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Question 1
Correct
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What factor would increase the likelihood of serotonin syndrome in an individual who is taking an SSRI medication?
Your Answer: Tramadol
Explanation:Serotonin Syndrome and Neuroleptic Malignant Syndrome are two conditions that can be difficult to differentiate. Serotonin Syndrome is caused by excess serotonergic activity in the CNS and is characterized by neuromuscular abnormalities, altered mental state, and autonomic dysfunction. On the other hand, Neuroleptic Malignant Syndrome is a rare acute disorder of thermoregulation and neuromotor control that is almost exclusively caused by antipsychotics. The symptoms of both syndromes can overlap, but there are some distinguishing clinical features. Hyper-reflexia, ocular clonus, and tremors are more prominent in Serotonin Syndrome, while Neuroleptic Malignant Syndrome is characterized by uniform ‘lead-pipe’ rigidity and hyporeflexia. Symptoms of Serotonin Syndrome usually resolve within a few days of stopping the medication, while Neuroleptic Malignant Syndrome can take up to 14 days to remit with appropriate treatment. The following table provides a useful guide to the main differentials of Serotonin Syndrome and Neuroleptic Malignant Syndrome.
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This question is part of the following fields:
- Psychopharmacology
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Question 2
Correct
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Which statement about pharmacokinetics in the elderly is incorrect?
Your Answer: The volume of distribution for lipid-soluble drugs decreases
Explanation:With aging, there is an increase in lean body weight and body water and a decrease in the proportion of fat. As a result, water-soluble drugs are distributed to a greater extent. Lipid-soluble drugs have a lower volume of distribution in the elderly due to the lower proportion of body fat.
Prescribing medication for elderly individuals requires consideration of their unique pharmacokinetics and pharmacodynamics. As the body ages, changes in distribution, metabolism, and excretion can affect how medication is absorbed and processed. For example, reduced gastric acid secretion and motility can impact drug absorption, while a relative reduction of body water to body fat can alter the distribution of lipid soluble drugs. Additionally, hepatic metabolism of drugs decreases with age, and the kidneys become less effective, leading to potential accumulation of certain drugs.
In terms of pharmacodynamics, receptor sensitivity tends to increase during old age, meaning smaller doses may be needed. However, older individuals may also take longer to respond to treatment and have an increased incidence of side-effects. It is important to start with a lower dose and monitor closely when prescribing medication for elderly patients, especially considering the potential for interactions with other medications they may be taking.
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This question is part of the following fields:
- Psychopharmacology
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Question 3
Incorrect
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A 32-year-old female patient with a diagnosis of alcohol use disorder is interested in decreasing her alcohol intake, but acknowledges that complete abstinence may not be achievable. What treatment options are appropriate in this case?
Your Answer: Acamprosate calcium
Correct Answer: Nalmefene
Explanation:Alcohol Dependence Treatment Options
Nalmefene has recently been approved for reducing alcohol consumption in alcohol-dependent patients who have a high risk of drinking but do not experience physical withdrawal symptoms and do not require immediate detoxification.
Acamprosate, when used in conjunction with counseling, may help maintain abstinence in alcohol-dependent patients who experience strong cravings.
Bupropion hydrochloride, which has been used as an antidepressant, has been found to be effective in maintaining smoking cessation.
Disulfiram, when consumed with alcohol, causes an extremely unpleasant systemic reaction due to the accumulation of acetaldehyde.
Naltrexone, an opioid-receptor antagonist, may be used to treat alcohol dependence after successful withdrawal.
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This question is part of the following fields:
- Psychopharmacology
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Question 4
Correct
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Which outcome is most likely to result from the use of interferon α?
Your Answer: Depression
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).
– CorticosteroidsMedications 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
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Question 5
Correct
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A client is referred with depression and is eager to begin medication. You find out that they have hypertension. What would be the most suitable treatment option?
Your Answer: Fluoxetine
Explanation:Antidepressants and Diabetes
Depression is a prevalent condition among patients with diabetes. It is crucial to select the appropriate antidepressant as some may have negative effects on weight and glucose levels. The first-line treatment for depression in diabetic patients is selective serotonin reuptake inhibitors (SSRIs), with fluoxetine having the most supporting data. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are also likely to be safe, but there is less evidence to support their use. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) should be avoided. These recommendations are based on the Maudsley Guidelines 10th Edition.
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This question is part of the following fields:
- Psychopharmacology
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Question 6
Correct
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What is an example of a first generation H1 antihistamine?
