-
Question 1
Incorrect
-
A 72 year old man with a progressive history of breathlessness is brought to the emergency department by his daughter. She reports that his breathing has recently worsened. Upon diagnosis of chronic obstructive pulmonary disease, he is prescribed several new medications. However, two weeks later, he returns to the emergency department with his daughter reporting that he has stopped sleeping, become agitated, and is incessantly talking. What is the most probable cause of his new presentation?
Your Answer: Salbutamol
Correct Answer: Budesonide
Explanation:Budesonide is a type of steroid that is often administered through an inhaler to manage asthma symptoms. However, it has been noted that the use of inhaled steroids can trigger episodes of hypomania and mania. This information was reported in a study by E Brown et al. titled The psychiatric side effects of corticosteroids, which was published in the Annals of Allergy, Asthma & Immunology in 1999.
Drug-Induced Mania: Evidence and Precipitating Drugs
There is strong evidence that mania can be triggered by certain drugs, according to Peet (1995). These drugs include levodopa, corticosteroids, anabolic-androgenic steroids, and certain classes of antidepressants such as tricyclic and monoamine oxidase inhibitors.
Additionally, Peet (2012) suggests that there is weaker evidence that mania can be induced by dopaminergic anti-Parkinsonian drugs, thyroxine, iproniazid and isoniazid, sympathomimetic drugs, chloroquine, baclofen, alprazolam, captopril, amphetamine, and phencyclidine.
It is important for healthcare professionals to be aware of the potential for drug-induced mania and to monitor patients closely for any signs of symptoms. Patients should also be informed of the risks associated with these medications and advised to report any unusual changes in mood of behavior.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 2
Correct
-
Which of the following is not an anticipated side effect of methylphenidate?
Your Answer: Tinnitus
Explanation:ADHD medications can be classified into stimulant and non-stimulant drugs. The therapeutic effects of these drugs are believed to be mediated through the action of noradrenaline in the prefrontal cortex. Common side effects of these drugs include decreased appetite, insomnia, nervousness, headache, and nausea. Stimulant drugs like dexamphetamine, methylphenidate, and lisdexamfetamine inhibit the reuptake of dopamine and noradrenaline. Non-stimulant drugs like atomoxetine, guanfacine, and clonidine work by increasing noradrenaline levels in the synaptic cleft through different mechanisms. The most common side effects of these drugs are decreased appetite, somnolence, headache, and abdominal pain.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 3
Incorrect
-
An important function of hepatic metabolism is to make a drug:
Your Answer: More lipid soluble
Correct Answer: More water soluble
Explanation:Understanding Biotransformation: A Metabolic Process for Excretion
Biotransformation is a metabolic process that occurs primarily in the liver, but also in other organs such as the kidneys, intestine, adipose, skin, and lungs. Its main function is to facilitate the excretion of both exogenous and endogenous substances by altering their chemical structures through a series of reactions. Enzymes found in the cytoplasm, endoplasmic reticulum, and mitochondria of cells catalyze these reactions, which can cause the substrate to become inactive, active, of even toxic.
Biotransformation is divided into three phases. Phase I reactions involve oxidation, reduction, of hydrolysis of the drug, yielding a polar, water-soluble metabolite that is often still active. Phase II reactions consist of adding hydrophilic groups to the original molecule, a toxic intermediate, of a nontoxic metabolite formed in phase I, to increase its polarity. The most common method is conjugation with glucuronic acid, but other groups such as sulphate, amino acids, acetate, and methyl can also be added. Phase III reactions occur post-phase II, where a chemical substance can undergo further metabolism and excretion through active transport into the urinary of hepatobiliary system.
Understanding biotransformation is crucial in pharmacology and toxicology, as it affects the efficacy and toxicity of drugs and other substances. By facilitating the excretion of these substances, biotransformation helps maintain homeostasis in the body and prevent accumulation of potentially harmful compounds.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 4
Correct
-
What should be avoided for a patient who has a high level of concern about gaining weight?
Your Answer: Mirtazapine
Explanation:Non-compliance is often caused by weight gain.
Antidepressants and Weight Gain
Studies suggest that certain types of antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs), may be more likely to cause weight gain than newer antidepressants like selective serotonin reuptake inhibitors (SSRIs). However, mirtazapine, a newer antidepressant, may have a similar risk for weight gain as TCAs. Among SSRIs, paroxetine may have a higher risk for weight gain during long-term treatment compared to other SSRIs. On the other hand, bupropion and nefazodone may have a lower risk for weight gain than SSRIs in the long term.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 5
Correct
-
Which benzodiazepine has the shortest half-life?
