Question 1

The tricyclic antidepressant class of medications can be characterized by all of the following properties except&#10;A) Long half-life&#10;B) Inexpensive cost&#10;C) Safety in overdose&#10;D) High rate of side effects

Accepted Answer

Tricyclic antidepressants are known for their long half-life, relatively low cost, and high likelihood of producing side effects. They also have a significant risk of overdose and are therefore not considered safe in this regard. Option C, "safety in overdose," is the exception that does not apply to this class of drugs.

Question 2

In treating a patient with depression for whom you want to increase norepinephrine, which of the following antidepressants would you choose because it specifically increases levels of norepinephrine?&#10;A) Reboxetine (Vestra)&#10;B) Fluoxetine (Prozac)&#10;C) Phenelzine (Nardil)&#10;D) Venlafaxine (Effexor)

Accepted Answer

Reboxetine is a selective norepinephrine reuptake inhibitor (NRI), meaning it specifically increases levels of norepinephrine in the brain. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and does not target norepinephrine specifically. Phenelzine is a monoamine oxidase inhibitor (MAOI) and also affects serotonin and dopamine levels, in addition to norepinephrine. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) and increases levels of both norepinephrine and serotonin.

Question 3

Which of the following reactions is indicative of a dystonic reaction?&#10;A) Oculogyric crisis and spasms of the back muscles&#10;B) Tongue thrusting and lip-smacking movements&#10;C) Pill-rolling hand movement and mask-like facial expression&#10;D) Urinary retention and orthostatic hypotension

Accepted Answer

Oculogyric crisis involves abnormal and prolonged upward deviation of the eyes, while spasms of the back muscles may cause torticollis (twisting of the neck). Both of these symptoms are indicative of dystonic reactions, which are neurological side effects of some medications. Tongue thrusting and lip-smacking (option B) are associated with tardive dyskinesia, while pill-rolling hand movement and mask-like facial expression (option C) are characteristic symptoms of Parkinson's disease. Urinary retention and orthostatic hypotension (option D) are not specific to any particular movement disorder or drug reaction.

Question 4

A patient with bipolar disorder who has been on lithium for 3 months has a blood lithium level of 0.3 mEq/L when tested. You anticipate&#10;A) Improvement of manic symptoms&#10;B) No improvement of manic symptoms&#10;C) Improvement of depressive symptoms&#10;D) Symptoms of moderate lithium toxicity

Accepted Answer

The therapeutic blood level of lithium for the treatment of bipolar disorder typically ranges from 0.6 to 1.2 mEq/L. A level of 0.3 mEq/L is below the therapeutic range, suggesting that the patient is unlikely to experience improvement of manic symptoms due to insufficient lithium concentration.

Question 5

Neuroleptic malignant syndrome is a serious complication of the use of antipsychotic medications. One of the first indicators of this complication is&#10;A) Increased motor activity&#10;B) Rapid temperature elevation to 103&#176;F&#10;C) Increase of aggressive behavior&#10;D) Nose twitching and abnormal tongue movements

Accepted Answer

Rapid temperature elevation to 103°F is one of the first indicators of neuroleptic malignant syndrome. Other symptoms may include muscle rigidity, altered mental status, autonomic instability, and elevated creatine kinase levels. It is a medical emergency and requires immediate treatment.

Question 6

A patient has been taking haloperidol (Haldol) IM, an antipsychotic drug, for years. You notice that he is grinding his teeth and smacking his lips frequently. You think that he may have&#10;A) Tardive dyskinesia&#10;B) Gustatory hallucinations&#10;C) Spasms of the jaw&#10;D) Parkinsonian symptoms

Accepted Answer

The patient's symptoms of grinding his teeth and smacking his lips frequently are indicative of tardive dyskinesia, a movement disorder that can be a side effect of long-term use of antipsychotic medications such as haloperidol. This condition is characterized by involuntary, repetitive movements of the face, tongue, and limbs.

