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  • Question 1 - Which statement accurately describes interactions involving chlorpromazine? ...

    Incorrect

    • Which statement accurately describes interactions involving chlorpromazine?

      Your Answer: Valproic acid increases the serum concentration of chlorpromazine

      Correct Answer: Chlorpromazine increases the serum concentration of valproic acid

      Explanation:

      The serum concentration of valproic acid may be elevated by chlorpromazine, although the reason for this is not fully understood. However, this outcome is widely acknowledged.

      Chlorpromazine: Photosensitivity Reactions and Patient Precautions

      Chlorpromazine, the first drug used for psychosis, is a common topic in exams. However, it is important to note that photosensitivity reactions are a known side effect of its use. Patients taking chlorpromazine should be informed of this and advised to take necessary precautions. Proper education and awareness can help prevent potential harm from photosensitivity reactions.

    • This question is part of the following fields:

      • Psychopharmacology
      14
      Seconds
  • Question 2 - Which option is considered to have the lowest risk of causing damage to...

    Incorrect

    • Which option is considered to have the lowest risk of causing damage to the heart?

      Your Answer: Imipramine

      Correct Answer: Lofepramine

      Explanation:

      Among the tricyclic antidepressants, Lofepramine has the lowest potential for causing cardiotoxicity.

      Antidepressants and Their Cardiac Effects

      SSRIs are generally recommended for patients with cardiac disease as they may protect against myocardial infarction (MI). Untreated depression worsens prognosis in cardiovascular disease. Post MI, SSRIs and mirtazapine have either a neutral of beneficial effect on mortality. Sertraline is recommended post MI, but other SSRIs and mirtazapine are also likely to be safe. However, citalopram is associated with Torsades de pointes (mainly in overdose). Bupropion, citalopram, escitalopram, moclobemide, lofepramine, and venlafaxine should be used with caution of avoided in those at risk of serious arrhythmia (those with heart failure, left ventricular hypertrophy, previous arrhythmia, of MI).

      Tricyclic antidepressants (TCAs) have established arrhythmogenic activity which arises as a result of potent blockade of cardiac sodium channels and variable activity at potassium channels. ECG changes produced include PR, QRS, and QT prolongation and the Brugada syndrome. Lofepramine is less cardiotoxic than other TCAs and seems to lack the overdose arrhythmogenicity of other TCAs. QT changes are not usually seen at normal clinical doses of antidepressants (but can occur, particularly with citalopram/escitalopram). The arrhythmogenic potential of TCAs and other antidepressants is dose-related.

      Overall, SSRIs are recommended for patients with cardiac disease, while caution should be exercised when prescribing TCAs and other antidepressants, especially in those at risk of serious arrhythmia. It is important to monitor patients closely for any cardiac effects when prescribing antidepressants.

    • This question is part of the following fields:

      • Psychopharmacology
      17.2
      Seconds
  • Question 3 - Which atypical antipsychotic has the lowest likelihood of causing weight gain? ...

    Correct

    • Which atypical antipsychotic has the lowest likelihood of causing weight gain?

      Your Answer: Aripiprazole

      Explanation:

      Weight gain is a common side effect of antipsychotic medications, which may be caused by various mechanisms such as 5HT2c and H1 antagonism, hyperprolactinaemia, and increased serum leptin. This weight gain is often due to increased food intake and reduced energy expenditure. Additionally, antipsychotic-induced weight gain can lead to diabetes mellitus, with females being more susceptible to metabolic side effects than males. Among antipsychotics, clozapine and olanzapine have the highest risk of weight gain, while quetiapine and risperidone have a moderate risk. On the other hand, aripiprazole, asenapine, and amisulpride (the 3 As) are associated with the least amount of weight gain.

    • This question is part of the following fields:

      • Psychopharmacology
      6
      Seconds
  • Question 4 - Which of the following is not a known adverse effect of valproate? ...

    Correct

    • Which of the following is not a known adverse effect of valproate?

      Your Answer: Weight loss

      Explanation:

      Valproate can cause weight gain, which is particularly concerning when it is combined with other medications like clozapine.

      Valproate: Forms, Doses, and Adverse Effects

      Valproate comes in three forms: semi-sodium valproate, valproic acid, and sodium valproate. Semi-sodium valproate is a mix of sodium valproate and valproic acid and is licensed for acute mania associated with bipolar disorder. Valproic acid is also licensed for acute mania, but this is not consistent with the Maudsley Guidelines. Sodium valproate is licensed for epilepsy. It is important to note that doses of sodium valproate and semi-sodium valproate are not the same, with a slightly higher dose required for sodium valproate.

