Psychopharmacology Practice Questions

Q: Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:

Lithium carbonate. **Lithium carbonate** - **Lithium** is a well-established and highly effective **mood stabilizer**, considered a first-line treatment for managing both **manic** and **depressive episodes** in bipolar disorder. - It helps prevent recurrent episodes and reduces the severity of mood swings, acting as a prophylactic agent. *Chlorpromazine* - **Chlorpromazine** is a **first-generation antipsychotic** that is primarily used to treat **schizophrenia** and other psychotic disorders. - While it can be used acutely to manage severe manic agitation, it is not a first-line agent for the long-term mood stabilization characteristic of bipolar disorder. *Haloperidol* - **Haloperidol** is another **first-generation antipsychotic** often used for acute treatment of **psychotic symptoms** or severe agitation, including in mania. - It is not a primary long-term mood stabilizer for bipolar disorder due to its side effect profile and lack of efficacy in preventing future mood episodes compared to lithium. *Diazepam* - **Diazepam** is a **benzodiazepine** primarily used for treating **anxiety**, muscle spasms, and acute seizures. - While it can help manage acute agitation and insomnia during a manic episode, it does not have mood-stabilizing properties and is not a long-term treatment for bipolar disorder.

Q: What serum lithium level indicates severe toxicity?

2.6 mEq/L. ***2.6 mEq/L*** - A serum lithium level of **2.6 mEq/L** falls within the **severe toxicity range (>2.5 mEq/L)**, which is the clinically relevant threshold for severe lithium toxicity. - At this level, patients typically present with severe neurological symptoms such as **seizures, altered consciousness, coma, cardiac arrhythmias, and multiorgan dysfunction**. - This represents the **most appropriate answer** as it defines the clinical threshold where severe toxicity begins and requires aggressive management. *0.6 mEq/L* - This level falls within the **therapeutic range (0.6-1.2 mEq/L)** for lithium maintenance therapy. - This is **not indicative of any toxicity** and represents an appropriate treatment level. *12 mEq/L* - While this level technically represents severe toxicity, it is **incompatible with life** and represents a lethal concentration. - Such levels are **not clinically encountered** as patients would not survive to present with this level. - The question asks for the level that **indicates** severe toxicity, which refers to the **diagnostic threshold (>2.5 mEq/L)**, not extreme outlier values. *<0.6 mEq/L* - A lithium level **below 0.6 mEq/L** is **subtherapeutic** and unlikely to provide adequate mood stabilization. - This level is **not associated with toxicity** but rather with insufficient therapeutic effect.

Q: Which of the following statements is true regarding akathisia?

Patients may exhibit restlessness and an urge to move.. ***Patients may exhibit restlessness and an urge to move.*** - **Akathisia** is a common **extrapyramidal side effect** characterized by an inner feeling of **restlessness** and an urge to move, which may manifest as pacing, fidgeting, or an inability to sit still. - This condition can be highly distressing for patients, leading to significant discomfort and non-adherence to medication. *Anticholinergics may be used in specific cases of akathisia.* - **Anticholinergics** like benztropine are typically used to treat **pseudoparkinsonism** and **dystonia**, another type of extrapyramidal symptom, but are generally **not effective** for akathisia. - **Beta-blockers** (e.g., propranolol) and **benzodiazepines** (e.g., lorazepam) are more commonly used for akathisia, although the primary approach is typically to reduce or switch the causative medication. *Akathisia is characterized by the presence of hallucinations.* - **Hallucinations** are perceptual disturbances, often associated with psychotic disorders or delirium, and are **not a defining symptom of akathisia**. - Akathisia is primarily a **motor and subjective sensory phenomenon**, distinct from psychotic symptoms. *Behavioral therapy is the primary treatment for akathisia.* - While supportive measures and **behavioral interventions** can help manage the distress, they are **not the primary treatment** for akathisia, which is generally pharmacological. - The most effective approach involves **reducing the dose** of the offending antipsychotic medication or **switching to another antipsychotic** with a lower propensity for causing akathisia.

Q: An SSRI antidepressant, such as fluoxetine, will be prescribed for an adult patient. You should advise him or her that two of the most likely side effects or adverse responses that may eventually occur at therapeutic blood levels are which of the following?

