Quiz 3 Andrea's Quiz Antipsychotics Antidepressants Anesthetics & Opioids

Question 1

Isoflurane and halothane are good examples of volatile liquid general anesthetics. Which of the following statements best compares or contrasts their actions?
A. Halothane is associated with a higher risk of hepatic toxicity, especially in patients who have been anesthetized with this drug before.
B. Halothane and Isoflurane typically raise BP, via direct vasoconstrictor effects.
C. Isoflurane sensitizes the myocardium to the arrhythmmogenic effects of catecholamines much more than halothane does.
D. Isoflurane prolongs the QT interval (ventricular repolarization), and is associated with a much higher risk of causing potentially fatal ventricular tachyarrhythmias, than halothane.
E. Use of Isoflurane for balanced anesthesia requires adjunctive use of nitrous oxide and neuromuscular blockers, use of halothane does not.

Answer 1

A. Halothane is associated with a higher risk of hepatic toxicity, especially in patients who have been anesthetized with this drug before.

Question 2

A patient has been taking an oral monoamine oxidase inhibitor MAOI, but the fact is unknown to the health team who is now taking care of her, for unrelated medical conditions in the hospital. The patient receives a drug that leads to a fatal response characterized by profound fever, delirium, psychotic behavior, and status epileptics. It was found to have occurred because of an interaction with the MAO. Which of the following drugs, or class of drugs, was most likely administered by the attending health team?
A. Pehytoin
B. Diazepam
C. Meperidine
D. A Barbiturate
E. Morphine

Answer 2

C. Meperidine

Question 3

A young boy is diagnosed with asthma. His primary symptom is frequent cough, not bronchospasm or wheezing. Other asthma medications are started, but until their effects develop fully we wish to suppress the cough without running a risk of suppressing ventilatory drive or causing sedation or other unwanted effects. Which of the following would best meet these needs?
A. Dextromethorphan
B. Codeine
C. Hydrocodone
D. Diphenhydramine
E. Promethazine

Answer 3

A. Dextromethorphan

Question 4

A 20 year old man is brought to the ER by his girlfriend after she found him unconscious in the bathroom of his apartment. He smokes 20 cigarettes a day and has a history of methamphetamine, cocaine, and heroin use. Temperature is 36.4° HR is 71 beats/min, respirations are 9 breaths/min, BP is 94/56 mm Hg, and oxygen saturation is 92%. Physical examination shows pinpoint pupils. Which of the following is the mechanism of action of the antidote that will be given to this patient?
A. Production of glutathione reserves.
B. Competitive binding with sulfhydryl groups on ions
C. Binding ot benzodiazepine receptors
D. Antagonism of opioid receptors
E. Interaction with alcohol dehydrogenase.

Answer 4

D. Antagonism of opioid receptors

Morphine(full agonist) OD = Antidote: Naloxone (Opioid receptor antagonist)

Question 5

A 36 y/o man complains to his physician of an inability to concentrate on his work, diminished interest in social and recreational activities, difficulty sleeping, and a general feeling of hopelessness. After a thorough evaluation, his physician prescribes psychotherapy and medication. Four weeks later, the man returns to his physician indicating that his symptoms have improved but that he is experienced delayed ejaculation and anorgasmmia. The drug prescribed for this patient most likely acts by which mechanism?
A. Blockade of presynaptic receptors
B. Inhibition of neuronal reuptake of Dopamine
C. Inhibition of neuronal repute of norepinephrine
D. Inhibition of neuronal repute of serotonin
E. Inhibition of monoamine oxidase

Answer 5

D. Inhibition of neuronal repute of serotonin

AE of SSRIs which include Fluoxetine, Paroxetine, Fluvoxamine, Citalopram and Sertraline are
Anxiety
Agitation (may need sedative)
Bruxism
Sexual dysfunction(anorgasmia)
Seizures(in OD).
Weight loss but regained after 12 months treatment

Question 6

34 A 29 y/o patient is taking antidepressant. He complains of feeling jittery and agitated at times and if he takes his medication in the afternoon he finds it difficult to get to sleep at night. He seems to have lost weight during the 6 months that he has been taking the drug. He has been warned not to take other drugs without consultation because severe reactions occurreed with opioid analgesics. The patient is probably taking
A. Alprazolam
B. Paroxetine
C. Trazodone
D. Bupropion
E. CHhlorpromazine

Answer 6

B. Paroxetine

Question 7

A 51 y/o woman with symptoms of major depression also has narrow-angle glaucoma. Which of the following should be avoided this patient?
A. Sertraline
B. Mirtazepine
C. Amitriptyline
D. Fluvoxamine
E. Bupropion