      Valproate is associated with many adverse effects, including nausea, tremor, liver injury, vomiting/diarrhea, gingival hyperplasia, memory impairment/confusional state, somnolence, weight gain, anaemia/thrombocytopenia, alopecia (with curly regrowth), severe liver damage, and pancreatitis. Increased liver enzymes are common, particularly at the beginning of therapy, and tend to be transient. Vomiting and diarrhea tend to occur at the start of treatment and remit after a few days. Severe liver damage is most likely to occur in the first six months of therapy, with the maximum risk being between two and twelve weeks. The risk also declines with advancing age.

      Valproate is a teratogen and should not be initiated in women of childbearing potential. Approximately 10% of children exposed to valproate monotherapy during pregnancy suffer from congenital malformations, with the risk being dose-dependent. The most common malformations are neural tube defects, facial dysmorphism, cleft lip and palate, craniostenosis, cardiac, renal and urogenital defects, and limb defects. There is also a dose-dependent relationship between valproate and developmental delay, with approximately 30-40% of children exposed in utero experiencing delay in their early development, such as talking and walking later, lower intellectual abilities, poor language skills, and memory problems. There is also a thought to be a 3-fold increase of autism in children exposed in utero.

    • This question is part of the following fields:

      • Psychopharmacology
      4.2
      Seconds
  • Question 5 - Regarding clozapine, which class of receptors does not experience any impact? ...

    Correct

    • Regarding clozapine, which class of receptors does not experience any impact?

      Your Answer: Glutamatergic

      Explanation:

      Clozapine is an atypical antipsychotic drug that acts as an antagonist at various receptors, including dopamine, histamine, serotonin, adrenergic, and cholinergic receptors. It is mainly metabolized by CYP1A2, and its plasma levels can be affected by inducers and inhibitors of this enzyme. Clozapine is associated with several side effects, including drowsiness, constipation, weight gain, and hypersalivation. Hypersalivation is a paradoxical side effect, and its mechanism is not fully understood, but it may involve clozapine agonist activity at the muscarinic M4 receptor and antagonist activity at the alpha-2 adrenoceptor. Clozapine is also associated with several potentially dangerous adverse events, including agranulocytosis, myocarditis, seizures, severe orthostatic hypotension, increased mortality in elderly patients with dementia-related psychosis, colitis, pancreatitis, thrombocytopenia, thromboembolism, and insulin resistance and diabetes mellitus. The BNF advises caution in using clozapine in patients with prostatic hypertrophy, susceptibility to angle-closure glaucoma, and adults over 60 years. Valproate should be considered when using high doses of clozapine, plasma levels > 0.5 mg/l, of when the patient experiences seizures. Myocarditis is a rare but potentially fatal adverse event associated with clozapine use, and its diagnosis is based on biomarkers and clinical features. The mortality rate of clozapine-induced myocarditis is high, and subsequent use of clozapine in such cases leads to recurrence of myocarditis in most cases.

    • This question is part of the following fields:

      • Psychopharmacology
      9.6
      Seconds
  • Question 6 - How can a dosette box help the elderly gentleman remember to take his...

    Incorrect

    • How can a dosette box help the elderly gentleman remember to take his medication?

      Your Answer: Lithium

      Correct Answer: Mirtazapine

      Explanation:

      Drug Stability

      The stability of drugs can vary greatly, with some medications being unable to be included in compliance aids due to their susceptibility to environmental factors. Certain drugs have a tendency to absorb moisture from the air, rendering them ineffective, with light known to accelerate this process. Examples of drugs that are unsuitable for compliance aids due to their susceptibility to environmental factors include Sodium valproate, Zopiclone, Venlafaxine, Topiramate, Methylphenidate, Mirtazapine, Olanzapine, Amisulpride, and Aripiprazole.

    • This question is part of the following fields:

      • Psychopharmacology
      22.4
      Seconds
  • Question 7 - A 35-year-old man with treatment-resistant depression has been prescribed tranylcypromine, the only class...

    Incorrect

    • A 35-year-old man with treatment-resistant depression has been prescribed tranylcypromine, the only class of antidepressants he has not yet tried. What dietary restriction should he follow to prevent a hypertensive crisis?