Sexual dysfunction and sleep disturbances. ***Sexual dysfunction and sleep disturbances*** - **Sexual dysfunction** is one of the most common and persistent adverse effects of SSRIs, affecting 40-65% of patients and continuing throughout treatment at therapeutic levels [2], [3]. - **Sleep disturbances** (insomnia or altered sleep architecture) can persist during long-term SSRI therapy and are among the eventual side effects patients experience [1], [2], [3]. - Both effects are characteristic of chronic SSRI use and significantly impact patient compliance and quality of life. *Sexual dysfunction and nausea* - While **sexual dysfunction** is indeed very common and persistent, **nausea** is typically a transient side effect that occurs during the first 1-2 weeks of treatment and usually resolves with continued use [2]. - The question specifically asks about *eventual* occurrence at therapeutic levels over time, making nausea less appropriate as it is not a chronic issue. *Tremor and weight gain* - **Tremor** is not among the most common side effects of SSRIs and occurs less frequently than sexual dysfunction or sleep disturbances. - **Weight gain** can occur with some SSRIs (particularly paroxetine), but fluoxetine is actually considered weight-neutral or may even cause weight loss in some patients, making this combination less likely for fluoxetine specifically [1]. *Headache and diarrhea* - Both **headache** and **diarrhea** are common initial side effects when starting SSRIs but typically improve or resolve within the first few weeks of treatment [1]. - These are transient effects rather than eventual persistent side effects that characterize long-term therapeutic use.

Q: A 78-year-old woman is brought to the clinic by her daughter due to concerns about her mother's mood. The patient's husband of 48 years passed away six months ago after a lengthy illness due to metastatic colon cancer. Since then, she reports having a poor appetite, decreased interest in activities, and frequent thoughts about dying. She is started on nortriptyline to help improve her mood and functional status. Which of the following is a common side effect of nortriptyline?

anticholinergic side effects. ***Anticholinergic side effects*** - **Nortriptyline** is a **tricyclic antidepressant (TCA)** known for its significant **antimuscarinic** activity, leading to anticholinergic effects. - Common anticholinergic side effects include **dry mouth, blurred vision, constipation, urinary retention**, and **tachycardia**. *Impaired cardiac contractility* - While TCAs can have **cardiac effects** (e.g., QT prolongation, arrhythmias), **impaired cardiac contractility** is not a common or typical direct side effect at therapeutic doses. - Other drug classes, such as certain **beta-blockers** or **calcium channel blockers**, are more commonly associated with this effect. *Weight loss* - **Weight gain** is a more common side effect associated with many antidepressants, including some TCAs. - While some individuals may experience initial appetite changes, **sustained weight loss** is not a characteristic side effect of **nortriptyline**. *Heart block* - TCAs can cause **conduction abnormalities** like **prolonged QRS duration** and **QT interval prolongation**, especially in overdose or in patients with pre-existing cardiac conditions. - However, direct **heart block** (e.g., AV block) is a less common side effect, usually associated with higher doses or specific patient vulnerabilities.

Q: What is the drug of choice for rapid relief of an acute panic attack?

Benzodiazepines (rapid anxiolytic action). ***Benzodiazepines (rapid anxiolytic action)*** - **Benzodiazepines** are used for **rapid symptomatic relief** of acute panic attacks due to their **fast onset of action** (within 30-60 minutes) and potent anxiolytic effects. - They work by enhancing the effect of **GABA**, an inhibitory neurotransmitter, leading to CNS depression and reduced anxiety. - **Important note:** While effective for acute relief, benzodiazepines are recommended only for **short-term use** (2-4 weeks) due to risks of dependence, tolerance, and withdrawal. - **First-line long-term treatment** for panic disorder is **SSRIs** (not benzodiazepines). *Beta-blockers (manage physical symptoms)* - **Beta-blockers** can help manage **physical symptoms** of anxiety such as palpitations and tremors, but they do not address the core psychological component of a panic attack. - They are often used as an adjunct or in performance anxiety situations, but not for acute panic attack relief. *Neuroleptics (antipsychotic agents)* - **Neuroleptics** (antipsychotic agents) are primarily used for treating **psychotic disorders** like schizophrenia, not panic attacks. - Their side effect profile and mechanism of action make them unsuitable for acute anxiety or panic. *Tricyclic Antidepressants (long-term management)* - **Tricyclic Antidepressants (TCAs)** like imipramine and clomipramine can be used for **long-term management** of panic disorder. - However, their onset of action is slow (2-4 weeks), making them unsuitable for acute panic attack relief. - **SSRIs are preferred over TCAs** for long-term management due to better tolerability.