Your Answer: Promethazine
Explanation:Promethazine is utilized for its sedative properties in cases of agitation due to the fact that first generation H1 antihistamines easily penetrate the BBB and induce drowsiness.
Antihistamines: Types and Uses
Antihistamines are drugs that block the effects of histamine, a neurotransmitter that regulates physiological function in the gut and potentiates the inflammatory and immune responses of the body. There are two types of antihistamines: H1 receptor blockers and H2 receptor blockers. H1 blockers are mainly used for allergic conditions and sedation, while H2 blockers are used for excess stomach acid.
There are also first and second generation antihistamines. First generation antihistamines, such as diphenhydramine and promethazine, have uses in psychiatry due to their ability to cross the blood brain barrier and their anticholinergic properties. They tend to be sedating and are useful for managing extrapyramidal side effects. Second generation antihistamines, such as loratadine and cetirizine, show limited penetration of the blood brain barrier and are less sedating.
It is important to note that there are contraindications to first-generation antihistamines, including benign prostatic hyperplasia, angle-closure glaucoma, and pyloric stenosis in infants. These do not apply to second-generation antihistamines.
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This question is part of the following fields:
- Psychopharmacology
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Question 7
Correct
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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.
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This question is part of the following fields:
- Psychopharmacology
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Question 8
Correct
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Which of the options below is not an accepted method for treating depression?
Your Answer: Zotepine
Explanation:Zotepine, which has been utilized globally to manage schizophrenia, has been removed from the UK market due to its potential to trigger seizures.
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
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Question 9
Correct
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Which individual brought clozapine into clinical use?
Your Answer: Kane
Explanation:Imipramine antidepressant effects were discovered by Kuhn. Kane introduced clozapine into clinical practice after conducting a successful double-blind multicenter trial comparing it with chlorpromazine in treatment-resistant schizophrenia. Charpentier synthesized chlorpromazine, while Klein discovered the use of iproniazid. Cade discovered the beneficial effect of lithium in treating mania.
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This question is part of the following fields:
- Psychopharmacology
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Question 10
Correct
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A 25-year-old woman is experiencing symptoms of anxiety and you believe that an anxiolytic medication may be helpful. What is a true statement about medications used to treat anxiety?
Your Answer: Fluoxetine causes few anticholinergic side effects
Explanation:Monoamine oxidase inhibitors (MAOIs) increase levels of noradrenaline, serotonin, and dopamine by inhibiting one of both of the monoamine oxidase enzymes, MAO-A and MAO-B. This is different from selective serotonin reuptake inhibitors (SSRIs) and tricyclics, which primarily affect serotonin levels. Tricyclics have anticholinergic and noradrenergic side effects, while SSRIs cause fewer anticholinergic effects but may lead to gastrointestinal problems, agitation, insomnia, and headaches. MAOIs have their own set of potential side effects, including interactions with certain foods and medications, as well as possible hypertensive crises.
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This question is part of the following fields:
- Psychopharmacology
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Question 11
Correct
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What is a true statement about benzodiazepines?
Your Answer: They cause anterograde amnesia
Explanation:Benzodiazepines have been found to suppress REM sleep and can lead to intense dreams and severe nightmares when discontinued due to a rebound effect. Additionally, they can cause anterograde amnesia, which is the inability to create new memories. While benzodiazepines do not directly induce of inhibit liver enzymes, they are metabolized by CYP3A4, which can be inhibited by certain medications such as SSRIs, erythromycin, and ketoconazole. Flumazenil, a medication used to manage benzodiazepine overdose, has a short half-life and may require repeated doses. However, benzodiazepines are not recommended for the treatment of depression of panic disorder.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 12
Incorrect
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Which of the following is excluded from the field of pharmacodynamics?
Your Answer: Drug side effects
Correct Answer: Drug metabolism
Explanation:Pharmacokinetics includes the study of drug metabolism.
Receptor Binding
Receptor binding is a crucial aspect of pharmacodynamics, which involves the study of how drugs affect the body. Receptors are specialized proteins located on the surface of inside cells that interact with specific molecules, such as neurotransmitters, hormones, of drugs. When a drug binds to a receptor, it can either activate or inhibit its function, leading to various biological effects. The affinity and efficacy of a drug for a receptor depend on its chemical structure, concentration, and the properties of the receptor. Understanding receptor binding is essential for developing safe and effective drugs, as well as for predicting drug interactions and side effects.