      Your Answer: Ricotta cheese

      Correct Answer: Broad bean pods

      Explanation:

      When monoamine oxidase inhibitors (MAOIs) are present, the enzyme that breaks down norepinephrine is inhibited. This can lead to a hypertensive crisis if a high tyramine meal is consumed. Broad bean pods contain tyramine, which increases the release of norepinephrine. Therefore, it is important to avoid certain foods when taking MAOIs, including dried, aged, smoked, fermented, spoiled of improperly stored meat, poultry and fish, aged cheese, tap and unpasteurized beers, Marmite, and soy products.

    • This question is part of the following fields:

      • Psychopharmacology
      14.5
      Seconds
  • Question 8 - What substance acts on the alpha-2-delta subunit of voltage-gated calcium channels in the...

    Incorrect

    • What substance acts on the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system to produce its effects?

      Your Answer: Topiramate

      Correct Answer: Pregabalin

      Explanation:

      Mechanisms of Action of Different Drugs

      Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.

    • This question is part of the following fields:

      • Psychopharmacology
      20.1
      Seconds
  • Question 9 - What is a true statement about drugs utilized for treating dementia? ...

    Incorrect

    • What is a true statement about drugs utilized for treating dementia?

      Your Answer: Galantamine blocks the effects of elevated levels of glutamate

      Correct Answer: Rivastigmine inhibits butyrylcholinesterase

      Explanation:

      Rivastigmine has the ability to inhibit both AChE and butyrylcholinesterase, while Donepezil is specifically a reversible inhibitor of AChE.

      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
      25.7
      Seconds
  • Question 10 - A client complains of feeling ill after abruptly discontinuing paroxetine. What symptom is...

    Incorrect

    • A client complains of feeling ill after abruptly discontinuing paroxetine. What symptom is most indicative of discontinuation syndrome associated with selective serotonin reuptake inhibitors?

      Your Answer: Myoclonic jerks

      Correct Answer: Diarrhoea

      Explanation:

      Discontinuation syndrome of selective serotonin reuptake inhibitors may manifest with diverse symptoms such as abdominal pain, vomiting, and diarrhea.

      Antidepressants can cause discontinuation symptoms when patients stop taking them, regardless of the type of antidepressant. These symptoms usually occur within 5 days of stopping the medication and can last up to 3 weeks. Symptoms include flu-like symptoms, dizziness, insomnia, vivid dreams, irritability, crying spells, and sensory symptoms. SSRIs and related drugs with short half-lives, such as paroxetine and venlafaxine, are particularly associated with discontinuation symptoms. Tapering antidepressants at the end of treatment is recommended to prevent these symptoms. TCAs and MAOIs are also associated with discontinuation symptoms, with amitriptyline and imipramine being the most common TCAs and all MAOIs being associated with prominent discontinuation symptoms. Patients at highest risk for discontinuation symptoms include those on antidepressants with shorter half-lives, those who have been taking antidepressants for 8 weeks of longer, those using higher doses, younger people, and those who have experienced discontinuation symptoms before. Agomelatine is not associated with any discontinuation syndrome. If a discontinuation reaction occurs, restarting the antidepressant of switching to an alternative with a longer half-life and tapering more slowly may be necessary. Explanation and reassurance are often sufficient for mild symptoms. These guidelines are based on the Maudsley Guidelines 14th Edition and a study by Tint (2008).

    • This question is part of the following fields:

      • Psychopharmacology
      26.7
      Seconds
  • Question 11 - What is an example of an atypical antipsychotic medication? ...

    Correct

    • What is an example of an atypical antipsychotic medication?

      Your Answer: Clozapine

      Explanation:

      Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.

    • This question is part of the following fields:

      • Psychopharmacology
      4.3
      Seconds
  • Question 12 - What is the most specific biomarker for myocarditis? ...

    Correct

    • What is the most specific biomarker for myocarditis?

      Your Answer: Troponin I

      Explanation:

      Elevated troponin levels typically manifest within a few hours of myocardial injury and persist for a maximum of two weeks.

