Psychopharm 2.0
A 32-year-old patient with schizophrenia, stable on olanzapine, gained over 20 pounds in one year (BMI now at 31 kg/m²) and has elevated fasting glucose and triglycerides. Which of the following is the best supported treatment for the metabolic side effects?
A. Insulin
B. Orlistat
C. Metformin
D. Gemfibrozil
E. Atorvastatin
C. Metformin
An 84-year-old patient presents to the emergency department with fever, dry mouth, and visual hallucinations. The patient is tachycardic and restless. The toxicity of which of the following medications is most likely to explain the patient's symptoms?
A. Lithium
B. Sertraline
C. Benztropine
D. Haloperidol
E. Divalproex
C. Benztropine
Prolonged stimulation of N-methyl-D-aspartic acid (NMDA) receptors is hypothesized to result in neuronal death due to:
A. Excessive calcium influx resulting in mitochondrial caspase activation
B. Reduced sodium influx resulting in relative hypotonicity and cellular necrosis
C. Excessive chloride influx resulting in relative hypertonicity and cellular necrosis
D. Increased ATP production resulting in collapse of sodium and potassium gradients
E. Increased production of beta-amyloid resulting in disruption of the cellular cytoskeleton
A. Excessive calcium influx resulting in mitochondrial caspase activation
The FDA has reported paradoxical drug responses of dissociative-like states with which of the following medication classes?
A. Stimulant
B. Antipsychotic
C. Antidepressant
D. Mood stabilizer
E. Sedative-hypnotic
E. Sedative-hypnotic
A patient with treatment-resistant depression has a rapid antidepressant response to a single dose of intravenous ketamine. Antagonism of which of the following neurotransmitter systems has been most implicated in this treatment response?
A. GABA
B. NMDA
C. Kainate
D. Histamine
E. Epinephrine
B. NMDA
A 30-year-old patient with treatment-resistant schizophrenia presents to the emergency department with dyspnea, orthostatic hypotension, and a heart rate of 130 bpm. He has been taking clozapine for several months. His complete blood count is normal except for an elevated eosinophil count. ECG reveals non-specific T-wave changes. Which of the following tests is most likely to be helpful in guiding acute management?
A. Clozapine level
B. Troponin level
C. Aldolase level
D. Electroencephalogram
E. Computed tomography scan of brain
B. Troponin level
Which of the following adjunctive treatments has been shown to reduce symptoms and improve biomarkers of inflammation and oxidative stress in people with schizophrenia?
A. Kava
B. Glycine
C. Valerian
D. St. John's wort
E. N-acetylcysteine
E. N-acetylcysteine
Cigarette smoking induces the metabolism of which of the following medications?
A. Alprazolam
B. Clozapine
C. Fluoxetine
D. Methadone
E. Quetiapine
B. Clozapine
A clinician is consulted for agitation management in a recently intubated patient. The patient is acutely presenting with fluctuating periods of inattention, poor awareness of surroundings and disorientation. Which neurotransmitter is most associated with the patient's acute mental status changes?
A. Serotonin
B. Glutamate
C. Acetylcholine
D. Norepinephrine
E. Gamma-Aminobutyric Acid
C. Acetylcholine
Which of the following factors is associated with a higher risk for developing neuroleptic malignant syndrome in patients being treated with antipsychotics?
A. Female gender
B. Low serum iron
C. Adjunctive valproic acid
D. Concurrent treatment with a SSRI
E. Elevated serum aspartate transaminase
B. Low serum iron
An elderly male has been on longstanding antiepileptic medication. Recently, he has had a fall without detected fracture, and a bone scan reveals low bone density. Which of the following medications should be avoided to prevent further bone loss?
A. Valproate
B. Topiramate
C. Lamotrigine
D. Zonisamide
E. Levetiracetam
A. Valproate
A woman with a history of bulimia and a new diagnosis of moderate major depressive disorder, without psychotic features, presents for an intake appointment. Which of the following medications would give her the ideal balance of efficacy with a minimal risk of side effects?
A. Bupropion
B. Fluoxetine
C. Phenelzine
D. Mirtazapine
E. Amitriptyline
B. Fluoxetine
Which of the following concomitant medications would warrant a lower starting and target dose of lamotrigine?