Answer 7

C. Amitriptyline

Question 8

A 25 y/o woman had a long history of depressive symptoms accompanied by body aches. Physical and laboratory tests were unremarkable. Which of the following drugs might be useful in this patient?
A. Duloxetine
B. Sertraline
C. Phenelzine
D. Mirtazapine
E. Fluoxetine

Answer 8

A. Duloxetine

Question 9

A patient has frequent facial tics and spontaneous outburst of foul language (coprolalia). Which of the following drugs would most likely be and probably most efficacious and safe initial treatment for this, assuming no specific contraindications to using it?
A. Clozapine
B. Levodopa
C. Phenpbarbital
D. Methylphenidate
E. Haloperidol

Answer 9

E. Haloperidol

Question 10

A 36 y/o man presents with symptoms of compulsive behavior. He must repeatedly align and realign the items on his desk thoughout the day. If anything is out of order he feels that "work will not be accomplished effectively or efficiently." He realized that his behavior is interfering with his ability to accomplish his daily tasks, but cannot seem to stop himself, Which of the following drugs would be most helpful to this patient?
A. Clozapine
B. Fluvoxamine
C. Phenobarbital
D. Methylphenidate
E. Haloperidol

Answer 10

B. Fluvoxamine

Question 11

A 51 y/o woman requires drug therapy for major depression. Her records indicate that she is currently being treated with Guanethidine for hypertension. Which agent would be appropriate for the patient's mood disorder but would most likely interfere with or antagonize her antihypterensive therapy?
A. Carbamazepine
B. Haloperidol
C. Midazolam
D. Nortriptyline
E. Sertraline

Answer 11

D. Nortriptyline

Question 12

Anesthesia protocols for day surgery may include sevoflurane because recovery from this agent is more rapid than that for older inhaled anesthetics. Rapid recovery from anesthesia with sevoflurane is associated with its
A. Redistribution from brain to skeletal muscle
B. Low MAC value
C. Rapid metabolism of liver enzymes
D. Low blood-gas partition coefficient
E. None of the above

Answer 12

D. Low blood-gas partition coefficient

Question 13

A patient develops profound fever, skeletal muscle rigidity, and autonomic and systemic electrolyte imbalances as part of a severe adverse response to psychoactive drug. The working diagnosis is neuroleptic malignant syndrome. In addition to adminstering dantrolene in an attempt to restore some resemblance of normal skeletal muscle function, which of the following other drugs is most likely to be given to help provide additional symptom relief?
A. Naloxone
B. Bromocriptine
C. Flumazenil
D. Diazepam
E. Benztropine
F. Propranolol?

Answer 13

B. Bromocriptine

Question 14

A 55 y/o teacher began to experience changes in mood. He was losing interest in his work and lacked the desire to play his daily tennis match. He began to have difficult thinking and concentrating and lacked decisiveness. He was preoccupied with feelings of guilt, worthlessness, and hopelessness. In addition to the psychiatric symptoms, the patient complained of muscle aches throughout his body. Physical and laboratory tests were unremarkable. After six weeks of therapy with fluoxetine, the patients symptoms resolve. However, that patient complains of sexual dysfunction. Which of the following drugs might be useful in this patient?
A. Lithium
B. Sertraline
C. Paroxetene
D. Fluvoxamine
E. Mirtazapine

Answer 14

E. Mirtazapine

Question 15

A 55 y/o hospitalized man who has not responded to first-line antidepressant medications is being treated with a drug considered to be a second line treatment for depression. The hospital staff has been advised not to give him and foods containing tyramine. Tyramine is an indirect acting amine found in dietary sources such as cheese, preserved sausages, and wine. The amine stimulates the sympathetic response by releasing norepinephrine from the synaptic vesicles. Which of the following antidepressant drugs was most likely prescribed to treat this patient?
A. Escitalopram
B. Bupropion
C. Imipramine
D. Buspirone
E. Tranylcypromine

Answer 15

E. Tranylcypromine

Question 16

About one year ago you diagnosed schizophrenia signs and symptoms in a 23 y/o otherwise healthy man. As a result of intensive psychotherapy, careful titration of chlorpromazine dosages, and remarkably good compliance on the patient’s part, he is well enough to return to work. Several months later at a scheduled visit, you observe numerous S/S of drug induced parkinsonism, and the patient reports rather distressing symptoms of akathisias. However, he states no recurrences of schizophrenia manifestations. Which of the following approves is most likely to alleviate the motor an subjective parkinsonian responses, and poses the lowest risk of causing schizophrenia signs and symptoms to reappear?
A. Add a centrally acting cholinesterase inhibitor (e.g., donepezil or tacrine
B. Add levodopa or levodopa plus carbidopa
C. Add benztropine
D. Switch from chlorpromazine to haloperidol
E. Add a catechol-O-methyltransferase inhibitor (e.g., tolcapone)