      Clozapine is an atypical antipsychotic drug that acts as an antagonist at various receptors, including dopamine, histamine, serotonin, adrenergic, and cholinergic receptors. It is mainly metabolized by CYP1A2, and its plasma levels can be affected by inducers and inhibitors of this enzyme. Clozapine is associated with several side effects, including drowsiness, constipation, weight gain, and hypersalivation. Hypersalivation is a paradoxical side effect, and its mechanism is not fully understood, but it may involve clozapine agonist activity at the muscarinic M4 receptor and antagonist activity at the alpha-2 adrenoceptor. Clozapine is also associated with several potentially dangerous adverse events, including agranulocytosis, myocarditis, seizures, severe orthostatic hypotension, increased mortality in elderly patients with dementia-related psychosis, colitis, pancreatitis, thrombocytopenia, thromboembolism, and insulin resistance and diabetes mellitus. The BNF advises caution in using clozapine in patients with prostatic hypertrophy, susceptibility to angle-closure glaucoma, and adults over 60 years. Valproate should be considered when using high doses of clozapine, plasma levels > 0.5 mg/l, of when the patient experiences seizures. Myocarditis is a rare but potentially fatal adverse event associated with clozapine use, and its diagnosis is based on biomarkers and clinical features. The mortality rate of clozapine-induced myocarditis is high, and subsequent use of clozapine in such cases leads to recurrence of myocarditis in most cases.

    • This question is part of the following fields:

      • Psychopharmacology
      5.9
      Seconds
  • Question 13 - What is a licensed treatment for PTSD? ...

    Correct

    • What is a licensed treatment for PTSD?

      Your Answer: Sertraline

      Explanation:

      While NICE recommends mirtazapine for the treatment of PTSD, its license only permits its use for major depression.

      Antidepressants (Licensed Indications)

      The following table outlines the specific licensed indications for antidepressants in adults, as per the Maudsley Guidelines and the British National Formulary. It is important to note that all antidepressants are indicated for depression.

      – Nocturnal enuresis in children: Amitriptyline, Imipramine, Nortriptyline
      – Phobic and obsessional states: Clomipramine
      – Adjunctive treatment of cataplexy associated with narcolepsy: Clomipramine
      – Panic disorder and agoraphobia: Citalopram, Escitalopram, Sertraline, Paroxetine, Venlafaxine
      – Social anxiety/phobia: Escitalopram, Paroxetine, Sertraline, Moclobemide, Venlafaxine
      – Generalised anxiety disorder: Escitalopram, Paroxetine, Duloxetine, Venlafaxine
      – OCD: Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Clomipramine
      – Bulimia nervosa: Fluoxetine
      – PTSD: Paroxetine, Sertraline

    • This question is part of the following fields:

      • Psychopharmacology
      4.1
      Seconds
  • Question 14 - What is a true statement about valproate? ...

    Correct

    • What is a true statement about valproate?

      Your Answer: The risk of congenital malformations is dose dependent

      Explanation:

      Valproate can pass through the placenta, increasing the likelihood of birth defects. The extent of risk during pregnancy is not fully understood, but it is believed to be influenced by the dosage. Children who were exposed to valproate in the womb may have a lower IQ, with those aged 6 showing an average decrease of 7-10 points compared to those exposed to other antiepileptic medications.

      Valproate: Forms, Doses, and Adverse Effects

      Valproate comes in three forms: semi-sodium valproate, valproic acid, and sodium valproate. Semi-sodium valproate is a mix of sodium valproate and valproic acid and is licensed for acute mania associated with bipolar disorder. Valproic acid is also licensed for acute mania, but this is not consistent with the Maudsley Guidelines. Sodium valproate is licensed for epilepsy. It is important to note that doses of sodium valproate and semi-sodium valproate are not the same, with a slightly higher dose required for sodium valproate.

      Valproate is associated with many adverse effects, including nausea, tremor, liver injury, vomiting/diarrhea, gingival hyperplasia, memory impairment/confusional state, somnolence, weight gain, anaemia/thrombocytopenia, alopecia (with curly regrowth), severe liver damage, and pancreatitis. Increased liver enzymes are common, particularly at the beginning of therapy, and tend to be transient. Vomiting and diarrhea tend to occur at the start of treatment and remit after a few days. Severe liver damage is most likely to occur in the first six months of therapy, with the maximum risk being between two and twelve weeks. The risk also declines with advancing age.

      Valproate is a teratogen and should not be initiated in women of childbearing potential. Approximately 10% of children exposed to valproate monotherapy during pregnancy suffer from congenital malformations, with the risk being dose-dependent. The most common malformations are neural tube defects, facial dysmorphism, cleft lip and palate, craniostenosis, cardiac, renal and urogenital defects, and limb defects. There is also a dose-dependent relationship between valproate and developmental delay, with approximately 30-40% of children exposed in utero experiencing delay in their early development, such as talking and walking later, lower intellectual abilities, poor language skills, and memory problems. There is also a thought to be a 3-fold increase of autism in children exposed in utero.