Your Answer: Zopiclone
Explanation:The half-lives of benzodiazepines that are important to keep in mind are as follows: Diazepam has a half-life of 20-100 hours (with an active metabolite half-life of 36-200 hours), Lorazepam has a half-life of 10-20 hours, Chlordiazepoxide has a half-life of 5-30 hours (with an active metabolite half-life of 36-200 hours), and Nitrazepam has a half-life of 15-38 hours.
The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 6
Correct
-
How does bupropion work?
Your Answer: NDRI (noradrenaline dopamine reuptake inhibitor)
Explanation:Bupropion is classified as a noradrenaline dopamine reuptake inhibitor (NDRI) and functions by elevating the levels of neurotransmitters such as noradrenaline and dopamine. It has been utilized as an antidepressant and a smoking cessation aid.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 7
Correct
-
Which of the options has the lowest degree of first pass effect association?
Your Answer: Lithium
Explanation:The First Pass Effect in Psychiatric Drugs
The first-pass effect is a process in drug metabolism that significantly reduces the concentration of a drug before it reaches the systemic circulation. This phenomenon is related to the liver and gut wall, which absorb and metabolize the drug before it can enter the bloodstream. Psychiatric drugs are not exempt from this effect, and some undergo a significant reduction in concentration before reaching their target site. Examples of psychiatric drugs that undergo a significant first-pass effect include imipramine, fluphenazine, morphine, diazepam, and buprenorphine. On the other hand, some drugs undergo little to no first-pass effect, such as lithium and pregabalin.
Orally administered drugs are the most affected by the first-pass effect. However, there are other routes of administration that can avoid of partly avoid this effect. These include sublingual, rectal (partly avoids first pass), intravenous, intramuscular, transdermal, and inhalation. Understanding the first-pass effect is crucial in drug development and administration, especially in psychiatric drugs, where the concentration of the drug can significantly affect its efficacy and safety.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 8
Correct
-
For a 45-year-old man who has not seen improvement with two different antidepressants, what combination of medications would you recommend?
Your Answer: Mirtazapine and sertraline
Explanation:The cautious use of combined antidepressants can be considered for depression management, taking into account their mechanism of action. NICE suggests the combination of mirtazapine and SSRI for treatment-resistant depression. However, other combinations should be avoided due to the risk of interaction.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 9
Correct
-
Antipsychotic drugs are known to cause hypotension, and it is believed that this effect is mediated by a specific type of receptor. Which receptor is thought to be responsible for this?
Your Answer: Alpha 1
Explanation:Postural hypotension is a known side effect of alpha-1-blockade.
Antipsychotics: Common Side Effects and Relative Adverse Effects
Antipsychotics are medications used to treat various mental health conditions, including schizophrenia and bipolar disorder. However, they can also cause side effects that can be bothersome of even serious. The most common side effects of antipsychotics are listed in the table below, which includes the adverse effects associated with their receptor activity.
Antidopaminergic effects: These effects are related to the medication’s ability to block dopamine receptors in the brain. They can cause galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, and tardive dyskinesia.
Anticholinergic effects: These effects are related to the medication’s ability to block acetylcholine receptors in the brain. They can cause dry mouth, blurred vision, urinary retention, and constipation.
Antiadrenergic effects: These effects are related to the medication’s ability to block adrenaline receptors in the body. They can cause postural hypotension and ejaculatory failure.
Histaminergic effects: These effects are related to the medication’s ability to block histamine receptors in the brain. They can cause drowsiness.
The Maudsley Guidelines provide a rough guide to the relative adverse effects of different antipsychotics. The table below summarizes their findings, with +++ indicating a high incidence of adverse effects, ++ indicating a moderate incidence, + indicating a low incidence, and – indicating a very low incidence.
Drug Sedation Weight gain Diabetes EPSE Anticholinergic Postural Hypotension Prolactin elevation
Amisulpride – + + + – – +++
Aripiprazole – +/- – +/- – – –
Asenapine + + +/- +/- – – +/-
Clozapine +++ +++ +++ – +++ +++ –
Flupentixol + ++ + ++ ++ + +++
Fluphenazine + + + +++ ++ + +++
Haloperidol + + +/- +++ + + +++
Olanzapine ++ +++ +++ +/- + + +
Paliperidone + ++ + + + ++ +++
Pimozide + + – + + + +++
Quetiapine ++ ++ ++ – + ++ –
Risperidone + ++ + + + ++ +++
Zuclopenthixol ++ ++ + ++ ++ + +++Overall, it is important to discuss the potential side effects of antipsychotics with a healthcare provider and to monitor for any adverse effects while taking these medications.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 10
Incorrect
-
What is a known factor that can increase the risk of QTc prolongation?