Answer 16

C. Add benztropine

Question 17

A patient suffering from bipolar affective disorder becomes pregnant. A drug that has been shown to have some clinical value in alleviated BAD symptoms and that is unlikely to cause problems regarding fetal development is?
A. Carbamezepine
B. Clonazepam
C. Valproic acid
D. Phenytoin
E. Methylphenidate

Answer 17

B. Clonazepam

Question 18

A 33 y/o female patient treated with haloperidol for a hx of schizophrenia is seen in the ED because of complaints of fever, stiffness, and tremor. Her temperature is 104°F, and her serum creatine kinase (CK) level is elevated. What has occurred?
A. Overdose
B. Parkinsonism
C. Allergy
D. Tardive Dyskinesia
E. Neuroleptic malignant syndrome (NMS)

Answer 18

E. Neuroleptic malignant syndrome (NMS)

Question 19

Which of the following drugs is a full agonist at opioid receptors; has excellent oral bioavailability, analgesic activity equivalent to that of morphine, and a longer duration of action; and milder withdrawal signs on abrupt D/C than morphine?
A. Nalbuphine
B. Oxycodone
C. Fentanyl
D. Methadone
E. Propoxyphene

Answer 19

D. Methadone

Question 20

A 45 y/o male with alcoholic cirrhosis is seen in the ED because of a laceration of the scalp. Of the following local anesthetics, which would be potentially toxic?
A. Chlor Procaine
B. Benzocaine
C. Tetracaine
D. Lidocaine
E. Procaine

Answer 20

D. Lidocaine

Question 21

A patient is transported to your emergencey department because of a seizure. A review of his history reveals that he has been treated by different physicians for different medical conditions, and there has ben no dialog between the two doctors in terms of what they've prescribed. One physicians has prescribed a drug for short term management of depression. Another has prescribed the very same drug to help the patient quit smoking cigarettes. Which of the following was most likely prescribed by both doctors, and was the most likely cause of the seizures?
A.Lithium
B. Fluoxetine
C. Chlordiazepoxide
D. Imipramine
E. Bupropion

Answer 21

E. Bupropion

Question 22

A patient has been diagnosed has having caridiotoxicity. Which of the following drugs used in the management of psychosis is most likely to cause the cardiotoxicity?
A. Thioridazine
B. Diazepam
C. Fluoxetine
D. Ethosuximide
E. All of the above

Answer 22

A. Thioridazine

Question 23

A patient is on long-term methadone therapy as part of a holistic plan to curb the opioid addiction and abuse. Which of the following best describes a characteristic of this drug?
A. Causes pentazocine-like activation of receptors and blockade of receptors
B. Remarkably devoid of such typical opioid analgesic side effects as constipation and respiratory depression
C. Has greater oral bioavailability than morphine, especially when oral administration is started
D. When abruptly stopped after long-term administration, causes a withdrawal syndrome that is more intense, but briefer, than that association with morphine or heroin withdrawal

Answer 23

C. Has greater oral bioavailability than morphine, especially when oral administration is started

Question 24

26 y/o woman with depression has been on antidepressant therapy for several months. Today she complains of missing her period and having galactorrhea, and your careful assessment suggests she has developed some dyskinesias not unlike those you would typically associate with a phenothiazine or butyrophenone (haloperidol) antipsychotic drug. Pregnancy tests are negative. Which of the following is most likely to have caused these findings?
A. Amoxapine
B. Tranylcypromine
C. Citalopram
D. Sertraline
E. Fluoxetine

Answer 24

A. Amoxapine

Question 25

A 31 y/o man with schizophrenia is evaluated because of signs of tradeoff dyskinesia. He has been treated with several different medications to control his schizophrenia during the past several years. His physician stops treatment with his current medication and prescribes Clozapine 25 mg. He is currently taking no other medications. This patient is most likely to require special monitoring and surveillance due to the potential of Clozapine to cause which of the following adverse effects?
A. Agranulocytosis
B. Seizures
C. Orthostatic HTN
D. QT prolongation
E. Diabetes

Answer 25

A. Agranulocytosis