    • This question is part of the following fields:

      • Psychopharmacology
      32.8
      Seconds
  • Question 15 - What is the estimated rate of adherence to prescribed medications across all age...

    Incorrect

    • What is the estimated rate of adherence to prescribed medications across all age groups and medication types?

      Your Answer: 66%

      Correct Answer: 50%

      Explanation:

      Across all medical specialties, it is typical for patients to take less than half of their prescribed doses of self-administered medications, indicating low adherence rates that have been shown to be around 50%.

    • This question is part of the following fields:

      • Psychopharmacology
      5.3
      Seconds
  • Question 16 - What is the mechanism of action of sildenafil? ...

    Correct

    • What is the mechanism of action of sildenafil?

      Your Answer: Inhibition of phosphodiesterase

      Explanation:

      Nitrous oxide functions as a vasodilator during penile erection by diffusing through the muscle cell membrane and binding to guanylyl cyclase. This enzyme catalyzes the conversion of GTP to cyclic GMP, which activates a cGMP-dependent protein kinase. This kinase stimulates the uptake of calcium by the endoplasmic reticulum of the muscle cell, leading to muscle relaxation and vasodilation, resulting in an erection.

      To end the erection, cGMP is converted into GMP by a specific phosphodiesterase (PDE). There are ten families of PDEs, with PDE5 being the primary PDE found in vascular smooth muscle. Sildenafil (Viagra) is a specific inhibitor of PDE5, blocking the breakdown of cGMP and prolonging the effects of cGMP, thereby prolonging the erection.

      Mechanisms of Action of Different Drugs

      Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.

    • This question is part of the following fields:

      • Psychopharmacology
      6.7
      Seconds
  • Question 17 - What is a true statement about the QTc interval? ...

    Correct

    • What is a true statement about the QTc interval?

      Your Answer: The Bazett formula over corrects the QTc at heart rates > 100 bpm

      Explanation:

      To obtain an accurate measurement of the QT interval, it is recommended to measure it in lead II of leads V5-6. The Bazett formula may not provide accurate corrections for heart rates above 100 bpm of below 60 bpm, but it can be used to estimate the QT interval at a standard heart rate of 60 bpm through the corrected QT interval (QTc).

      QTc Prolongation: Risks and Identification

      The QT interval is a measure of the time it takes for the ventricles to repolarize and is calculated from the beginning of the QRS complex to the end of the T wave. However, the QT interval varies with the heart rate, making it difficult to use a single number as a cut-off for a prolonged QT. Instead, a corrected QT interval (QTc) is calculated for each heart rate using various formulas. A QTc over the 99th percentile is considered abnormally prolonged, with approximate values of 470 ms for males and 480 ms for females.

      Prolonged QT intervals can lead to torsade de pointes (TdP), a polymorphic ventricular tachycardia that can be fatal if it degenerates into ventricular fibrillation. TdP is characterized by a twisting of the QRS complexes around an isoelectric line and is often asymptomatic but can also be associated with syncope and death. An accurate diagnosis requires an ECG to be recorded during the event. It is important to note that an increase in the QT interval due to a new conduction block should not be considered indicative of acquired LQTS and risk for TdP.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 18 - A patient with no significant psychiatric history develops an unexpected episode of mania...

    Correct

    • A patient with no significant psychiatric history develops an unexpected episode of mania at the age of 50. When you are admitting her it comes to your attention that she has recently been started on a number of new medications. Which of the following would be most likely to precipitate an episode of mania?

      Your Answer: Prednisolone

      Explanation:

      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
      21.8
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  • Question 19 - What is the estimated volume in which a drug is distributed throughout the...

    Correct

    • What is the estimated volume in which a drug is distributed throughout the body based on the plasma concentration of 0.1 mg/L after administering a 50 mg dose?

      Your Answer: 500 L

      Explanation:

      The voltage drop (Vd) is equal to the ratio of the applied voltage (A) to the circuit resistance (C). Therefore, in this case, Vd is equal to 500 volts, as calculated by dividing 50 volts by 0.1 ohms.

      Understanding the Volume of Distribution in Pharmacology

      The volume of distribution (Vd) is a crucial concept in pharmacology that helps determine how a drug distributes in the body. It is also known as the apparent volume of distribution, as it is an abstract volume. The Vd indicates whether a drug concentrates in the plasma of spreads out in the body. Drugs that are highly polar tend to stay in central compartments such as the plasma, resulting in a low Vd. Conversely, drugs that are more lipid-soluble are distributed widely, such as in fat, resulting in a high Vd.