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This question is part of the following fields:
- Psychopharmacology
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Question 13
Correct
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Which substances are metabolized by the enzyme CYP1A2?
Your Answer: Clozapine
Explanation: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.
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This question is part of the following fields:
- Psychopharmacology
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Question 14
Correct
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Identify the option that represents a secondary amine.
Your Answer: Desipramine
Explanation:Tricyclic Antidepressants: Uses, Types, and Side-Effects
Tricyclic antidepressants (TCAs) are a type of medication used for depression and neuropathic pain. However, due to their side-effects and toxicity in overdose, they are not commonly used for depression anymore. TCAs can be divided into two types: first generation (tertiary amines) and second generation (secondary amines). The secondary amines have a lower side effect profile and act primarily on noradrenaline, while the tertiary amines boost serotonin and noradrenaline.
Some examples of secondary amines include desipramine, nortriptyline, protriptyline, and amoxapine. Examples of tertiary amines include amitriptyline, lofepramine, imipramine, clomipramine, dosulepin (dothiepin), doxepin, trimipramine, and butriptyline. Common side-effects of TCAs include drowsiness, dry mouth, blurred vision, constipation, and urinary retention.
Low-dose amitriptyline is commonly used for neuropathic pain and prophylaxis of headache. Lofepramine has a lower incidence of toxicity in overdose. However, amitriptyline and dosulepin (dothiepin) are considered the most dangerous in overdose. It is important to consult with a healthcare provider before taking any medication and to follow their instructions carefully.
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This question is part of the following fields:
- Psychopharmacology
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Question 15
Correct
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A 45-year-old woman with paranoid schizophrenia is experiencing abnormal liver function tests while taking risperidone. The physician has requested a change in antipsychotic medication. What is the most suitable alternative antipsychotic to prescribe?
Your Answer: Haloperidol
Explanation:For individuals with hepatic impairment, it is advisable to use low dose haloperidol. Amisulpride and paliperidone are eliminated through the kidneys, but there is no clinical data to support their safety in this population. Aripiprazole, olanzapine, quetiapine, and risperidone undergo significant liver metabolism. Chlorpromazine has a high potential for liver toxicity. Clozapine should not be used in individuals with active liver disease.
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This question is part of the following fields:
- Psychopharmacology
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Question 16
Correct
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A 28-year-old female with a history of seizures is prescribed an anticonvulsant but experiences pain in her left flank after 10 months. An ultrasound reveals the presence of a kidney stone.
Which anticonvulsant is the most probable cause of this adverse effect?Your Answer: Topiramate
Explanation:Long-term use of topiramate for approximately one year can result in systemic metabolic acidosis due to the inhibition of carbonic anhydrase, leading to distal tubular acidification and impaired acid excretion by the kidneys. Additionally, topiramate use can elevate urine pH and decreased urine citrate, which is a crucial inhibitor of kidney stone formation.
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This question is part of the following fields:
- Psychopharmacology
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Question 17
Correct
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Which antidepressant is known for having a lower occurrence of sexual dysfunction as a side effect?
Your Answer: Mirtazapine
Explanation: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.
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This question is part of the following fields:
- Psychopharmacology
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Question 18
Correct
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Question 19
Correct
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Which of the options below produces a metabolite that remains active in the body?
Your Answer: Fluoxetine
Explanation:Antidepressants with Active Metabolites
Many antidepressants have active metabolites that can affect the body’s response to the medication. For example, amitriptyline has nortriptyline as an active metabolite, while clomipramine has desmethyl-clomipramine. Other antidepressants with active metabolites include dosulepin, doxepin, imipramine, lofepramine, fluoxetine, mirtazapine, trazodone, and venlafaxine.
These active metabolites can have different effects on the body compared to the original medication. For example, nortriptyline is a more potent inhibitor of serotonin and norepinephrine reuptake than amitriptyline. Similarly, desipramine, the active metabolite of imipramine and lofepramine, has a longer half-life and is less sedating than the original medication.
It is important for healthcare providers to be aware of the active metabolites of antidepressants when prescribing medication and monitoring patients for side effects and efficacy.
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This question is part of the following fields:
- Psychopharmacology
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Question 20
Correct
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During which decade was chlorpromazine first introduced into psychiatric clinical practice?
Your Answer: 1950s
Explanation:Charpentier synthesised Chlorpromazine in 1950, and it was subsequently introduced into clinical practice in the 1950s.
