Question 1

Alprazolam (Xanax)is contraindicated in a patient taking which medication?

Accepted Answer

Alprazolam is metabolized by an enzyme called CYP3A4 in the liver. Ketoconazole is a strong inhibitor of CYP3A4 and can significantly increase the levels of alprazolam in the body, leading to an increased risk of side effects such as drowsiness and respiratory depression. Therefore, alprazolam should not be taken with ketoconazole.

Question 2

Which of the following drugs is used to manage both positive and negative mood symptoms of schizophrenia because of the low incidence of side effects and increased safety profile over clozapine (Clozaril)?

Accepted Answer

Olanzapine (Zyprexa) is a second-generation antipsychotic that is used to manage both positive and negative mood symptoms of schizophrenia because it has a lower incidence of side effects and an increased safety profile over clozapine (Clozaril), which is another second-generation antipsychotic that is known for its efficacy in managing treatment-resistant schizophrenia but also poses a risk for potentially fatal agranulocytosis (a condition characterized by a severe reduction in white blood cells that can lead to severe infections). Fluphenazine (Prolixin) is a first-generation antipsychotic that is associated with a higher risk of side effects such as extrapyramidal symptoms (movement disorders) and tardive dyskinesia (involuntary movements), while doxepin (Silenor) and venlafaxine (Effexor) are antidepressants that are not approved for the treatment of schizophrenia.

Question 3

When starting a patient on imipramine (Tofranil),how long should it take for the antidepressant clinical effects to appear?

Accepted Answer

It can take up to 14 to 60 days for the clinical effects of imipramine to appear. This is because it takes time for the medication to build up in the body and for changes in neurotransmitter levels to occur. It is important for patients to continue taking the medication as directed and to follow up with their healthcare provider to monitor for any side effects or changes in symptoms.

Question 4

Which selective SSRI is secreted in breast milk?

Accepted Answer

Fluoxetine (Prozac) is the only selective serotonin reuptake inhibitor (SSRI) that is secreted in breast milk.

Question 5

Which benzodiazepine is metabolized in the liver and therefore should not be used in those with liver disease?

Accepted Answer

Midazolam (Versed) is metabolized in the liver, producing active metabolites. In patients with liver disease, its metabolism can be impaired, leading to increased effects and potential toxicity.

Question 6

Which of the following drugs can cause extrapyramidal side effects,such as akathisia,dystonia,and neuroleptic malignant syndrome?

Accepted Answer

Fluphenazine is a typical antipsychotic medication that can cause extrapyramidal side effects, such as akathisia (restlessness), dystonia (muscle spasms), and neuroleptic malignant syndrome (a potentially life-threatening condition). Fluoxetine, amitriptyline, and bupropion are not typically associated with extrapyramidal side effects.

Question 7

Tardive dyskinesia is a side effect of which drug?

Accepted Answer

Tardive dyskinesia is a side effect commonly associated with long-term use of antipsychotic medications, such as chlorpromazine (Thorazine), which is a typical antipsychotic.

Question 8

Diazepam has a fast onset,with peak effect occurring in:

Accepted Answer

Diazepam has a fast onset, with peak effect occurring in 30 minutes to 2 hours.

Question 9

Sertraline (Zoloft)is usually dosed:

Accepted Answer

Sertraline (Zoloft) is typically dosed once daily, often in the morning to minimize insomnia, a common side effect.

Question 10

Which drug is a tricyclic antidepressant that is preferred in the treatment of severely depressed patients who are anxious and agitated,specifically because of its sedating effect?

Accepted Answer

Doxepin (Silenor) is a tricyclic antidepressant that has a strong sedative effect, which can be beneficial for severely depressed patients who are anxious and agitated. Protriptyline (Vivactil) is also a tricyclic antidepressant but has a stimulating effect and may actually worsen agitation and anxiety. Sertraline (Zoloft) and venlafaxine (Effexor) are selective serotonin reuptake inhibitors (SSRIs) and do not have significant sedative effects.

Question 11

Although tricyclic antidepressants (TCAs)and selective SSRIs have about the same efficacy when treating depression,TCAs:

Accepted Answer

Tricyclic antidepressants (TCAs) generally take more time to reach steady state and show clinical effectiveness compared to selective serotonin reuptake inhibitors (SSRIs). This is due to their pharmacokinetic properties and the time required to achieve therapeutic plasma concentrations.