      The Vd is calculated by dividing the amount of drug in the body by the concentration in the plasma. Clinically, the Vd is used to determine the loading dose of a drug required for a desired blood concentration and to estimate blood concentration in the treatment of overdose. The units of Vd are in volume.

      The apparent volume of distribution is dependent on the drug’s lipid of water solubility, plasma protein binding, and tissue binding. Plasma protein binding affects the Vd, as drugs that bind to plasma proteins like albumin have a smaller apparent volume of distribution. This is because they are extracted from plasma and included in drug concentration measurements, which can give a misleading impression of their volume of distribution. Understanding the Vd is essential in pharmacology to ensure the safe and effective use of drugs.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 20 - Which of the following is most strongly linked to delirium? ...

    Correct

    • Which of the following is most strongly linked to delirium?

      Your Answer: Pethidine

      Explanation:

      Prescribing in the Elderly: Iatrogenic Consequences

      Many medications, both prescribed and over-the-counter, can have significant adverse effects in the elderly population. It is important to note that the lists provided below are not exhaustive, and only the most common and important examples are given.

      Medications Linked to Delirium and Other Cognitive Disorders

      Medications are the most common reversible cause of delirium and dementia in the elderly. Many medications can cause cognitive impairment, but the classes of drugs most strongly associated with the development of drug-induced dementia are opioids, benzodiazepines, and anticholinergics.

      According to a systematic review done in 2011 (Clegg, 2011), long-acting benzodiazepines (e.g., diazepam) are more troublesome than those that are shorter-acting. Opioids are associated with an approximately 2-fold increased risk of delirium in medical and surgical patients (Clegg, 2011). Pethidine appears to have a higher risk of delirium compared with other members of the opioid class. This may be because pethidine can accumulate when renal function is impaired and is converted to a metabolite with anticholinergic properties.

      Some antipsychotic drugs have considerable antimuscarinic (anticholinergic) activity (e.g., chlorpromazine and clozapine), which may cause of worsen delirium. Delirium is uncommon in newer antipsychotics (but has been reported).

      Medications Linked to Mood Changes

      The following medications are well known to precipitate mood changes:

      – Centrally-acting antihypertensives (e.g., methyldopa, reserpine, and clonidine) can cause depressive symptoms.
      – Interferon-a is capable of inducing depressive symptoms.
      – Digoxin is capable of inducing depressive symptoms.
      – Corticosteroids can cause depressive, manic, and mixed symptoms with of without psychosis.
      – Antidepressants can precipitate mania.

      Medications Linked to Psychosis

      The following medications are well known to precipitate psychosis:

      – Anti-Parkinson’s Medications (e.g., bromocriptine, amantadine, selegiline, anticholinergics (e.g., trihexyphenidyl, benztropine, benzhexol), and levodopa).
      – Corticosteroids

      Medications Linked to Anxiety

      The following medications are well known to precipitate anxiety:

      – Stimulants
      – β adrenergic inhalers

    • This question is part of the following fields:

      • Psychopharmacology
      4.4
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  • Question 21 - What is a true statement about pregabalin? ...

    Incorrect

    • What is a true statement about pregabalin?

      Your Answer: It acts on GABA-A receptors

      Correct Answer: It has a high bioavailability

      Explanation:

      Pregabalin: Pharmacokinetics and Mechanism of Action

      Pregabalin is a medication that acts on the alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system. It is known for its anticonvulsant, analgesic, and anxiolytic properties. By decreasing presynaptic calcium currents, it reduces the release of excitatory neurotransmitters that contribute to anxiety. Despite being a GABA analogue, it does not affect GABA receptors of metabolism.

      Pregabalin has predictable and linear pharmacokinetics, making it easy to use in clinical practice. It is rapidly absorbed and proportional to dose, with a time to maximal plasma concentration of approximately 1 hour. Steady state is achieved within 24-48 hours, and efficacy can be observed as early as day two in clinical trials. It has a high bioavailability and a mean elimination half-life of 6.3 hours.

      Unlike many medications, pregabalin is not subject to hepatic metabolism and does not induce of inhibit liver enzymes such as the cytochrome P450 system. It is excreted unchanged by the kidneys and does not bind to plasma proteins. This means that it is unlikely to cause of be affected by pharmacokinetic drug-drug interactions.

      While there is some potential for abuse of pregabalin, the euphoric effects disappear with prolonged use. Overall, pregabalin is a safe and effective medication for the treatment of various conditions, including anxiety and neuropathic pain.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 22 - What category of antipsychotic does Sulpiride belong to? ...

