Neurology and Psychiatry

Question 1

This is a long-acting cholinesterase inhibitor and muscarinic modulator, was the first drug shown to have any benefit in Alzheimer’s disease.

Answer 1

Tacrine (tetrahydroaminoacridine, THA)

Question 2

Drug for Alzheimer’s Disease that binds to NMDA receptor channels in a use-dependent manner and produces a noncompetitive blockade.

Answer 2

Memantine

Question 3

This is an inhibitor of beta-site amyloid precursor protein cleaving enzyme (BACE1), reduces the production of amyloid β.

Answer 3

Verubecestat

Question 4

2 newer drugs for the treatment of amyotrophic lateral sclerosis (ALS) that appear to have spasm reducing effects, possibly through inhibition of glutamatergic transmission in the CNS.

Answer 4

Idrocilamide and riluzole

Question 5

3 MAO inhibitors that increase dopamine stores and are used as adjunct for levodopa in PD therapy

Answer 5

Rasagiline
Selegiline
Safinamide

Question 6

This is a non-ergot derivative for mild Parkinsonism that may ameliorate affective symptoms. A possible neuroprotective effect has been suggested by its ability to scavenge hydrogen peroxide and enhance neurotrophic activity in mesencephalic dopaminergic cell cultures.

Answer 6

Pramipexole

Question 7

What receptors do pramipexole bind?

Answer 7

D3 family of receptors

Question 8

Another nonergoline derivative that is a relatively pure D2 receptor agonist that is effective as monotherapy in patients with mild disease and as a means of smoothing the response to levodopa in patients with more advanced disease and response fluctuations.

Answer 8

Ropinirole

Question 9

This dopamine agonist is delivered daily through a skin patch, is approved for treatment of early Parkinson’s disease. It supposedly provides more continuous dopaminergic stimulation than oral medication in early parkinsonism

Answer 9

Rotigotine

Question 10

Lithium ion, used in treatment of bipolar (manic-depressive) disorder, affects the cellular metabolism of:

Answer 10

phosphoinositides

Question 11

This prototypical sodium channel-blocking antiseizure drug is also effective for the treatment of trigeminal and glossopharyngeal neuralgia, and mania in bipolar disorder

Answer 11

Carbamazepine

Question 12

This sodium channel-blocking antiseizure drug effective for the treatment of focal and generalized tonic-clonic seizures can also improve depression in patients with epilepsy and reduce the risk of relapse in bipolar disorder

Answer 12

Lamotrigine

Question 13

Aripiprazole, quetiapine, and olanzapine were the first-line drugs known as _________ for nearly all phases of bipolar disorder across guidelines

Answer 13

Atypical antipsychotics

Question 14

Some of the intramuscular antipsychotics, like haloperidol, have been approved for the control of _________ associated with bipolar disorder and schizophrenia.

Answer 14

agitation

Question 15

Catatonic forms of schizophrenia are best managed by intravenous:

Answer 15

benzodiazepine

Question 16

The most commonly used off-label symptomatic medications for MS fatigue are:

Answer 16

amantadine and modafinil

Question 17

____________, the most commonly used PD medication with anticholinergic effects, is thought to reduce classic motor symptoms through its antimuscarinic effect, enhancement of dopaminergic transmission, and non-selective NMDA receptor antagonism.

Answer 17

Amantadine

Question 18

Which antiseizure drug has gingival hyperplasia and hirsutism occur to some degree in most patients?

Answer 18

Phenytoin

Question 19

What are the most common dose-related adverse effects requiring dosage adjustment for phenytoin?

Answer 19

Diplopia and ataxia

Question 20

What dose-dependent ADE of carbamazepine occurs first?

Answer 20

diplopia

Question 21

This sodium channel-blocking antiseizure drug either enhances a poorly understood type of sodium channel inactivation called slow inactivation or binds selectively to the fast inactivated state of sodium channels—as is the case for other sodium channel-blocking antiseizure drugs, except that the binding is much slower.

Answer 21

Lacosamide

Question 22

What congenital disorder is contraindicated for the use of lacosamide

Answer 22

PKU

The oral solution contains aspartame, which is a source of phenylalanine and could be harmful in people with phenylketonuria.

