarily treated with psychotherapy (e.g., CBT) and medications like **SSRIs** or **SNRIs**. - Liothyronine is **not a primary or adjunctive treatment** for social phobia. *Alzheimer's disease* - **Alzheimer's disease** is a neurodegenerative disorder treated with cholinesterase inhibitors (e.g., donepezil) and NMDA receptor antagonists (e.g., memantine). - There is currently **no established role for liothyronine** in the treatment of Alzheimer's disease. *Cataplexy* - **Cataplexy**, a symptom of narcolepsy, is characterized by sudden muscle weakness triggered by strong emotions. - It is typically managed with medications like **sodium oxybate** or certain antidepressants (e.g., venlafaxine), not liothyronine.

Q: Which of the following was the PRIMARY indication for which venlafaxine was first FDA approved?

Major depressive disorder. ***Major depressive disorder***- Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) [1], and its primary FDA approval was for the treatment of major depressive disorder [1]- Its mechanism of action, increasing the availability of serotonin and norepinephrine in the brain, is highly effective for managing symptoms of depression [2]- It was first approved by the FDA in 1993 specifically for this indication*Attention deficit hyperactivity disorder (ADHD)*- While some antidepressants are used off-label for ADHD, particularly norepinephrine-reuptake inhibitors like atomoxetine, venlafaxine was not primarily approved for this condition- The mainstays for ADHD treatment are typically stimulants (e.g., methylphenidate, amphetamine) or non-stimulants like atomoxetine*Bipolar disorder*- Venlafaxine can be used as an adjunct in treating the depressive phase of bipolar disorder, but it is not indicated as a monotherapy due to the risk of inducing mania or hypomania- The primary medications for bipolar disorder are mood stabilizers (e.g., lithium, valproate) and atypical antipsychotics*Schizophrenia*- Venlafaxine has no role in the primary treatment of schizophrenia, which is a psychotic disorder- The first-line treatment for schizophrenia involves antipsychotic medications that primarily target dopamine and serotonin receptors

Q: Which FDA approved drug is used for refractory schizophrenia?

Clozapine. ***Clozapine*** - **Clozapine** is an **atypical antipsychotic** uniquely approved for the treatment of **refractory schizophrenia**, where other antipsychotics have failed. - Its efficacy in treatment-resistant cases is attributed to its complex pharmacological profile, including antagonism of multiple **dopamine** and **serotonin receptors**. *Amoxapine* - **Amoxapine** is a **tetracyclic antidepressant** with some antipsychotic properties due to **dopamine receptor blockade**, but it is not a first-line or approved treatment for refractory schizophrenia. - It's primarily used for **major depressive disorder** and carries a risk of inducing **extrapyramidal symptoms**. *Haloperidol* - **Haloperidol** is a **first-generation (typical) antipsychotic** effective in treating acute psychotic symptoms but generally not used as the agent of choice for **refractory schizophrenia**. - Its primary mechanism involves potent **D2 dopamine receptor blockade**, which often leads to significant **extrapyramidal side effects**. *Penfluridol* - **Penfluridol** is a **long-acting, first-generation antipsychotic** that is used for maintenance treatment of schizophrenia, but it is not specifically indicated or uniquely effective for **refractory cases**. - It has a prolonged duration of action, making it suitable for patients requiring less frequent dosing to improve **medication adherence**.

Q: Which of the following is the preferred first-line pharmacological treatment for tardive dyskinesia?

