Question 1

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

Pseudoparkinsonism

Accepted Answer

The symptoms described (drooling, tremor, and slight pill-rolling movement of the fingers) are characteristic of pseudoparkinsonism, which is an extrapyramidal symptom commonly associated with the use of antipsychotic medications such as fluphenazine. Anticholinergic effects refer to a different set of possible side effects from antipsychotic medications, while tardive dyskinesia and dystonic reactions also involve different sets of symptoms.

Question 2

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

A blood lithium level of 0.3 mEq/L is considered to be in the therapeutic range for bipolar disorder. However, it can take up to 6 months for lithium to reach its full therapeutic effect. Therefore, it is not uncommon for patients to not see improvement in their symptoms after only 3 months of treatment. It is important to continue monitoring the patient's symptoms and lithium levels to determine if a dosage adjustment is necessary. Additionally, a blood lithium level of 0.3 mEq/L is not indicative of lithium toxicity.

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 (uncontrollable upward deviation of the eyes) and spasms of the back muscles are characteristic of dystonic reactions, which are a type of extrapyramidal side effect (EPS) that can result from certain medications or drug interactions. Tongue thrusting and lip-smacking movements are indicative of tardive dyskinesia, which is another type of EPS. Pill-rolling hand movement and mask-like facial expression are symptoms of Parkinson's disease. Urinary retention and orthostatic hypotension are not associated with dystonic reactions or EPS in general, but are potential side effects of certain medications.

Question 4

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 (SNRI), which means it specifically increases levels of norepinephrine. Choices B, C, and D are all either selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs) and do not specifically target norepinephrine.

Question 5

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 AIMS (Abnormal Involuntary Movement Scale) scale is a commonly used screening tool for identifying EPS symptoms in patients receiving long-term antipsychotic treatment. It assesses abnormal involuntary movements such as tremors, rigidity, and dyskinesias. Beck's inventory scale, Ham-D scale, and Zung scale are not designed to assess EPS symptoms.

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

Grinding of teeth and smacking of lips are symptoms of tardive dyskinesia, a side effect of long-term use of antipsychotic drugs like haloperidol. Tardive dyskinesia is a movement disorder characterized by involuntary movements of the tongue, lips, face, and other parts of the body.

Question 7

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 highest anticholinergic side effects among the different classes of antidepressants. This is due to their affinity for muscarinic acetylcholine receptors. TCAs can cause dry mouth, constipation, urinary retention, blurred vision, and confusion in patients. It is important to consider these side effects when selecting a medication for a patient with a history of anticholinergic sensitivity or cognitive impairment.

Question 8

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

Older typical antipsychotic medications such as Haldol primarily work by blocking dopamine receptors in all four dopamine pathways, thereby reducing the amount of dopamine activity in the brain.

Question 9

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 treating depression by blocking the reuptake of both serotonin and norepinephrine in the brain. By blocking the reuptake of these neurotransmitters, TCAs increase their levels in the brain, leading to improved mood and decreased symptoms of depression.

Question 10

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 not safe in overdose, as they can lead to severe toxicity and even death. The other options are all properties that can be associated with tricyclic antidepressants.

Question 11

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 answer of A patient who is receiving the typical...

Question 12

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

The answer of Neuroleptic malignant syndrome is a serious complication...

Question 13

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 14

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...

Deck 6: Psychopharmacotherapy