A Historical Note on the Development of Zimelidine, the First Selective Serotonin Reuptake Inhibitor
In 1960s, evidence began to emerge suggesting a significant role of serotonin in depression. This led to the development of zimelidine, the first selective serotonin reuptake inhibitor (SSRI). Zimelidine was derived from pheniramine and was marketed in Europe in 1982. However, it was removed from the market in 1983 due to severe side effects such as hypersensitivity reactions and Guillain-Barre syndrome.
Despite its short-lived availability, zimelidine paved the way for the development of other SSRIs such as fluoxetine, which was approved by the FDA in 1987 and launched in the US market in 1988 under the trade name Prozac. The development of SSRIs revolutionized the treatment of depression and other mood disorders, providing a safer and more effective alternative to earlier antidepressants such as the tricyclics and MAO inhibitors.
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This question is part of the following fields:
- Psychopharmacology
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Question 21
Correct
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A 28-year-old woman who is taking antiepileptic medication reports experiencing visual field defects three months after starting a new anticonvulsant. Which specific drug is the most likely cause of this presentation?
Your Answer: Vigabatrin
Explanation:Vigabatrin is an anticonvulsant drug that has been associated with irreversible concentric visual field loss in 30-50% of patients with long-term exposure. This visual field loss can vary in severity and is often asymptomatic, making regular visual field testing essential for patients taking this medication. It is important for healthcare providers to monitor patients closely for any signs of visual field loss and to consider alternative treatment options if necessary. For more information on anticonvulsant drugs, please refer to GP Notebook.
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This question is part of the following fields:
- Psychopharmacology
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Question 22
Correct
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What is the reason for the induction of CYP1A2, and how does it related to the need for higher doses of clozapine in certain individuals?
Your Answer: Smoking
Explanation: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.
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This question is part of the following fields:
- Psychopharmacology
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Question 23
Correct
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A 32-year-old woman is being readmitted to the hospital due to a relapse of her schizophrenia. She reports difficulty remembering to take her oral antipsychotic medication, even when she is feeling well. What long-acting injection (LAI) antipsychotic could be prescribed to improve adherence after she is discharged from the hospital?
Your Answer: Paliperidone
Explanation:Antipsychotic Medications and Their Forms of Administration
Antipsychotic medications are available in various forms of administration, including oral and long-acting injectable (LAI) forms. Paliperidone, a medication closely related to risperidone, is available in both oral form (Invega) and as a monthly LAI (Xeplion). Amisulpride and zotepine are currently only available in oral form, while asenapine, released in 2012 in the UK, is only available in oral (sublingual/buccal) form. Sertindole, an oral antipsychotic, was withdrawn from the European market for several years in the late 1990s due to concerns about QTc interval prolongation.
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This question is part of the following fields:
- Psychopharmacology
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Question 24
Incorrect
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What is a true statement about drugs utilized for treating dementia?
Your Answer: Galantamine is an NMDA antagonist
Correct Answer: Rivastigmine inhibits butyrylcholinesterase
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 25
Incorrect
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A 55-year-old man complains of frequent nighttime urination.
He has been taking lithium for his bipolar disorder for more than a decade without any notable adverse effects. His eGFR is 38 mls/min and his serum creatinine is slightly elevated.
What is the most probable diagnosis?Your Answer: Tubulointerstitial nephritis
Correct Answer: Nephrogenic diabetes insipidus
Explanation:Nocturia is often the first indication of nephrogenic diabetes insipidus, which can occur in 20-40% of patients who take lithium for an extended period. This condition can cause a gradual decrease in the GFR, which may be reversible in the early stages. If muscle mass is reduced of the diet is low in protein, the serum creatinine level may be normal of near-normal.
Hyperparathyroidism is not a likely cause because although 15-20% of long-term lithium users may have elevated calcium levels, only a few will experience hyperparathyroidism symptoms.
Syndrome of inappropriate ADH secretion is not associated with lithium therapy and would not present with polyuria of renal impairment.
Tubulointerstitial nephritis is a rare complication of lithium therapy.
Water intoxication would cause polyuria of dilutional hyponatremia, but not renal impairment.
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This question is part of the following fields:
- Psychopharmacology
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Question 26
Incorrect
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A client in their 50s taking risperidone reports an atypical feeling during ejaculation and absence of semen. Which receptor is responsible for this side effect due to the medication's antagonism?