    Correct

    • What category of antipsychotic does Sulpiride belong to?

      Your Answer: Substituted benzamide

      Explanation:

      Antipsychotics can be classified in different ways, with the most common being typical (first generation) and atypical (second generation) types. Typical antipsychotics block dopamine (D2) receptors and have varying degrees of M1, Alpha-1, and H1 receptor blockade. Atypical antipsychotics have a lower propensity for extrapyramidal side-effects and are attributed to the combination of relatively lower D2 antagonism with 5HT2A antagonism. They are also classified by structure, with examples including phenothiazines, butyrophenones, thioxanthenes, diphenylbutylpiperidine, dibenzodiazepines, benzoxazoles, thienobenzodiazepine, substituted benzamides, and arylpiperidylindole (quinolone). Studies have found little evidence to support the superiority of atypicals over typicals in terms of efficacy, discontinuation rates, of adherence, with the main difference being the side-effect profile. The Royal College also favors classification by structure.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 23 - Which statement accurately defines bioavailability? ...

    Correct

    • Which statement accurately defines bioavailability?

      Your Answer: The fraction of an administered dose of unchanged drug that reaches the systemic circulation

      Explanation:

      Understanding Bioavailability in Drug Trials

      Bioavailability is a crucial factor in drug trials, as it determines the percentage of a drug that reaches the systemic circulation after administration. This can be affected by factors such as absorption and metabolic clearance. For example, if a drug called X is administered orally and only 60% reaches the systemic circulation, its bioavailability is 0.6 of 60%. However, if the same drug is administered intravenously, plasma levels may reach 100%.

      One way to potentially increase bioavailability is through the rectal route, which bypasses around two thirds of the first-pass metabolism. This is because the rectum’s venous drainage is two thirds systemic (middle and inferior rectal vein) and one third portal (superior rectal vein). As a result, drugs administered rectally may reach the circulatory system with less alteration and in greater concentrations. Understanding bioavailability and exploring different administration routes can help optimize drug efficacy in clinical trials.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 24 - Which of the following is not an inhibitor of the Cytochrome P450 system?...

    Correct

    • Which of the following is not an inhibitor of the Cytochrome P450 system?

      Your Answer: Phenytoin

      Explanation:

      Certain substances can either induce or inhibit the activity of enzymes responsible for metabolizing drugs in the body. Inducers include smoking, alcohol, barbiturates, carbamazepine, Phenytoin, and St John’s Wort, while inhibitors include chlorpromazine, SSRIs, and grapefruit juice.

      The Cytochrome P450 system is a group of enzymes that metabolize drugs by altering their functional groups. The system is located in the liver and small intestine and is involved in drug interactions through enzyme induction of inhibition. Notable inducers include smoking, alcohol, and St John’s Wort, while notable inhibitors include grapefruit juice and some SSRIs. CYP2D6 is important due to genetic polymorphism, and CYP3A4 is the most abundant subfamily and is commonly involved in interactions. Grapefruit juice inhibits both CYP1A2 and CYP3A4, while tobacco smoking induces CYP1A2. The table summarizes the main substrates, inhibitors, and inducers for each CYP enzyme.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 25 - You are asked to review a woman on a hospital ward with hemochromatosis...

    Correct

    • You are asked to review a woman on a hospital ward with hemochromatosis who has been observed to be low in mood. On review of her blood results you note significant hepatic impairment. Your history and examination confirms that she is depressed. Which of the following medications would be indicated to manage her depression?

      Your Answer: Sertraline

      Explanation:

      Haemochromatosis is a genetic condition that causes a gradual accumulation of iron in the body over time. If left untreated, this excess iron can be deposited in organs like the liver and heart, potentially leading to organ failure. Treatment typically involves phlebotomy, which removes excess iron from the body and helps maintain healthy iron levels.

      Hepatic Impairment: Recommended Drugs

      Patients with hepatic impairment may experience reduced ability to metabolize drugs, toxicity, enhanced dose-related side effects, reduced ability to synthesize plasma proteins, and elevated levels of drugs subject to first-pass metabolism due to reduced hepatic blood flow. The Maudsley Guidelines 14th Ed recommends the following drugs for patients with hepatic impairment:

      Antipsychotics: Paliperidone (if depot required), Amisulpride, Sulpiride

      Antidepressants: Sertraline, Citalopram, Paroxetine, Vortioxetine (avoid TCA and MAOI)

      Mood stabilizers: Lithium

      Sedatives: Lorazepam, Oxazepam, Temazepam, Zopiclone 3.75mg (with care)

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 26 - What is the safest option for post-MI use? ...

