Pharmacotherapy

Question 1

Indications for anxiolytics include:
1) Generalized anxiety disorder
2) Panic disorder
3) Agoraphobia
4) Anxiety in depression
5) Autism
6) Agitation related to psychosis
7) Schizophrenia

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st, 2nd, 3rd, 4th and 6th answers are correct
C) only the 1st, 2nd, 3rd, 4th, 6th and 7th answers are correct
D) only the1st, 4th, 6th and 7th answers are correct
E) all of the answers are correct

Answer 1

B) only the 1st, 2nd, 3rd, 4th and 6th answers are correct

Question 2

Pharmacological agents not recommended for the long-term treatment of anxiety:
1) Antipsychotics
2) Barbiturates
3) Beta blockers
4) Partial agonists of 5-HT1A receptors
5) High-potency benzodiazepines
6) Dual-action antidepressants
7) SSRI antidepressants

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st, 2nd, 3rd, 4th and 6th answers are correct
C) only the 1st, 2nd, 3rd, 4th, 6th and 7th answers are correct
D) only the1st, 4th, 6th and 7th answers are correct
E) all of the answers are correct

Answer 2

A) only the 1st, 2nd and 3rd answers are correct

Question 3

Match the following characteristics with a benzodiazepine:
A) clonazepam
B) midazolam
C) both of the above
D) none of the above

PSY - 5.4.1 - its antagonist is flumazenil
PSY - 5.4.2 - its elimination half-life is app. 30-40 hours
PSY - 5.4.3 - high-potency benzodiazepine
PSY - 5.4.4 - indicated for the treatment of depression
PSY - 5.4.5 - indicated for the short-term treatment (max. 2 weeks) of severe insomnia

Answer 3

1- C
2- A
3- A
4- D
5- B

Question 4

How is this clinical syndrome called?
A 35-year-old woman has been taking 0.5 mg alprazolam 3 times a day for her anxiety symptoms for 3 months. As she has recovered and fears that becomes dependent, stops taking medication. Then, anxiety symptoms come back in a more severe form and sleep disturbances occur.
A) Benzodiazepine withdrawal
B) Rebound phenomenon
C) Relapse
D) Panic disorder

Answer 4

B) Rebound phenomenon

Question 5

Which of the following treatment options would you use in this case?
A 35-year-old woman has been taking 0.5 mg alprazolam 3 times a day for her anxiety symptoms for 3 months. As she has recovered and fears that becomes dependent, stops taking medication. Then, anxiety symptoms come back in a more severe form and sleep disturbances occur.
1) Readministration of the original dose of alprazolam and then slow dose reduction (10-25% weekly).
2) Switch to another benzodiazepine with longer elimination half-life (e.g. clonazepam) and then slow dose reduction.
3) Psychoeducation and teaching of relaxing methods (e.g. autogenic training).
4) Readministration of alprazolam and initiation of an SSRI or dual-action antidepressant for the long-term treatment of anxiety disorder and then slow dose reduction and discontinuation of benzodiazepine.

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 5

A) only the 1st, 2nd and 3rd answers are correct

Question 6

Which one of the following is not a selective serotonin reuptake inhibitor (SSRI)?
A) fluoxetine
B) moclobemide
C) citalopram
D) sertraline
E) paroxetine

Answer 6

B) moclobemide

Question 7

Therapeutic blood concentration of lithium:
A) 0.1-0.2 mmol/l
B) 0.2-0.3 mmol/l
C) 0.5-1.0 mmol/l
D) 1.5-2.0 mmol/l
E) 2.0-3.0 mmol/l

Answer 7

C) 0.5-1.0 mmol/l

Question 8

What is the main reason for monitoring patients’ lithium concentration?
A) to control patients’ adherence and compliance
B) the therapeutic range and toxic lithium levels are very close
C) lithium is excreted rapidly form the body
D) lithium is more of a salt, rather than a medication
E) none of the statements above

Answer 8

B) the therapeutic range and toxic lithium levels are very close

Question 9

Toxic conditions caused by tricyclic antidepressants resemble this type of intoxication the most:
A) amphetamine intoxication
B) atropine intoxication
C) intoxication with barbiturates
D) barbiturate withdrawal syndrome
E) lithium intoxication

Answer 9

B) atropine intoxication

Question 10

Common side effects of selective serotonin reuptake inhibitors (SSRI):
1) delirium
2) sexual dysfunction (late ejaculation, anorgasmia)
3) epileptic seizures
4) nausea

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 10

C) only the 2nd and 4th answers are correct

Question 11

Mood stabilizers used for the treatment of bipolar disorder:
1) carbamazepine
2) valproic acid
3) lithium
4) lamotrigine

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 11

E) all of the answers are correct

Question 12

Characteristics of lithium intoxication:
1) tremor
2) confusion
3) diarrhoea
4) binge eating

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 12

A) only the 1st, 2nd and 3rd answers are correct

Question 13

Contraindication(s) of lithium:
1) simultaneous antipsychotic treatment
2) hypothyroidism
3) psychotic symptoms
4) renal failure

