Psychiatry - Pharmacotherapy Flashcards by Moh Khosh

PSY - 5.1
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
B) only the 1st, 2nd, 3rd, 4th and 6th answers are correct
EXPLANATION
Benzodiazepines are regularly used in the treatment of anxiety disorders and anxiety symptoms and/or agitation related to other mental disorders. They are not indicated for the treatment of the primary symptoms of autism or schizophrenia.

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PSY - 5.3
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

ANSWER
A) only the 1st, 2nd and 3rd answers are correct
EXPLANATION
Antipsychotics have no specific anxiolytic effect. Barbiturates are out of use due to their hepatotoxic effect and high abuse potential. Beta blockers have indication only for the treatment of occasional social phobia.

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PSY-5.4.1-5.4.5
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
PSY - 5.4.1 - its antagonist is flumazenil - C)

PSY - 5.4.2 - its elimination half-life is app. 30-40 hours - A)

PSY - 5.4.3 - high-potency benzodiazepine - A)

PSY - 5.4.4 - indicated for the treatment of depression - D)

PSY - 5.4.5 - indicated for the short-term treatment (max. 2 weeks) of severe insomnia - B)

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PSY - 5.5
How is this clinical syndrome called?

ANSWER
B) Rebound phenomenon
EXPLANATION
The presence of anxiety symptoms more severe than the original symptoms refers to rebound phenomenon (and not to relapse) due to the sudden discontinuation of medication. Other symptoms referring to withdrawal (sweating, tremor, tachycardia) are not present.

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PSY - 5.6
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
A) only the 1st, 2nd and 3rd answers are correct
EXPLANATION
As it is rebound phenomenon, the initiation of long-term treatment is not indicated. Rebound symptoms can be prevented with slower dose reduction or the administration of another agent with longer half-life. Relaxing methods can help to reduce the present symptoms. Psychoeducation can help the patient to know the effective use and the risks of sudden discontinuation of a medication.

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PSY - 5.7
Which one of the following is not a selective serotonin reuptake inhibitor (SSRI)?

A) fluoxetine
B) moclobemide
C) citalopram
D) sertraline
E) paroxetine

ANSWER
B) moclobemide
EXPLANATION
Moclobemide is a reversible monoaminoxidase inhibitor (RIMA or MAOI).

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PSY - 5.8
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
C) 0.5-1.0 mmol/l
EXPLANATION
The therapeutic concentration of lithium is in the range of 0.5-1.0 mmol/l, below this level it is ineffective, and above this it is toxic.

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PSY - 5.9
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
B) the therapeutic range and toxic lithium levels are very close
EXPLANATION
The regular monitoring of blood lithium concentration. is necessary because the therapeutic range and toxic concentrations are very close, higher than optimal doses or any type of dysfunction of the body fluid balance can lead to toxic lithium levels and serious adverse events.

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PSY - 5.10
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
B) atropine intoxication
EXPLANATION
Due to the anticholinergic effects, intoxication caused by tricyclic antidepressants resembles atropine intoxication.

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PSY - 5.11
Common side effects of selective serotonin reuptake inhibitors (SSRI):

1) delirium
2) sexual dysfunction (late ejaculation, anorgasmia)
3) epileptic seizures
4) nausea

ANSWER
C) only the 2nd and 4th answers are correct
EXPLANATION
delirium and epileptic seizures are very severe adverse events which don’t occur due to SSRI treatment. Sexual dysfunction and nausea are typical, less severe side effects.

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PSY - 5.12
Mood stabilizers used for the treatment of bipolar disorder:

1) carbamazepine
2) valproic acid
3) lithium
4) lamotrigine

ANSWER
E) all of the answers are correct
EXPLANATION
Both lithium and mood stabilizing antiepileptic medications are used for the maintenance treatment of bipolar disorder.

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PSY - 5.13
Characteristics of lithium intoxication:

1) tremor
2) confusion
3) diarrhoea
4) binge eating

ANSWER
A) only the 1st, 2nd and 3rd answers are correct
EXPLANATION
Tremor and diarrhoea are very typical for lithium intoxication, at higher concentrations confusion and altered consciousness (coma) are also observable

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PSY - 5.15
Contraindication(s) of lithium:

1) simultaneous antipsychotic treatment
2) hypothyroidism
3) psychotic symptoms
4) renal failure

ANSWER
C) only the 2nd and 4th answers are correct
EXPLANATION
Psychotic symptoms and antipsychotic treatment are not contraindications; patients treated with lithium often are characterized by these conditions. Hypothyroidism and renal failure can be chronic side effects of lithium treatment, and lead to additional somatic symptoms. Pre-existing renal failure would lead to toxic lithium doses.

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PSY - 5.16
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

ANSWER
E) all of the answers are correct
EXPLANATION
All of these treatments can result in depressed mood as a side effect.

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PSY - 5.17
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

ANSWER
E) all of the answers are correct
EXPLANATION
Antidepressant drugs have shown efficacy in all of these disorders; bulimia, chronic pain syndromes, anxiety disorders, and atypical depression.

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PSY - 5.19
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
A) only the 1st, 2nd and 3rd answers are correct
EXPLANATION
Lithium influences ion transport through biological membranes, neurotransmission, and second messenger systems intracellularly. It specifically acts on elevated and instable mood. Lithium carbonate is effective both for the treatment of acute mania and for maintenance treatment.

PSY - 5.20
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

ANSWER
E) all of the answers are correct
EXPLANATION
SSRI antidepressants show effectiveness not only in affective disorders, but also in bulimia, OCD, and other anxiety disorders, like panic disorder. The dysregulation of serotonin has been implicated in all of these disorders.