Question 12

Patients taking nortriptyline and amitriptyline should be monitored for which of the following?

Accepted Answer

Patients taking nortriptyline and amitriptyline should be monitored for confusion because both medications are tricyclic antidepressants that can cause central nervous system side effects, including confusion. While hypertension, weight loss, and elevated liver enzymes can also occur with these medications, they are not the primary side effects that require monitoring.

Question 13

Benzodiazepines are regulated by the Controlled Substances Act as which class of medication and thus have restrictions on their prescribing?

Accepted Answer

Benzodiazepines are classified as Schedule IV controlled substances, which means they have a low to moderate potential for abuse and dependence, but still have restrictions on their prescribing. This includes limitations on refills and requiring a written, non-electronic prescription from the prescriber.

Question 14

Which selective serotonin reuptake inhibitor (SSRI)is used in the treatment of obsessive-compulsive disorder and in treating depression that is resistant to other drugs?

Accepted Answer

The answer of Which selective serotonin reuptake inhibitor (SSRI)is used...

Question 15

Although many SSRIs inhibit reuptake of serotonin at CNS neurons,this agent causes more serotonin and norepinephrine to be released.

Accepted Answer

Venlafaxine (Effexor) is a serotonin-norepinephrine reuptake inhibitor (SNRI), which means that it blocks the reuptake of both serotonin and norepinephrine in the brain. This results in increased levels of both neurotransmitters in the synaptic cleft, which can lead to improved mood and increased energy levels.

Question 16

Which drug is used in the treatment of depression but has also recently found favor as an agent in smoking cessation programs when combined with behavior modification?

Accepted Answer

Bupropion (Wellbutrin) is a drug commonly used for the treatment of depression, but it has also been found to be effective as an aid in smoking cessation programs when combined with behavior modification techniques. It works by increasing the levels of dopamine and norepinephrine in the brain, which can help to reduce the craving for nicotine. Therefore, D is the correct answer.

Question 17

Which medication requires complete blood count monitoring due to the increased risk of aplastic anemia?

Accepted Answer

Carbamazepine (Tegretol) is known to increase the risk of aplastic anemia and requires routine monitoring of complete blood counts. Aplastic anemia is a rare but serious condition where the bone marrow is unable to produce enough red blood cells, white blood cells, and platelets. This can lead to severe infections, bleeding, and fatigue. Monitoring blood counts allows for early detection and management of this serious adverse effect. Olanzapine (Zyprexa), aripiprazole (Abilify), and duloxetine (Cymbalta) do not have a known association with aplastic anemia and do not require routine blood count monitoring.

Question 18

What is lithium?

Accepted Answer

Lithium is a light alkaline metal that belongs to the alkali metal group on the periodic table. It is a monovalent cation similar in properties to sodium and potassium.

Question 19

Which statement best describes the actions of gamma-aminobutyric acid (GABA)?

Accepted Answer

Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the central nervous system (CNS) and works to decrease the activity of neurons it binds to, leading to a decrease in overall CNS activity. It is not a substance that excites a postsynaptic neuron or an emotional state, and although some medications used to treat anxiety target GABA receptors, it is not a natural substance commonly used for anxiety treatment.

Question 20

Trazodone (Desyrel)should be taken in divided doses because it can increase the concentration of which drug?

Accepted Answer

Trazodone can increase the concentration of warfarin (Coumadin) in the blood, potentially leading to an increased risk of bleeding. This interaction is significant and requires careful monitoring of warfarin levels and adjustments to its dosage as necessary when trazodone is initiated or discontinued.

Quiz 15: Practical Pharmacotherapy of Drugs Used to Treat Psychiatric Disorders

Alprazolam (Xanax) is contraindicated in a patient taking which medication?

Which of the following drugs is used to manage both positive and negative mood symptoms of schizophrenia because of the low incidence of side effects and increased safety profile over clozapine (Clozaril) ?

When starting a patient on imipramine (Tofranil) ,how long should it take for the antidepressant clinical effects to appear?