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 13

C) only the 2nd and 4th answers are correct

Question 14

Which of the following pharmacological and non-pharmacological treatments can elicit depressed mood as a side-effect?
1) interferon-alpha treatment
2) oral anticoncipient treatment
3) high dose steroid treatment
4) deep brain stimulation in Parkinson’s disorder

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 14

E) all of the answers are correct

Question 15

In which psychiatric disorders have been antidepressants (tricyclics and MAO inhibitors) shown to be efficacious?
1) bulimia
2) chronic pain syndrome
3) anxiety disorders
4) atypical depression

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 15

E) all of the answers are correct

Question 16

Selective serotonin reuptake inhibitor (SSRI) molecules have less severe side effects than most of the classic antidepressants, except in the case of:
1) delirium
2) blurred vision
3) dry mouth
4) hypotension
5) dysuria

A) only the 1st, 3rd and 5th answers are correct
B) only the 2nd and 4th answers are correct
C) all of the answers are correct
D) none of the answers is correct

Answer 16

D) none of the answers is correct

Question 17

Lithium carbonate treatment is effective in:
1) treatment of acute mania
2) treatment of schizoaffective disorder, manic type
3) maintenance treatment of bipolar disorder, prevention of recurring mania
4) treatment of dementia

A) only the 1st, 2nd and 3rd answers are correct
B) only the 2nd and 4th answers are correct
C) only the 1st and 3rd answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 17

A) only the 1st, 2nd and 3rd answers are correct

Question 18

Selective serotonin reuptake inhibitor (SSRI) antidepressants have been shown to be effective in these psychiatric disorders:
1) bulimia
2) affective disorders
3) obsessive-compulsive disorder (OCD)
4) panic disorder

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 18

E) all of the answers are correct

Question 19

Which of the following side effects are not typical for treatment with tricyclic antidepressants?
1) dry mouth
2) action tremor
3) obstipation
4) extrapyramidal movement disorders (dystonia, resting tremor, rigidity)

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 19

D) only the 4th answer is correct

Question 20

Anticholinergic side effects caused by tricyclic antidepressants occur at high frequency in elderly patients:
1) tachycardia
2) obstipation
3) urinary retention
4) blurred vision

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 20

E) all of the answers are correct

Question 21

Side effects of tricyclic antidepressants:
1) hypertension
2) dry mouth
3) diarrhoea
4) blurred vision

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 21

C) only the 2nd and 4th answers are correct

Question 22

Categorize these antidepressants along the listed pharmacological subgroups!
A) Selective serotonin reuptake inhibitor (SSRI)
B) Tricyclic antidepressant (TCA)
C) Reversible monoaminoxidase inhibitor (RIMA or MAOI)
D) Noradrenergic and specific serotonergic antidepressant (NaSSA)
E) Selective serotonin-noradrenaline reuptake inhibitor (SNRI)

PSY - 5.24.1 - moclobemide
PSY - 5.24.5 - mirtazapine
PSY - 5.24.4 - sertraline
PSY - 5.24.3 - amitriptiline
PSY - 5.24.2 - venlafaxine

Answer 22

1- C
2- E
3- B
4- A
5- D

Question 23

What is the pharmacological base of the therapeutic effect of typical antipsychotics?
A) They are agonists of dopamine receptors in the mesolimbic pathway (excitement).
B) They are antagonists of dopamine receptors in the nigrostriatal pathway (inhibition).
C) They are antagonists of dopamine receptors in the tuberoinfundibular pathway (inhibition).
D) They are antagonists of dopamine receptors in the mesolimbic pathway (inhibition).
E) They are antagonists of dopamine receptors in the mesocortical pathway (inhibition).

Answer 23

D) They are antagonists of dopamine receptors in the mesolimbic pathway (inhibition).

Question 24

The following antipsychotic is a partial agonist at the dopamine D2 receptor:
A) clozapine
B) haloperidol
C) aripiprazole
D) risperidone
E) olanzapine

Answer 24

C) aripiprazole

Question 25

The following are to be monitored regularly when administering antipsychotic medication except for:
A) complete blood count
B) blood lipids
C) body weight
D) thyroid hormones
E) transaminases, gamma-glutamyl transferase

Answer 25

D) thyroid hormones

Question 26

The following is/are the symptoms of neuroleptic malignant syndrome (NMS):
1) hyperthermia
2) muscular rigidity
3) confusion
4) hyperprolactinaemia

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 26

A) only the 1st, 2nd and 3rd answers are correct

Question 27

The following adverse effects of antipsychotics may need emergency treatment:
1) acute dystonia
2) akathisia
3) oculogyric crisis
4) neuroleptic malignant syndrome

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 27

E) all of the answers are correct

Question 28

Every typical antipsychotic needs to be switched to an atypical one in the case of the following:
1) extrapyramidal neurological adverse effects
2) positive past pharmacological history for serotonin syndrome
3) absence of improvement
4) noncompliance
5) positive past history for leukopenia