Your Answer: Glutaminergic
Correct Answer: Adrenergic
Explanation:Antipsychotic medications change the tension of the bladder of urethral sphincter, which can result in the backward flow of semen into the bladder during ejaculation. This effect is believed to be caused by blocking the 1-adrenergic receptor.
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.
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This question is part of the following fields:
- Psychopharmacology
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Question 27
Incorrect
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A 30-year-old male with a history of depression is interested in trying agomelatine as a potential treatment. Can you explain the mechanism of action of agomelatine?
Your Answer: Selective serotonin reuptake inhibition
Correct Answer: MT1 and MT2 receptor agonist
Explanation:Agomelatine acts as a melatonergic agonist at MT1 and MT2 receptors and also as a 5-HT2C antagonist, indirectly increasing norepinephrine and dopamine levels to alleviate depression. Moclobemide, an MAO-A inhibitor, boosts serotonin, dopamine, and norepinephrine levels in the brain, resulting in antidepressant effects. Fluoxetine, a selective serotonin reuptake inhibitor, elevates serotonin levels, while venlafaxine, a serotonin and norepinephrine reuptake inhibitor, enhances the concentration of both chemicals in the brain, leading to antidepressant benefits.
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This question is part of the following fields:
- Psychopharmacology
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Question 28
Incorrect
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What is the primary mechanism of action of Valdoxan (agomelatine), an antidepressant?
Your Answer: GABA potentiation
Correct Answer: Melatonin (MT) receptor agonism
Explanation:Agomelatine (Valdoxan) is a novel antidepressant that functions as an agonist at both MT1 and MT2 receptors, while also acting as a 5HT2C antagonist. Unlike most other antidepressants, it does not affect monoamine uptake.
First-generation antipsychotics work by antagonizing D2 receptors.
Benzodiazepines exert their effects by potentiating GABA.
Noradrenaline reuptake inhibition is a common mechanism of action for many antidepressants, including SNRIs and tricyclics.
SSRI (and other) antidepressants function by inhibiting the reuptake of serotonin. -
This question is part of the following fields:
- Psychopharmacology
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Question 29
Incorrect
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What medication does not impact the QTc interval?
Your Answer: Amisulpride
Correct Answer: Aripiprazole
Explanation:Aripiprazole does not affect the QTc interval and has minimal risk of extrapyramidal side effects, sedation, of weight gain. Amisulpride, citalopram, and quetiapine have a moderate effect on the QTc interval, which requires ECG monitoring due to a prolongation of >10 msec. Haloperidol has a high effect on the QTc interval, which mandates ECG monitoring due to a prolongation of >20 msec.
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This question is part of the following fields:
- Psychopharmacology
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Question 30
Incorrect
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A 24-year-old male patient with a history of hallucinations and delusions was started on multiple medications by a psychiatrist. However, on the second day of treatment, he developed excessive sweating, fever, agitation, and aggressive behavior. The psychiatrist continued with the medications, which were eventually stopped after 4 days. Over the next few days, the patient's condition worsened, and he developed diarrhea and sustained high-grade fever. He was transferred to a hospital, where he was found to have hypertonia in all four limbs, mainly in the lower extremities, and hyper-reflexia, including bilateral sustained ankle clonus.
These signs and symptoms are most helpful in distinguishing between serotonin syndrome and neuroleptic malignant syndrome.Your Answer:
Correct Answer: Hyper-reflexia
Explanation:Serotonin Syndrome and Neuroleptic Malignant Syndrome are two conditions that can be difficult to differentiate. Serotonin Syndrome is caused by excess serotonergic activity in the CNS and is characterized by neuromuscular abnormalities, altered mental state, and autonomic dysfunction. On the other hand, Neuroleptic Malignant Syndrome is a rare acute disorder of thermoregulation and neuromotor control that is almost exclusively caused by antipsychotics. The symptoms of both syndromes can overlap, but there are some distinguishing clinical features. Hyper-reflexia, ocular clonus, and tremors are more prominent in Serotonin Syndrome, while Neuroleptic Malignant Syndrome is characterized by uniform ‘lead-pipe’ rigidity and hyporeflexia. Symptoms of Serotonin Syndrome usually resolve within a few days of stopping the medication, while Neuroleptic Malignant Syndrome can take up to 14 days to remit with appropriate treatment. The following table provides a useful guide to the main differentials of Serotonin Syndrome and Neuroleptic Malignant Syndrome.
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This question is part of the following fields:
- Psychopharmacology
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