PSY - 5.21
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)

ANSWER
D) only the 4th answer is correct
EXPLANATION
Tricyclic antidepressants have no major effect on the dopaminergic pathways; therefore they cause extrapyramidal side effects very rarely.

PSY - 5.22
Anticholinergic side effects caused by tricyclic antidepressants occur at high frequency in elderly patients:

1) tachycardia
2) obstipation
3) urinary retention
4) blurred vision

ANSWER
E) all of the answers are correct
EXPLANATION
Anticholinergic side effects caused by tricyclic antidepressants, such as tachycardia, obstipation, urinary retention and blurred vision; occur more frequently in elderly patients.

PSY - 5.23
Side effects of tricyclic antidepressants:

1) hypertension
2) dry mouth
3) diarrhoea
4) blurred vision

ANSWER
C) only the 2nd and 4th answers are correct
EXPLANATION
Tricyclic antidepressants act by inhibiting the reuptake of serotonin and noradrenaline, but they also block alpha1 adrenergic, acetylcholine, and histamine 1 receptors. Anticholinergic effects are responsible for the dry mouth and blurred vision; the other two are not observable during TCA treatment.

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

ANSWER
PSY - 5.24.2 - venlafaxine - E)
PSY - 5.24.1 - moclobemide - C)
PSY - 5.24.5 - mirtazapine - D)
PSY - 5.24.4 - sertraline - A)
PSY - 5.24.3 - amitriptiline - B)

PSY - 5.25
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
D) They are antagonists of dopamine receptors in the mesolimbic pathway (inhibition).
EXPLANATION
According to the dopamine hypothesis of schizophrenia there is an increased dopaminergic neurotransmission in the limbic system and there is a decreased dopaminergic neurotransmission in the prefrontal cortex. The former accounts for the positive symptoms whereas the latter accounts for the negative and cognitive ones. The therapeutic effect of typical antipsychotics results from the blockade of dopaminergic receptors in the mesolimbic pathway. Inhibition of the nigrostriatal and the tuberoinfundibular pathways is responsible for adverse effects.

PSY - 5.27
The following antipsychotic is a partial agonist at the dopamine D2 receptor:

A) clozapine
B) haloperidol
C) aripiprazole
D) risperidone
E) olanzapine

ANSWER
C) aripiprazole
EXPLANATION
Aripiprazole is a partial agonist at the dopamine D2 receptor. At low levels of dopamine it has an agonist effect while at high levels it has an antagonist effect.

PSY - 5.29
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
D) thyroid hormones
EXPLANATION
It is recommended to check the levels of thyroid hormones at the initiation of treatment, but regular follow-up is only necessary when there are clinical symptoms.

PSY - 5.30 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 A) only the 1st, 2nd and 3rd answers are correct EXPLANATION hyperprolactinaemia is not a symptom of neuroleptic malignant syndrome.

PSY - 5.31 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 E) all of the answers are correct

PSY - 5.32 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 B) only the 1st and 3rd answers are correct EXPLANATION atypical antipsychotics are rarely associated with extrapyramidal neurological adverse effects and they address negative and affective symptomsas well

PSY-5.33.1-5.33.4 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 PSY - 5.33.1 - depression - C) PSY - 5.33.2 - agitated psychosis - B) PSY - 5.33.3 - acute mania - B) PSY - 5.33.4 - treatment-resistant schizophrenia - A)

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

PSY-5.35.1-5.35.7 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 PSY - 5.35.1 - risperidone - B) PSY - 5.35.2 - alprazolam - D) PSY - 5.35.3 - quetiapine - B) PSY - 5.35.4 - paroxetine - C) PSY - 5.35.5 - trazodone - C) PSY - 5.35.6 - amisulpride - B) PSY - 5.35.7 - haloperidol - A)

PSY - 5.36 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 B) akathisia EXPLANATION at the initiation of an antipsychotic treatment neuroleptic-induced acute akathisia may appear with characteristic symptoms of relentless pace movement, agitation and dysphoria.

PSY - 5.37 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 D) increasing the dosage of haloperidol EXPLANATION akathisia is an early adverse effect of antipsychotic medication which is not to be underdiagnosed just because the symptoms are attributed to psychosis. In akathisia the increase of the dosage of the antipsychotic is contraindicated.

PSY - 5.48 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 D) treating the underlying disease EXPLANATION The cause behind secondary dementias is an underlying disease, so the most effective treatment is that of the underlying disease.

PSY - 5.49 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 C) answers 2, and 4 are correct. EXPLANATION After one year of follow-up, the progression of Alzheimer's disease can be effectively slowed by acetylcholinesterase inhibitors and memantine.

PSY - 5.50 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 A) answers 1, 2, and 3 are correct. EXPLANATION Piracetam, nicergoline and gingko biloba products are recommended in treating vascular dementia because of their nootropic effect.

PSY-5.52.1-5.52.4 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 PSY - 5.52.1 - dementia in Parkinson's disease - B) PSY - 5.52.2 - vascular dementia - D) PSY - 5.52.3 - Alzheimer's disease - A) PSY - 5.52.4 - dementia in hypothyroidism - C)

PSY - 5.53 Antipsychotics may have the following central anticholinergic adverse effects except for: A) drowsiness B) hyperthermia C) myoclonus D) mydriasis E) delirium

ANSWER D) mydriasis EXPLANATION mydriasis is a common peripheral anticholinergic adverse effect of antipsychotics; therefore they are contraindicated in glaucoma.