Q: A patient diagnosed with schizophrenia presented with an acute exacerbation of symptoms. After receiving an injection of haloperidol in the casualty, the patient suddenly developed deviation of the eyeballs and torticollis. What is the diagnosis?

Acute dystonia. ***Acute dystonia*** * **Acute dystonia** is a common **extrapyramidal side effect** of high-potency antipsychotics like **haloperidol**, characterized by sudden, involuntary muscle contractions occurring within **minutes to hours** of drug administration. * **Deviation of the eyeballs (oculogyric crisis)** and **torticollis** (spasms of neck muscles) are classic presentations of acute dystonia. * Treatment includes **anticholinergic agents** (e.g., benztropine, trihexyphenidyl) or **antihistamines** (e.g., diphenhydramine), which provide rapid relief. *Akathisia* * **Akathisia** is characterized by an internal feeling of **restlessness** and an urge to move, which is often relieved by movement. * It does not present with fixed abnormal postures or sudden, sustained muscle contractions like oculogyric crisis or torticollis. *Malignant hyperthermia* * **Malignant hyperthermia** is a rare, life-threatening reaction to certain **anesthetic drugs**, characterized by **rapidly increasing body temperature**, muscle rigidity, and metabolic acidosis. * It is not typically associated with antipsychotic use or the specific localized dystonic movements described. *Drug induced parkinsonism* * **Drug-induced parkinsonism** presents with symptoms resembling Parkinson's disease, including **tremor**, **rigidity**, **bradykinesia**, and postural instability. * These symptoms develop more **gradually** (days to weeks) and are distinct from the sudden, acute, sustained muscle contractions seen in dystonia.

Q: A patient presents with symptoms of major depressive disorder. Which medication should be prescribed for treatment?

Sertraline. ***Sertraline*** - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)**, which are first-line agents for treating major depressive disorder due to their efficacy and generally favorable side effect profile. - SSRIs work by increasing the availability of **serotonin** in the brain, helping to improve mood and reduce symptoms of depression. *Haloperidol* - **Haloperidol** is a **first-generation antipsychotic** primarily used to treat psychotic disorders like **schizophrenia** and severe agitation, not major depressive disorder. - It works by blocking **dopamine D2 receptors**, and its side effects can include **extrapyramidal symptoms**. *Alprazolam* - **Alprazolam** is a **benzodiazepine** used to treat anxiety disorders and panic attacks due to its *rapid onset of action* in reducing anxiety symptoms. - While it can alleviate anxiety that co-occurs with depression, it is not an antidepressant and does not treat the underlying depressive disorder; it also carries a risk of **dependence and withdrawal**. *Olanzapine* - **Olanzapine** is a **second-generation antipsychotic** used for conditions such as **schizophrenia** and **bipolar disorder**. - While it can be used as an **adjunctive treatment** in some cases of treatment-resistant depression, it is not a first-line monotherapy for major depressive disorder.

Q: Which of the following antidepressants can also be used as an antipsychotic?

Amoxapine. ***Amoxapine*** - Amoxapine is a **tetracyclic antidepressant** with a unique pharmacological profile, as it acts as a dopamine receptor antagonist, particularly at the **D2 receptor**. - Its **dopamine receptor blocking activity** confers antipsychotic properties, making it useful in treating mood disorders with psychotic features. *Amitriptyline* - Amitriptyline is a **tricyclic antidepressant (TCA)** primarily used for depression, neuropathic pain, and migraine prophylaxis. - It primarily acts by inhibiting the reuptake of **norepinephrine and serotonin**, with no significant dopamine receptor blocking activity. *Trazodone* - Trazodone is a **serotonin antagonist and reuptake inhibitor (SARI)**, commonly used for depression and insomnia. - Its main mechanism involves **blocking 5-HT2A receptors** and inhibiting serotonin reuptake, without antipsychotic effects. *Doxepin* - Doxepin is another **tricyclic antidepressant (TCA)** used for depression, anxiety, and insomnia. - It primarily inhibits the reuptake of **norepinephrine and serotonin** and has significant antihistaminic effects, but lacks antipsychotic properties.