Question 23

2 antiseizure drugs that contain sulphur and can cause kidney or renal stones

Answer 23

Zonisamide and Topiramate

Question 24

Long-term __________ therapy for seizures is often associated with significant weight loss, primarily due to a reduction in body fat mass.

Answer 24

topiramate

Question 25

Acute myopia and angle-closure glaucoma is an ADE of which anti-seizure drug?

Answer 25

topiramate

Question 26

Less common but more serious SE of this antiseizure drug are behavioral and mood changes, such as irritability, aggression, agitation, anger, anxiety, apathy, depression, and emotional lability

Answer 26

Levetiracetam

Question 27

The metabolism of levetiracetam occurs in the:

Answer 27

blood There is no metabolism in the liver, and drug interactions are minimal.

Question 28

MS drug that downregulates the immune response to myelin antigens by induction and activation of suppressor T cells that migrate to the central nervous system.

Answer 28

Glatiramer acetate

Question 29

MS drug for activation of the NRF-2 pathway resulting in reduction of the oxidative stress that contributes to demyelination; it also appears to help protect the nerve cells from inflammation.

Answer 29

Dimethyl fumarate

Question 30

This is FDA-approved for the treatment of relapsing-remitting multiple sclerosis. It is hypothesized to decrease the number of activated lymphocytes in the central nervous system.

Answer 30

Teriflunomide

Question 31

2 idiosyncratic ADEs of Valproate

Answer 31

hepatic toxicity and thrombocytopenia

Question 32

Valproate can cause lethargy associated with increased blood _____ concentrations

Answer 32

ammonia Fatal hyperammonemic encephalopathy has occurred in patients with genetic defects in urea metabolism; the drug is contraindicated in these patients.

Question 33

Because of the risk of agranulocytosis, patients receiving clozapine must have weekly blood counts for the first __________ of treatment and every __________ thereafter.

Answer 33

6 months of treatment 3 weeks thereafter

Question 34

This is the most important unwanted effect of antipsychotic drugs.

Answer 34

Tardive dyskinesia

Question 35

This drug has relatively very little affinity for NET but potently binds SERT. This selectivity for the serotonin transporter contributes its known benefits in the treatment of OCD.

Answer 35

clomipramine (TCA)

Question 36

The ___________provide much more rapid relief of both generalized anxiety and panic than do any of the antidepressants.

Answer 36

benzodiazepines

Question 37

This is a selective MT1 and MT2 agonist that is approved for the medical treatment of insomnia. This drug has no addiction liability (it is not a controlled substance), and it appears to be distinctly more efficacious than melatonin (but less efficacious than benzodiazepines) as a hypnotic.

Answer 37

Ramelteon

Question 38

This is a selective inhibitor of the GAT-1 GABA transporter, is a second-line treatment for focal seizures. It is contraindicated in generalized onset epilepsies.

Answer 38

Tiagabine

Question 39

This is considered a “rationally designed” antiseizure drug because it was developed with the understanding that potentiation of GABA action in the brain is a possible antiseizure mechanism.

Answer 39

Tiagabine

Question 40

Gabapentinoids bind avidly to ____, a protein that serves as an auxiliary subunit of voltage-gated calcium channels but may also have other functions.

Answer 40

α2δ

Question 41

These drugs are used in the treatment of focal seizures and various nonepilepsy indications, such as neuropathic pain, restless legs syndrome, and anxiety disorders.

Answer 41

Gabapentinoids (gabapentin and pregabalin)

Question 42

The chemical structure of tiagabine consists of the active moiety—__________—and a lipophilic anchor that allows the molecule to cross the blood-brain barrier.

Answer 42

nipecotic acid

Question 43

This differs from other SSRIs in some important respects as it's metabolized to an active product which may have greater plasma concentrations. The elimination half-life of this active product is about three times longer than the drug itself and contributes to the longest half-life of all the SSRIs.

Answer 43

Fluoxetine

Question 44

Fluoxetine has to be discontinued _____________ before an MAOI can be administered to mitigate the risk of serotonin syndrome.