Valbenazine. ***Valbenazine*** - **Valbenazine** is a **VMAT2 inhibitor** approved by the FDA as a **first-line treatment** for tardive dyskinesia. - It works by reducing **presynaptic dopamine release**, thereby mitigating involuntary movements. - Along with deutetrabenazine, it represents the **preferred pharmacological approach** for tardive dyskinesia, with good efficacy and tolerability. *Tetrabenazine* - **Tetrabenazine** is also a **VMAT2 inhibitor** that reduces dopamine levels. - However, the **newer VMAT2 inhibitors** (valbenazine and deutetrabenazine) are generally **preferred as first-line** due to **better tolerability** (lower risk of depression, parkinsonism, and somnolence) and simpler dosing schedules. - Tetrabenazine may still be used when newer agents are unavailable. *Baclofen* - **Baclofen** is a **GABA-B receptor agonist** primarily used for spasticity and muscle rigidity. - While it has been explored for tardive dyskinesia, it is **not considered first-line** pharmacological treatment due to **limited efficacy** compared to VMAT2 inhibitors. *Cessation of antipsychotic medication* - While sometimes considered, outright **cessation** of antipsychotic medication is often **not feasible** or desirable due to the risk of **relapse of underlying psychiatric illness**. - It can sometimes even **worsen tardive dyskinesia symptoms** temporarily (withdrawal-emergent dyskinesia). - The first-line approach involves **pharmacological treatment with VMAT2 inhibitors** to manage the dyskinesia while maintaining psychiatric stability.

Q: Which of the following conditions is a contraindication for ECT?

Raised ICT. ***Raised ICT*** - **Raised intracranial tension (ICT)** is an absolute contraindication for ECT due to the transient increase in **cerebral blood flow** and pressure during the procedure. - This increase in pressure can lead to **brain herniation** or further neurological compromise in patients with pre-existing elevated ICT. *Severe medical illness* - While severe medical illness can pose a risk, it is generally considered a **relative contraindication** rather than an absolute one. - The decision to proceed with ECT in such cases involves a careful **risk-benefit analysis** and close monitoring. *Severe heart disease* - **Severe heart disease**, such as **unstable angina** or **recent myocardial infarction**, is a relative contraindication. - It requires careful cardiac evaluation and management, but does not absolutely preclude ECT if the benefits outweigh the risks. *Pregnancy complications* - **Pregnancy** itself is not a contraindication for ECT; in some cases, it may be the preferred treatment for severe psychiatric illness during pregnancy. - However, complications might necessitate careful monitoring and adjustment of the procedure.

Q: Psychotic patient on antipsychotic drugs develops torticollis within 4 days of therapy. What is the treatment?

Central anticholinergic drugs. ***Central anticholinergic drugs*** - The patient is experiencing an **acute dystonic reaction**, a common extrapyramidal side effect of antipsychotics, such as **torticollis**, which requires immediate treatment with central anticholinergic agents. - Medications like **benztropine** or **diphenhydramine** are indicated to quickly reverse these symptoms by blocking acetylcholine activity in the basal ganglia. *Peripheral anticholinergic drugs* - These agents primarily act outside the central nervous system and are not effective in treating centrally mediated extrapyramidal symptoms like **acute dystonia**. - Their main use is for conditions like **bradycardia** or to reduce **gastrointestinal motility**. *Beta blockers* - **Beta-blockers** are primarily used to treat **akathisia** (restlessness) associated with antipsychotic medication, not acute dystonic reactions like torticollis. - They work by reducing the somatic manifestations of anxiety and motor restlessness. *Dantrolene* - **Dantrolene** is a **direct skeletal muscle relaxant** primarily used in the treatment of **neuroleptic malignant syndrome** or **malignant hyperthermia**. - It is not the first-line treatment for acute dystonic reactions as it does not address the underlying neurochemical imbalance.

Q: Which of the following is the most commonly prescribed first-line medication for ADHD?

Methylphenidate. ***Methylphenidate*** - **Methylphenidate** is a central nervous system stimulant and is widely considered a **first-line treatment** for ADHD in both children and adults. - It works by increasing the levels of **dopamine** and **norepinephrine** in the brain, improving attention and reducing impulsivity. - Most commonly prescribed due to extensive clinical experience, proven efficacy, and favorable safety profile. *Atomoxetine* - **Atomoxetine** is a **non-stimulant** medication used for ADHD, but it is typically considered second-line due to slower onset of action compared to stimulants. - It selectively inhibits the reuptake of **norepinephrine**, taking several weeks to show full therapeutic effect. - Preferred when stimulants are contraindicated or not tolerated. *Dextroamphetamine* - **Dextroamphetamine** is an effective **stimulant** medication for ADHD, but it is often reserved as an alternative if methylphenidate is not well-tolerated or effective. - It also increases **dopamine** and **norepinephrine** but has a slightly different pharmacological profile and duration of action. *Guanfacine* - **Guanfacine** is an **alpha-2 adrenergic agonist** used as adjunctive or alternative therapy for ADHD. - It is **not a first-line medication** and is typically used when stimulants are ineffective, contraindicated, or for specific symptom management (especially hyperactivity/impulsivity). - Has a different mechanism of action focusing on prefrontal cortex modulation.