Q: A patient with schizophrenia was started on haloperidol 5 mg. The next day, he presented with uprolling of the eyes. A complete neurological examination revealed no spasticity or any other abnormality, and visual acuity and ophthalmoscopic findings are normal. The most likely diagnosis is:

Acute dystonia. ***Acute dystonia*** - The rapid onset of **uprolling of the eyes** (oculogyric crisis) shortly after starting **haloperidol**, a potent D2 blocker, is a classic presentation of acute dystonia. - This extrapyramidal symptom is characterized by **involuntary muscle contractions** affecting various body parts, including the eyes, neck (**torticollis**), and jaw. *Akathisia* - Akathisia is characterized by a **subjective feeling of inner restlessness** and an objective need to move, often described as an inability to sit still. - While it is an extrapyramidal symptom, it doesn't typically manifest as involuntary eye movements like oculogyric crisis. *Seizure* - Seizures typically involve **loss of consciousness**, generalized tonic-clonic movements, or altered mental status, none of which are described. - The patient's presentation of isolated eye uprolling without other neurological findings or changes in consciousness makes a seizure unlikely. *Tardive dyskinesia* - **Tardive dyskinesia** is a late-onset extrapyramidal side effect, typically developing after months or years of antipsychotic use, not within a day of starting the medication. - It is characterized by **involuntary, repetitive movements**, often involving the face, mouth, and tongue (e.g., lip smacking, grimacing).

Question 1

Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:

Accepted Answer

Lithium carbonate

Answer

Chlorpromazine

Answer

Haloperidol

Answer

Diazepam

Question 2

What serum lithium level indicates severe toxicity?

Accepted Answer

2.6 mEq/L

Answer

0.6 mEq/L

Answer

12 mEq/L

Answer

<0.6 mEq/L

Question 3

Which of the following statements is true regarding akathisia?

Accepted Answer

Patients may exhibit restlessness and an urge to move.

Answer

Anticholinergics may be used in specific cases of akathisia.

Answer

Akathisia is characterized by the presence of hallucinations.

Answer

Behavioral therapy is the primary treatment for akathisia.

Question 4

An SSRI antidepressant, such as fluoxetine, will be prescribed for an adult patient. You should advise him or her that two of the most likely side effects or adverse responses that may eventually occur at therapeutic blood levels are which of the following?

Accepted Answer

Sexual dysfunction and sleep disturbances

Answer

Sexual dysfunction and nausea

Answer

Headache and diarrhea

Answer

Tremor and weight gain

Question 5

A 78-year-old woman is brought to the clinic by her daughter due to concerns about her mother's mood. The patient's husband of 48 years passed away six months ago after a lengthy illness due to metastatic colon cancer. Since then, she reports having a poor appetite, decreased interest in activities, and frequent thoughts about dying. She is started on nortriptyline to help improve her mood and functional status. Which of the following is a common side effect of nortriptyline?

Accepted Answer

anticholinergic side effects

Answer

weight loss

Answer

impaired cardiac contractility

Answer

heart block

Question 6

What is the drug of choice for rapid relief of an acute panic attack?

Accepted Answer

Benzodiazepines (rapid anxiolytic action)

Answer

Neuroleptics (antipsychotic agents)

Answer

Beta-blockers (manage physical symptoms)

Answer

Tricyclic Antidepressants (long-term management)

Question 7

A patient diagnosed with schizophrenia presented with an acute exacerbation of symptoms. After receiving an injection of haloperidol in the casualty, the patient suddenly developed deviation of the eyeballs and torticollis. What is the diagnosis?

Accepted Answer

Acute dystonia

Answer

Akathisia

Answer

Malignant hyperthermia

Answer

Drug induced parkinsonism

Question 8

A patient presents with symptoms of major depressive disorder. Which medication should be prescribed for treatment?

Accepted Answer

Sertraline

Answer

Haloperidol

Answer

Olanzapine

Answer

Alprazolam

Question 9

Which of the following antidepressants can also be used as an antipsychotic?

Accepted Answer

Amoxapine

Answer

Trazodone

Answer

Doxepin

Answer

Amitriptyline

Question 10

A patient with schizophrenia was started on haloperidol 5 mg. The next day, he presented with uprolling of the eyes. A complete neurological examination revealed no spasticity or any other abnormality, and visual acuity and ophthalmoscopic findings are normal. The most likely diagnosis is:

Accepted Answer

Acute dystonia

Answer

Akathisia

Answer

Seizure

Answer

Tardive dyskinesia

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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