A. Carbamazepine
B. Valproate
C. Topiramate
D. Risperidone
E. Olanzapine
B. Valproate
Which of the following is first-line therapy for seasonal affective disorder?
A. Exercise
B. Melatonin
C. Fluoxetine
D. Bright light therapy
E. Cognitive behavioral therapy
D. Bright light therapy
Which of the following cognitive enhancers circulates largely unbound to serum proteins and has limited significant drug interactions?
A. Modafinil
B. Donepezil
C. Memantine
D. Galantamine
E. Rivastigmine
E. Rivastigmine
Which of the following medications has been shown to be effective in the treatment of motor and vocal tics associated with Tourette syndrome refractory to treatment with antipsychotics and alpha adrenergic-agonists?
A. Tetrabenazine
B. Valproic acid
C. Levetiracetam
D. Gabapentin
A. Tetrabenazine
A psychiatrist evaluates a 26-year-old woman, who presents with an episode of major depressive disorder that began two weeks after the birth of her child. Which of the following medications has both the lowest passage into breastmilk and the most evidence for infant safety?
A. Lithium
B. Sertraline
C. Fluoxetine
D. Phenelzine
E. Olanzapine
B. Sertraline
Which of the following medications is most likely to help a patient diagnosed with multiple sclerosis who is suffering from frequent episodes of inappropriate and uncontrollable laughter?
A. Bupropion
B. Propranolol
C. Risperidone
D. Amitriptyline
E. Carbamazepine
D. Amitriptyline
A patient with a history of bipolar disorder is admitted with vancomycin-resistant enterococci (VRE) bacteremia. Vitals: heart rate 105 bpm, blood pressure 171/95 mm Hg, respiratory rate 18/min, temperature 100.9° F (38.3° C). The patient has upper extremity tremors, hyperreflexia, myoclonic jerks, disorientation to time and place, and responds to visual hallucinations. Current medications: linezolid, lithium, sertraline, risperidone. Which of the following is the most likely diagnosis?
A. Delirious mania
B. Malignant catatonia
C. Serotonin syndrome
D. Neuroleptic malignant syndrome
E. Delirium secondary to VRE bacteremia
C. Serotonin syndrome
Which of the following medications has an FDA-approved indication as an antisomnolence agent for those with obstructive sleep apnea?
A. Modafinil
B. Guanfacine
C. Atomoxetine
D. Methylphenidate
E. Lisdexamfetamine
A. Modafinil
A 22-year-old man has a history of episodic severe headaches, characterized by severe pain behind the eye, abrupt onset, and duration of one hour, accompanied by conjunctival injection. Previously the headaches occurred a few times per year, but they are now occurring with increased frequency, with headache-free periods of only one week. Which of the following would be most effective in preventing the headaches?
A. Ibuprofen
B. Verapamil
C. Prednisone
D. Gabapentin
E. Amitriptyline
B. Verapamil
Mirtazapine induces less nausea than many other anti-depressants due to its blockade of which of the following serotonin receptors?
A. 5HT-1
B. 5HT-2
C. 5HT-3
D. 5HT-4
E. 5HT-5
C. 5HT-3
Loss of nicotinic receptor sites and potentiation of remaining receptor sites are processes involved in the pathophysiology of:
A. bipolar disorder.
B. Alzheimer disease.
C. non-epileptic seizures.
D. major depressive disorder.
E. obsessive-compulsive disorder.
B. Alzheimer disease.
A 20-year-old woman suddenly develops profound arm and leg weakness following a pie eating contest. She is awake and alert with normal speech and facial strength. Her father has similar episodes of weakness. Serum potassium level during the episode is decreased. Which of the following can reduce future attacks of weakness?
A. Aspirin
B. Betaseron
C. Gabapentin
D. Acetazolamide
E. Carbamazepine
D. Acetazolamide
A patient is being transitioned from olanzapine to ziprasidone due to rapid development of dyslipidemia and weight gain. To avoid lowering the oral absorption of ziprasidone by 50%, the patient is counseled to take the medication:
A. while fasting.
B. with a low-fat content meal.
C. with at least eight ounces of water.
D. with a high carbohydrate content meal.
E. with a caloric intake of at least 500 calories.
E. with a caloric intake of at least 500 calories.