Your Answer: Hypothyroidism
Correct Answer: Anorexia nervosa
Explanation:Amantadine and QTc Prolongation
Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 11
Incorrect
-
What is the primary metabolic pathway for benzodiazepines?
Your Answer: CYP17A1
Correct Answer: CYP3A4
Explanation:CYP3A4 is responsible for metabolizing the majority of benzodiazepines in the liver.
Benzodiazepines: Effective but Addictive
Benzodiazepines are a class of drugs that are commonly used to treat anxiety. They are divided into two categories: hypnotics, which have a short half-life, and anxiolytics, which have a long half-life. While they can be effective in reducing anxiety symptoms, they are also highly addictive and should not be prescribed for more than one month at a time.
Benzodiazepines are particularly effective as hypnotics, but they do have some negative effects on sleep. They suppress REM sleep, and when they are discontinued, a rebound effect is often seen. This means that people may experience more vivid dreams and nightmares when they stop taking the medication. It is important for doctors to carefully monitor patients who are taking benzodiazepines to ensure that they are not becoming addicted and that they are not experiencing any negative side effects.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 12
Incorrect
-
Which of the following is not a way in which galantamine works?
Your Answer: Increased availability of acetylcholine
Correct Answer: Inhibits butyrylcholinesterase
Explanation:In the treatment of Alzheimer’s disease, acetylcholinesterase inhibitors such as galantamine are utilized to enhance central acetylcholine levels. Although they share this common mechanism of action, there are variations in how they function. Unlike galantamine, rivastigmine has the ability to inhibit butyrylcholinesterase.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 13
Incorrect
-
What is the accurate definition of drug clearance?
Your Answer: The total amount of drug that is removed from the plasma in a specified time period
Correct Answer: The volume of plasma cleared of a drug over a specified time period
Explanation:Drug Clearance: Understanding the Rate of Drug Removal from the Body
Drug clearance refers to the efficiency of drug removal from the plasma, and is measured as the volume of plasma cleared of a drug over a specific time period. The unit of measurement for drug clearance is volume per time. Clearance of a drug involves both metabolism and excretion. When drug intake equals clearance, it is referred to as a steady state, which is usually achieved by 4.5 half-lives. The time taken to reach steady state depends on the half-life of the drug.
There are two main types of clearance: hepatic and renal. Hepatic clearance involves the conversion of the parent drug into a different chemical entity by the liver enzymes, while renal clearance involves the removal of the drug from the plasma into the urine. The clearance of a drug can take one of two forms: zero and first-order kinetics. In zero-order reactions, the clearance of a drug is constant and not related to the concentration of the drug in the plasma. This type of reaction is typically found when the material needed for the reaction to proceed (e.g. enzyme) is saturated. Ethanol and Phenytoin are good examples of this.
Most drugs tend to follow first-order reactions, where the clearance is related to the concentration of the drug in the plasma. The half-life of a drug is the time taken for its concentration to fall by half. In first-order reactions, this is constant. In zero-order reactions, it gets progressively shorter.
It is important to note that elimination and clearance are not the same. Elimination is the irreversible removal of the drug from the body, while clearance is a theoretical volume of blood that is cleared of the drug per unit of time, which is independent of the drug dose of concentration. Understanding drug clearance is crucial in determining the appropriate dosing regimen for a drug.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 14
Incorrect
-
What is true about hyponatremia caused by antidepressants?
Your Answer: TCAs are associated with a greater risk of hyponatremia than SSRIs
Correct Answer: Onset is usually within 30 days of starting treatment
Explanation:Hyponatremia is commonly linked to the use of SSRIs (antidepressants) and typical antipsychotics.
Hyponatremia in Psychiatric Patients
Hyponatremia, of low serum sodium, can occur in psychiatric patients due to the disorder itself, its treatment, of other medical conditions. Symptoms include nausea, confusion, seizures, and muscular cramps. Drug-induced hyponatremia is known as the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), which results from excessive secretion of ADH and fluid overload. Diagnosis is based on clinically euvolemic state with low serum sodium and osmolality, raised urine sodium and osmolality. SSRIs, SNRIs, and tricyclics are the most common drugs that can cause SIADH. Risk factors for SIADH include starting a new drug, and treatment usually involves fluid restriction and sometimes demeclocycline.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 15
Correct
-
A client who needs to begin taking an antipsychotic expresses worry about the potential for weight gain. They inquire about which antipsychotic is linked to the highest amount of weight gain. What would you say in response?