Answer 44

4 weeks or longer

Question 45

Selective serotonin reuptake inhibitors (SSRIs): [P] Fluoxetine and paroxetine inhibit _________ and increase concentrations of timolol, propranolol, metoprolol, carvedilol, and nebivolol

Answer 45

CYP2D6

Question 46

Thus, clozapine should never be discontinued abruptly unless clinically needed because of adverse effects such as _______ or ________, which are true medical emergencies.

Answer 46

myocarditis or agranulocytosis

Question 47

This is the only second-generation antipsychotic drug approved to reduce the risk of suicide in patients with history of schizophrenia

Answer 47

Clozapine

Question 48

__________ dried leaf extract is usually standardized to contain 24% flavone glycosides and 6% terpene lactones. The daily dose most commonly studied and associated with a benefit in clinical trials of dementia is 240 mg daily of the dried extract in two divided doses.

Answer 48

Ginkgo biloba

Question 49

Peptide deposits in the cerebral cortex in Alzheimer's disease, which eventually forms extracellular plaques and cerebral vascular lesions

Answer 49

amyloid beta (Aa)

Question 50

Proteins that form intra- and interneuronal fibrillary tangles in Alzheimer's disease

Answer 50

tau protein

Question 51

Pharmacologic doses of ____________ enhance the extracerebral metabolism of levodopa and may therefore prevent its therapeutic effect unless a peripheral decarboxylase inhibitor is also taken.

Answer 51

pyridoxine (vitamin B6)

Question 52

Levodopa + MAO-A inhibitors can cause:

Answer 52

hypertensive crisis

Question 53

This is a calcium channel blocker used in Europe, has been reported in clinical trials to effectively reduce the severity of the acute attack and to prevent recurrences of migraine

Answer 53

Flunarizine

Question 54

___________, a 5-HT1a agonist and 5-HT2A antagonist, is approved for treatment of hypoactive sexual desire disorder in women.

Answer 54

Flibanserin

Question 55

A drug that inhibit microtubule disassembly that may be helpful in Alzheimer's disease

Answer 55

epothilone-D

Question 56

If the patient improves with edrophonium, a/an (increase or decrease) in cholinesterase inhibitor dosage may be indicated

Answer 56

increase

Question 57

Drug for long-term therapy of myasthenia gravis

Answer 57

pyridostigmine

Question 58

If the patient has myasthenia gravis, an improvement in muscle strength that lasts about ________ minutes with 2-8 mg IV injection of edrophonium can usually be observed

Answer 58

5 minutes

Question 59

The short-acting cholinesterase inhibitor edrophonium was used to treat arrhythmias, particularly:

Answer 59

paroxysmal supraventricular tachycardia (supraventricular tachyarrhythmias)

Question 60

This is an oxazoline derivative of prednisolone with anti-inflammatory and immunosuppressive activity for the treatment of DMD

Answer 60

Deflazacort

Question 61

Selective COMT inhibitors such as ________ and ________ also prolong the action of levodopa by diminishing its peripheral metabolism

Answer 61

tolcapone entacapone

Question 62

The commercial preparation named _______ consists of a combination of levodopa with both carbidopa and entacapone. It is available in three strengths: 50, 100, 150

Answer 62

Stalevo

Question 63

Subcutaneous injection of _________ , a potent nonergoline dopamine agonist that interacts with post-synaptic D2 receptors in the caudate nucleus and putamen, is effective for the temporary relief (“rescue”) of off-periods of akinesia in patients on optimized dopaminergic therapy.

Answer 63

apomorphine hydrochloride (Apokyn)

Question 64

Apomorphine + Serotonin antagonists can cause

Answer 64

severe hypotension

Question 65

Overdosage of amantadine for PD can produce what adverse effect?

Answer 65

acute toxic psychosis

Question 66

COMT inhibitor for PD that may cause an increase in liver enzyme levels and has been associated rarely with death from acute hepatic failure

Answer 66

Tolcapone

Question 67

A humanized IgG4 that inhibits the α4-mediated adhesion of leukocytes to their cognate receptor. It is indicated for patients with multiple sclerosis and Crohn’s disease who have not tolerated or had inadequate responses to conventional treatments.

Answer 67

Natalizumab