Question 7

TCAs are effective in treatment of depression because they block&#10;A) Reuptake of serotonin and dopamine&#10;B) Reuptake of serotonin and norepinephrine&#10;C) Action of monoamine oxidase enzyme&#10;D) Histamine receptors

Accepted Answer

TCAs (tricyclic antidepressants) are effective in the treatment of depression because they block the reuptake of both serotonin and norepinephrine in the brain, increasing the availability of these neurotransmitters and improving mood. While TCAs can also interact with other receptors, such as histamine receptors, their primary mechanism of action is through the inhibition of serotonin and norepinephrine reuptake.

Question 8

Which class of antidepressants has the most anticholinergic side effects?&#10;A) Monoamine oxidase inhibitors (MAOIs)&#10;B) Selective serotonin reuptake inhibitors (SSRIs)&#10;C) Tricyclic antidepressants (TCAs)&#10;D) Serotonin norepinephrine reuptake inhibitors (SNRIs)

Accepted Answer

Tricyclic antidepressants (TCAs) have the most anticholinergic side effects among antidepressants, which can lead to dry mouth, constipation, urinary retention, blurred vision, and cognitive impairment. MAOIs, SSRIs, and SNRIs have a lower risk of anticholinergic side effects.

Question 9

A patient who is receiving the typical antipsychotic medication haloperidol is stepping back and forth from foot to foot and says that he feels very restless. This could be a manifestation of&#10;A) Neuroleptic malignant syndrome&#10;B) Akathisia&#10;C) Increasing psychosis&#10;D) An anticholinergic response

Accepted Answer

The patient's symptoms are indicative of akathisia, which is a common side effect of typical antipsychotic medications like haloperidol. Akathisia is characterized by restlessness, pacing, and an inability to sit still. Neuroleptic malignant syndrome is a rare but serious side effect of antipsychotic medications that presents with muscle rigidity, fever, and altered mental status. Increasing psychosis would not likely present as restlessness. An anticholinergic response might cause dry mouth, blurred vision, or constipation, but would not likely cause restlessness specifically.

Question 10

A patient has been treated for the past several years with fluphenazine (Prolixin). You notice that he is drooling and has a tremor and slight pill-rolling movement of the fingers. These are the extrapyramidal symptoms known as

A) Anticholinergic effects
B) Pseudoparkinsonism
C) Tardive dyskinesia
D) Dystonic reaction

Accepted Answer

The symptoms described, including drooling, tremor, and pill-rolling movement of the fingers, are consistent with pseudoparkinsonism, which is an extrapyramidal symptom associated with antipsychotic medications like fluphenazine (Prolixin). Anticholinergic effects typically include side effects such as dry mouth and constipation, while tardive dyskinesia and dystonic reactions are other types of extrapyramidal symptoms but present in different ways.

Question 11

Antidepressants are used with caution in which of the following disorders?&#10;A) Major depression with atypical features&#10;B) Adjustment disorder with depression&#10;C) Bipolar disorders&#10;D) Dysthymia

Accepted Answer

The answer of Antidepressants are used with caution in which...

Question 12

Because of the severe problems caused by chronic extrapyramidal side effects (EPSs), patients receiving long-term use of antipsychotics must be carefully monitored for the development of EPS symptoms. One of the most commonly used screeners is

A) Beck's inventory scale
B) Ham-D scale
C) Zung scale
D) AIMS scale

Accepted Answer

The answer of Because of the severe problems caused by...

Question 13

The older typical antipsychotic medications would be expected to be most effective for which of the following target symptoms?&#10;A) Social isolation&#10;B) Apathy&#10;C) Hallucinations&#10;D) Lack of motivation

Accepted Answer

The answer of The older typical antipsychotic medications would be...

Question 14

Among the following statements, which best describes the action of older typical antipsychotic medications such as Haldol?&#10;A) They block dopamine receptors in all four dopamine pathways.&#10;B) They decrease available amounts of serotonin and norepinephrine.&#10;C) They decrease the metabolism of dopamine in the synaptic cleft.&#10;D) They selectively block reuptake of dopamine.

Accepted Answer

The answer of Among the following statements, which best describes...

Deck 6: Psychopharmacotherapy