Drug-Drug Interactions
Other
Mood Stabilizers
Blood Monitoring
Antidepressants
100

Which of the following agents is likely to decrease lithium levels


  1. Caffeine

  2. Lisinopril

  3. Ibuprofen

  4. Quetiapine

  5. HCTZ

Caffeine

100

Which of the following second generation antipsychotic medications has the lowest affinity for the D2 receptor?

  1. Quetiapine

  2. Olanzapine

  3. Geodon

  4. Paliperidone

  5. Risperidal 

Quetiapine

100

Which of the following when added to lithium for treatment resistant bipolar depression is the least likely to induce rapid cycling or a mixed state


  1. Bupropion

  2. Duloxetine

  3. Imipramine

  4. Venlafaxine

  5. Desipramine

Bupropion

100

Which of the following values in CBC is most relevant to follow when treating with depakote


  1. Hematocrit

  2. Hemoglobin

  3. Platelet count

  4. WBC count

  5. MCV

Platelet Count

100

Which of the following antidepressant medications is indicated for the treatment of neuropathic pain associated with diabetes?


  1. Bupropion

  2. Duloxetine

  3. Paroxetine

  4. Mirtazapine

  5. Fluvoxamine

duloxetine

200

Which of the following concomitant medications would warrant a lower starting and target dose of lamotrigine:


  1. Carbamazepine

  2. Valproate

  3. Topiramate

  4. Risperidone

  5. Olanzapine

Valproate

200

A patient with schizoaffective disorder is being treated with ECT. After electrical stimulus is delivered, the patient has a prolonged seizure, requiring anticonvulsant medication. Which is most likely to cause this side effect?


  1. Zyprexa

  2. Fluoxetine

  3. Lamictal

  4. Lithium

  5. Clonazepam

Lithium

200

Patient with history of seizure disorder presents to ED with acute onset of cramping lower back pain and hematuria. Which of the following anti-convulsant medications may have contributed to patient’s acute medical emergency?


  1. Phenytoin

  2. Topiramate

  3. Lamotrigine

  4. Carbamazepine

  5. Divalproex Sodium

Topiramate - Kidney Stones!

200

Patients taking lithium are more likely to show elevated levels of which of the following serum electrolytes independent of renal function


  1. Sodium

  2. Potassium

  3. Calcium

  4. Magnesium

  5. Chloride

Calcium

200

34 year old with terminal lung cancer admitted for difficulty breathing and pain. Patient reports depressed mood, poor appetite, fatigue, and impaired concentration. Death is not imminent, but prognosis is less than 3 weeks. Which of the following is the most appropriate treatment for patient’s depression?


  1. Sertraline

  2. Diazepam

  3. Duloxetine

  4. Mirtazapine

  5. Methylphenidate 

methylphenidate

300

47 year old with epilepsy has seizures that are well controlled on antiepileptic drug monotherapy, but patient develops nausea, ataxia, diplopia when treated with erythromycin for a sinus infection. This patient is most likely taking which of the following antiepileptic medications.


  1. Valproate

  2. Gabapentin

  3. Topiramate

  4. Keppra

  5. Carbamazepine



Carbamazepine:

Because it acts as both an inducer and substrate at CYP3A4

300

Lamictal is not found to be efficacious in which of the following conditions:

  1. Partial seizures

  2. Bipolar I disorder

  3. Acute mania

  4. Pain syndromes

  5. None of the above

acute mania

300

Factors that predict a better response to tegretol than to lithium in bipolar I disorder include each of the following except:


  1. First episode mania

  2. Dysphoric mania

  3. Comorbid seizure disorder

  4. Negative family history

  5. Rapid cycling 

First episode mania

300

32 year old female presents with diarrhea of two weeks. On examination she is anxious and tremulous and is not oriented. She states she has been taking some drug, and adds she doubled her dose. Which medications is most likely to have been prescribed


  1. Carbamazepine

  2. Valproic Acid

  3. Lithium

  4. Lamotrigine

  5. Topamax

lithium

300

Which of the following SSRI augmentation agents would be the best choice for a 58 year old female patient with depression and pronounced psychomotor retardation.


  1. Lithium

  2. Estrogen

  3. Olanzapine

  4. Mirtazapine

  5. liothyronine

liothyronine

400

Patient on risperidone 2 mg is started on prozac 20 mg to treat comorbid depressive symptoms. Following initiation of prozac, patient develops an acute dystonic reaction. Which of the following is most likely responsible.

  1. Inhibition of CYP2D6 by Prozac

  2. Inhibition of CYP2D6 by Risperidone

  3. Induction of CYP2D6 by Risperidone

  4. Induction of CYP3A4 by Prozac

  5. Inhibition of CYP3A4 by Prozac

Inhibition of CYP2D6 by Prozac

400

Tolerance to lithium can sometimes be overcome by the addition of:


  1. Depakote

  2. Carbamazepine

  3. Lamictal

  4. Atypical antipsychotic

  5. All of the Above

all of the above

400

Which one of the following is an indication for valproic acid

  1. Acute manic episodes

  2. Complex partial seizures

  3. Prophylaxis for migraine

  4. Simple and complex absence seizures

  5. All of the above

all of the above
400

Co-administration of lamotrigine with which of the following medications requires reducing the usual recommended dosage of lamotrigine by half during initial titration?



  1. Lithium

  2. Valproate

  3. Sertraline

  4. Quetiapine

  5. Carbamazepine

valproate

400

Which of the following selective serotonin reuptake inhibitors has strongest association with birth defects?


  1. Sertraline

  2. Citalopram

  3. Paroxetine

  4. Fluoxetine

  5. Fluvoxamine

Paroxetine

500

Patient is treated with clozapine and valproic acid. Over the period of a week, psychiatrist increases valproic acid and starts fluvoxamine for depression, while aspirin, atorvastatin and zolpidem was continued by PCP. Patient has a seizure. Which change to pharmacologic regimen is most likely contributed to increased clozaril levels?

  1. Aspirin

  2. Zolpidem

  3. Atorvastatin

  4. Fluvoxamine

  5. Valproic acid 

Fluvoxamine

500

Which of the following is a first-line medication with demonstrated efficacy in multiple, randomized clinical trials for treatment of bipolar depression.


  1. Paroxetine

  2. Quetiapine

  3. Ziprasidone

  4. Aripiprazole

  5. Divalproex sodium

Quetiapine

500

Drugs that may precipitate mania include all of the following except:


  1. Bromocriptine

  2. Disulfiram

  3. Isoniazid

  4. Propranolol

  5. All of the above

propranolol

500

Which of the following antidepressants plasma levels correlates with therapeutic response?


  1. Trazodone

  2. Imipramine

  3. Amoxapine

  4. Trimipramine

  5. Clomipramine

Imipramine

500

Patient enters ED with 5 day history of worsening HA, restlessness, hot and cold sensations, past 24 hours jerking of arms and legs. Patient reports starting some medication 2 weeks ago for anxiety and has continued taking it. Due to increasing restlessness 5mg of haldol were given. When psychiatry resident arrives, patient is drowsy, but sweating with uncontrollable shivering and hyperreflexia. Which of the following is the most appropriate treatment at this time. 

  1. Physotigmine 1 mg IM

  2. Haloperidol 10 mg IV

  3. Benztropine 2 mg IM

  4. Amantadine 100 mg po

  5. Cyproheptadine 8 mg po




Cyproheptadine 8 mg po

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