    Correct

    • What is the safest option for post-MI use?

      Your Answer: Sertraline

      Explanation:

      Antidepressants and Their Cardiac Effects

      SSRIs are generally recommended for patients with cardiac disease as they may protect against myocardial infarction (MI). Untreated depression worsens prognosis in cardiovascular disease. Post MI, SSRIs and mirtazapine have either a neutral of beneficial effect on mortality. Sertraline is recommended post MI, but other SSRIs and mirtazapine are also likely to be safe. However, citalopram is associated with Torsades de pointes (mainly in overdose). Bupropion, citalopram, escitalopram, moclobemide, lofepramine, and venlafaxine should be used with caution of avoided in those at risk of serious arrhythmia (those with heart failure, left ventricular hypertrophy, previous arrhythmia, of MI).

      Tricyclic antidepressants (TCAs) have established arrhythmogenic activity which arises as a result of potent blockade of cardiac sodium channels and variable activity at potassium channels. ECG changes produced include PR, QRS, and QT prolongation and the Brugada syndrome. Lofepramine is less cardiotoxic than other TCAs and seems to lack the overdose arrhythmogenicity of other TCAs. QT changes are not usually seen at normal clinical doses of antidepressants (but can occur, particularly with citalopram/escitalopram). The arrhythmogenic potential of TCAs and other antidepressants is dose-related.

      Overall, SSRIs are recommended for patients with cardiac disease, while caution should be exercised when prescribing TCAs and other antidepressants, especially in those at risk of serious arrhythmia. It is important to monitor patients closely for any cardiac effects when prescribing antidepressants.

    • This question is part of the following fields:

      • Psychopharmacology
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  • Question 27 - What is the main way in which galantamine works? ...

    Incorrect

    • What is the main way in which galantamine works?

      Your Answer: Selective and reversible inhibitor of acetylcholinesterase

      Correct Answer: Competitive and reversible inhibitor of acetylcholinesterase

      Explanation:

      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
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  • Question 28 - A 65-year-old patient with first onset psychosis is prescribed olanzapine and shows a...

    Correct

    • A 65-year-old patient with first onset psychosis is prescribed olanzapine and shows a good response. After twelve months of therapy, their BMI has increased from 25 to 35. An attempt to reduce the dose precipitates a relapse in their illness, lifestyle interventions are also unsuccessful. A trial of a switch to which of the following antipsychotics would be indicated in order to attempt to reduce their weight whilst also addressing the psychosis?

      Your Answer: Aripiprazole

      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
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  • Question 29 - A patient prescribed quetiapine (500mg once daily) at the age of 65 had...

    Correct

    • A patient prescribed quetiapine (500mg once daily) at the age of 65 had a recent ECG which showed a QTc interval of 510 ms. Which of the following would be the most appropriate next step?:

      Your Answer: Stop quetiapine completely and then switch to aripiprazole and refer to cardiology

      Explanation:

      Aripiprazole and olanzapine are preferred over haloperidol due to its high impact on the QTc interval. Risperidone can also be considered as a viable option in cases where the QTc interval is elevated.

      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
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  • Question 30 - A child is given a single dose of 160mg of medication Y and...

    Correct

    • A child is given a single dose of 160mg of medication Y and their blood levels are measured at different times. At four hours, the blood level is 80 mg/ml, at eight hours it is 40 mg/ml, at twelve hours it is 20 mg/ml, and at twenty-four hours it is 5 mg/ml. What is the half-life of medication Y?

      Your Answer: 4 hours

      Explanation:

      A drug’s half-life is an estimation of the time it takes for the drug’s initial concentration in the body to decrease by half. For example, if a drug’s half-life is 4 hours and the initial concentration is 160 mg, it’s estimated that 80 mg will remain after 4 hours.

      Other important pharmacokinetic values include the volume of distribution, which is the apparent volume that contains the drug, concentration, which is the amount of drug per unit volume, elimination rate constant, which is the rate at which the drug is removed from the body, and clearance, which is the volume of blood cleared of the drug per unit time. When the overall intake of a drug is equal to the rate of elimination, this is known as steady state, which is typically achieved after approximately 4-5 half life times.

    • This question is part of the following fields:

      • Psychopharmacology
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