A) only the 1st, 2nd and 3rd answers are correct
B) only the 1st and 3rd answers are correct
C) only the 2nd and 4th answers are correct
D) only the 4th answer is correct
E) all of the answers are correct

Answer 28

B) only the 1st and 3rd answers are correct

Question 29

Which drug is indicated in the following disorders? Match an indication with a drug.
A) clozapine
B) risperidone
C) citalopram

PSY - 5.33.1 - depression
PSY - 5.33.2 - agitated psychosis
PSY - 5.33.3 - acute mania
PSY - 5.33.4 - treatment-resistant schizophrenia

Answer 29

1- C
2- B
3- B
4- A

Question 30

Which drug is the most likely to cause the following adverse effects? Match an adverse effect with a drug.
A) aripiprazole
B) clozapine
C) sertindole
D) haloperidol

PSY - 5.34.5 - metabolic syndrome
PSY - 5.34.4 - tardive dyskinesia
PSY - 5.34.2 - acute dystonia
PSY - 5.34.1 - leukopenia
PSY - 5.34.3 - QT prolongation

Answer 30

1- B
2- D
3- C
4- D
5- B

Question 31

Which psychopharmacological group do the following psychiatric drugs belong to? Match a drug with a psychopharmacological group.
A) first generation (typical) antipsychotics
B) second generation (atypical) antipsychotics
C) antidepressants
D) anxiolytics

PSY - 5.35.1 - risperidone
PSY - 5.35.2 - alprazolam
PSY - 5.35.3 - quetiapine
PSY - 5.35.4 - paroxetine
PSY - 5.35.5 - trazodone
PSY - 5.35.6 - amisulpride
PSY - 5.35.7 - haloperidol

Answer 31

1- B
2- D
3- B
4- C
5- C
6- B
7- A

Question 32

What may cause the symptoms?
A young man was involuntarily admitted to a closed psychiatric hospital ward. He was extremely agitated and excited. He reported command hallucinations which made him feel intensely anxious. 10 mg of haloperidol (IM) was administered as short-term treatment, later he was given 3x4 mg (solution) of haloperidol daily. Following a transient improvement of 3 days, he reported muscular discomfort, relentless pace, intensifying agitation, insomnia despite drowsiness.

A) recurrence of hallucinations
B) akathisia
C) worsening anxiety as a result of persistent hallucinations
D) tension as a result of being closed in
E) acute dyskinesia

Answer 32

B) akathisia

Question 33

Which therapeutic intervention is contraindicated in this case?
A young man was involuntarily admitted to a closed psychiatric hospital ward. He was extremely agitated and excited. He reported command hallucinations which made him feel intensely anxious. 10 mg of haloperidol (IM) was administered as short-term treatment, later he was given 3x4 mg (solution) of haloperidol daily. Following a transient improvement of 3 days, he reported muscular discomfort, relentless pace, intensifying agitation, insomnia despite drowsiness.
A) decreasing the dosage of haloperidol
B) administering a beta blocker
C) giving clonazepam as adjuvant treatment
D) increasing the dosage of haloperidol
E) administering anticholinergics

Answer 33

D) increasing the dosage of haloperidol

Question 34

Cognitive symptoms of secondary dementias improve greatly with the following therapy:
A) treating behavioural symptoms
B) acethylcholinesterase inhibitor therapy
C) Vitamin C
D) treating the underlying disease

Answer 34

D) treating the underlying disease

Question 35

Which of the following has a proven effect on the progression of Alzheimer’s disease?
1) Vitamin C
2) acetylcholinesterase inhibitors (donepezil, rivastigmine)
3) anti-inflammatory drugs
4) partial NMDA-receptor antagonist (memantine)

A) answers 1, 2, and 3 are correct.
B) answers 1, and 3 are correct
C) answers 2, and 4 are correct.
D) only answer 4 is correct.
E) all answers are correct.

Answer 35

C) answers 2, and 4 are correct.

Question 36

Which of the following drugs are used in vascular dementia, although their effect is not evidence-based?
1) piracetam
2) gingko biloba
3) nicergoline
4) lemongrass extract

A) answers 1, 2, and 3 are correct.
B) answers 1, and 3 are correct
C) answers 2, and 4 are correct.
D) only answer 4 is correct.
E) all answers are correct.

Answer 36

A) answers 1, 2, and 3 are correct.

Question 37

Match the diagnoses with the therapies!
A) AChE inhibitors
B) L-DOPA
C) L-thyroxin
D) nootropics

PSY - 5.52.1 - dementia in Parkinson’s disease
PSY - 5.52.2 - vascular dementia
PSY - 5.52.3 - Alzheimer’s disease
PSY - 5.52.4 - dementia in hypothyroidism

Answer 37

1- B
2- D
3- A
4- C

Question 38

Antipsychotics may have the following central anticholinergic adverse effects except for:
A) drowsiness
B) hyperthermia
C) myoclonus
D) mydriasis
E) delirium

Answer 38

D) mydriasis