Question 1

The tricyclic antidepressant class of medications can be characterized by all of the following properties except

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?

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?

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

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

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

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

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?

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

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

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?

Accepted Answer

Antidepressants can sometimes trigger manic or hypomanic episodes in patients with bipolar disorder, so they should be used cautiously and only under close supervision. Patients with major depression with atypical features, adjustment disorder with depression, and dysthymia may benefit from antidepressant treatment without such concerns.

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

Accepted Answer

The AIMS (Abnormal Involuntary Movement Scale) is a widely used tool for monitoring the development and severity of extrapyramidal side effects in patients receiving long-term use of antipsychotics. The scale assesses abnormal involuntary movements, such as tremors, dyskinesia, and dystonia, which are commonly associated with antipsychotic use. The other scales mentioned, Beck's inventory scale, Ham-D scale, and Zung scale, are not specific to detecting EPS symptoms and are not the most commonly used screeners in this context.

Question 13

The older typical antipsychotic medications would be expected to be most effective for which of the following target symptoms?

Accepted Answer

Typical antipsychotic medications are most effective for treating positive symptoms of schizophrenia, such as hallucinations and delusions. They are less effective for treating negative symptoms like social isolation, apathy, and lack of motivation.

Question 14

Among the following statements, which best describes the action of older typical antipsychotic medications such as Haldol?

Accepted Answer

Older typical antipsychotic medications such as Haldol primarily work by blocking dopamine receptors in all four dopamine pathways. This leads to a decrease in dopamine activity, which can help alleviate symptoms of psychosis and schizophrenia.

Quiz 6: Psychopharmacotherapy