Q: What is a significant risk associated with the use of SSRIs in young individuals for the management of depression?

Suicidal ideation. ***Correct: Suicidal ideation*** - The use of **SSRIs in young individuals** (particularly those under 25 years of age) has been associated with an increased risk of suicidal thoughts and behaviors, especially during the **initial phases of treatment** (first 1-2 months). - This risk is significant enough to warrant an **FDA black box warning** for all antidepressants. - Requires **careful monitoring** and patient/family education about warning signs and changes in mood or behavior. - Risk is highest in the first few weeks; close follow-up is essential. *Incorrect: Nihilistic ideation* - While a severe symptom in some mental health conditions, **nihilistic ideation** (belief that nothing exists or that the self/world is unreal) is not a commonly documented or specific risk directly associated with SSRI use. - This is more typically associated with **severe psychotic depression** or delusional disorders rather than being a side effect of medication. *Incorrect: Guilt feelings* - **Guilt feelings** are a **core symptom of depression itself** (one of the cognitive symptoms) and are actually targeted for reduction by SSRI treatment. - They are not a significant risk or adverse effect caused by SSRI use; rather, successful treatment typically reduces excessive guilt. *Incorrect: Envy-related thoughts* - **Envy-related thoughts** are not a documented side effect or risk associated with SSRI use in medical literature. - These are psychological constructs that are not directly influenced or exacerbated by SSRI medications.

Question 1

What is the classical drug of choice for Tourette syndrome?

Accepted Answer

Haloperidol

Answer

Amantadine

Answer

Propranolol

Answer

Diazepam

Question 2

What is the treatment of choice for akathisia?

Accepted Answer

Propranolol

Answer

Benztropine

Answer

Dantrolene

Answer

Lithium

Question 3

What is a therapeutic indication for the use of liothyronine?

Accepted Answer

Resistant depression

Answer

Social phobia

Answer

Cataplexy

Answer

Alzheimer's disease

Question 4

Which of the following was the PRIMARY indication for which venlafaxine was first FDA approved?

Accepted Answer

Major depressive disorder

Answer

Bipolar disorder

Answer

Attention deficit hyperactivity disorder (ADHD)

Answer

Schizophrenia

Question 5

Which FDA approved drug is used for refractory schizophrenia?

Accepted Answer

Clozapine

Answer

Amoxapine

Answer

Haloperidol

Answer

Penfluridol

Question 6

Which of the following is the preferred first-line pharmacological treatment for tardive dyskinesia?

Accepted Answer

Valbenazine

Answer

Tetrabenazine

Answer

Baclofen

Answer

Cessation of antipsychotic medication

Question 7

Which of the following conditions is a contraindication for ECT?

Accepted Answer

Raised ICT

Answer

Severe medical illness

Answer

Severe heart disease

Answer

Pregnancy complications

Question 8

Psychotic patient on antipsychotic drugs develops torticollis within 4 days of therapy. What is the treatment?

Accepted Answer

Central anticholinergic drugs

Answer

Peripheral anticholinergic drugs

Answer

Beta blockers

Answer

Dantrolene

Question 9

Which of the following is the most commonly prescribed first-line medication for ADHD?

Accepted Answer

Methylphenidate

Answer

Atomoxetine

Answer

Dextroamphetamine

Answer

Guanfacine

Question 10

What is a significant risk associated with the use of SSRIs in young individuals for the management of depression?

Accepted Answer

Suicidal ideation

Answer

Nihilistic ideation

Answer

Guilt feelings

Answer

Envy-related thoughts

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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