Your Answer: Clozapine
Explanation:Antipsychotic drugs are known to cause weight gain, but some more than others. The reason for this is not due to a direct metabolic effect, but rather an increase in appetite and a decrease in activity levels. The risk of weight gain appears to be linked to clinical response. There are several suggested mechanisms for this, including antagonism of certain receptors and hormones that stimulate appetite. The risk of weight gain varies among different antipsychotics, with clozapine and olanzapine having the highest risk. Management strategies for antipsychotic-induced weight gain include calorie restriction, low glycemic index diet, exercise, and switching to an alternative antipsychotic. Aripiprazole, ziprasidone, and lurasidone are recommended as alternative options. Other options include aripiprazole augmentation, metformin, orlistat, liraglutide, and topiramate.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 16
Incorrect
-
What is the presumed cause of the sexual dysfunction associated with SSRIs?
Your Answer: 5-HT3 agonism
Correct Answer: 5-HT2 agonism
Explanation:The inhibition of sexual behavior is caused by the activation of 5-HT2 receptors. However, this effect can be reversed by using 5-HT2 antagonists like cyproheptadine and 5-HT1a agonists like buspirone. These drugs are effective in treating sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs).
Antidepressants can cause sexual dysfunction as a side-effect, although the rates vary. The impact on sexual desire, arousal, and orgasm can differ depending on the type of antidepressant. It is important to rule out other causes and consider non-pharmacological strategies such as reducing the dosage of taking drug holidays. If necessary, switching to a lower risk antidepressant of using pharmacological options such as phosphodiesterase inhibitors of mirtazapine augmentation can be considered. The Maudsley Guidelines 14th Edition provides a helpful table outlining the risk of sexual dysfunction for different antidepressants.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 17
Correct
-
Which is the accurate half-life of donepezil?
Your Answer: 70 hours
Explanation:Without prior knowledge, it would be difficult to accurately answer this question. However, one could make an educated guess by eliminating the options of 5, 9, and: and narrowing down the possible answers.
Pharmacological management of dementia involves the use of acetylcholinesterase inhibitors (AChE inhibitors) and memantine. AChE inhibitors prevent the breakdown of acetylcholine, which is deficient in Alzheimer’s due to the loss of cholinergic neurons. Donepezil, galantamine, and rivastigmine are commonly used AChE inhibitors in the management of Alzheimer’s. However, gastrointestinal side effects such as nausea and vomiting are common with these drugs.
Memantine, on the other hand, is an NMDA receptor antagonist that blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction. It has a half-life of 60-100 hours and is primarily renally eliminated. Common adverse effects of memantine include somnolence, dizziness, hypertension, dyspnea, constipation, headache, and elevated liver function tests.
Overall, pharmacological management of dementia aims to improve cognitive function and slow down the progression of the disease. However, it is important to note that these drugs do not cure dementia and may only provide temporary relief of symptoms.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 18
Correct
-
Which of the following is not a side-effect related to the extrapyramidal system?
Your Answer: Myoclonus
Explanation:Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 19
Incorrect
-
Which medications have the potential to reduce the contraceptive effect of oral contraceptives?
Your Answer: Amitriptyline
Correct Answer: St John's Wort
Explanation:Out of the given options, only St John’s Wort is explicitly stated in the interactions section of the BNF as causing a decrease in contraceptive effectiveness. While tricyclic antidepressants are also mentioned, the BNF notes that their impact may be on the effectiveness of the antidepressant rather than the contraceptive.
Interactions with Oral Contraceptives
Psychiatric drugs such as St John’s Wort, Carbamazepine, Phenytoin, Topiramate, and Barbiturates can interact with oral contraceptives and lead to a reduced contraceptive effect. It is important to be aware of these potential interactions to ensure the effectiveness of oral contraceptives.
-
This question is part of the following fields:
- Psychopharmacology
-
-
Question 20
Correct
-
A 45-year-old woman taking medication for her depression experiences dry mouth and blurred vision. Which psychotropic medication is most likely causing these side effects?
Your Answer: Amitriptyline
Explanation:Anticholinergic side effects, such as dry mouth, urinary retention, and dry skin, are commonly associated with Amitriptyline and other tricyclic antidepressants.
-
This question is part of the following fields:
- Psychopharmacology
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)