psych: Pharmacotherapy (share)

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

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

1) Generalized anxiety disorder

2) Panic disorder

3) Agoraphobia

4) Anxiety in depression

6) Agitation related to psychosis

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.

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

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

1) Antipsychotics

2) Barbiturates

3) Beta blockers

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.

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

PSY - 5.4.1 - its antagonist is flumazenil - C) both of the above

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

PSY - 5.4.3 - high-potency benzodiazepine - A) clonazepam

PSY - 5.4.4 - indicated for the treatment of depression - D) none of the above

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

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

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.

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

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

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).

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.

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

A) fluoxetine

B) moclobemide

C) citalopram

D) sertraline

E) paroxetine

B) moclobemide

EXPLANATION

Moclobemide is a reversible monoaminoxidase inhibitor (RIMA or MAOI).

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

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.

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

B) atropine intoxication

EXPLANATION

Due to the anticholinergic effects, intoxication caused by tricyclic antidepressants resembles atropine intoxication.

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

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

2) sexual dysfunction (late ejaculation, anorgasmia)

4) nausea

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.

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

E) all of the answers are correct

1) carbamazepine

2) valproic acid

3) lithium

4) lamotrigine

EXPLANATION

Both lithium and mood stabilizing antiepileptic medications are used for the maintenance treatment of bipolar disorder.

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

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

1) tremor

2) confusion

3) diarrhoea

EXPLANATION

Tremor and diarrhoea are very typical for lithium intoxication, at higher concentrations confusion and altered consciousness (coma) are also observable.

Contraindication(s) of lithium:

1) simultaneous antipsychotic treatment

2) severe 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

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

2) severe hypothyroidism

4) renal failure

EXPLANATION

Psychotic symptoms and antipsychotic treatment are not contraindications; patients treated with lithium often are characterized by these conditions. Severe 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

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

E) all of the answers are correct

1) interferon-alpha treatment

2) oral anticoncipient treatment

3) high dose steroid treatment

4) deep brain stimulation in Parkinson's disorder

EXPLANATION

All of these treatments can result in depressed mood as a side effect.

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

E) all of the answers are correct

1) bulimia

2) chronic pain syndrome

3) anxiety disorders

4) atypical depression

EXPLANATION

Antidepressant drugs have shown efficacy in all of these disorders; bulimia, chronic pain syndromes, anxiety disorders, and atypical depression.

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

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

1) treatment of acute mania

2) treatment of schizoaffective disorder, manic type

3) maintenance treatment of bipolar disorder, prevention of recurring mania

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.

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

E) all of the answers are correct

1) bulimia

2) affective disorders

3) obsessive-compulsive disorder (OCD)

4) panic disorder

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.

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 - 5.24.2 - venlafaxine

PSY - 5.24.3 - amitriptiline

PSY - 5.24.4 - sertraline

PSY - 5.24.5 - mirtazapine

PSY - 5.24.1 - moclobemide - C) Reversible monoaminoxidase inhibitor (RIMA or MAOI)

PSY - 5.24.2 - venlafaxine - E) Selective serotonin-noradrenaline reuptake inhibitor (SNRI)

PSY - 5.24.3 - amitriptiline - B) Tricyclic antidepressant (TCA)

PSY - 5.24.4 - sertraline - A) Selective serotonin reuptake inhibitor (SSRI)

PSY - 5.24.5 - mirtazapine - D) Noradrenergic and specific serotonergic antidepressant (NaSSA)

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).

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.

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

A) clozapine

B) haloperidol

C) aripiprazole

D) risperidone

E) olanzapine

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.

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

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.

The following is/are the symptoms of neuroleptic malignant syndrome (NMS):

1) fever

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

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

1) fever

2) muscular rigidity

3) confusion

EXPLANATION

Hyperprolactinaemia is not a symptom of neuroleptic malignant syndrome.

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

E) all of the answers are correct

1) acute dystonia

2) akathisia

3) oculogyric crisis

4) neuroleptic malignant syndrome

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

PSY - 5.33.1 - depression - C) citalopram

PSY - 5.33.2 - agitated psychosis - B) risperidone

PSY - 5.33.3 - acute mania - B) risperidone

PSY - 5.33.4 - treatment-resistant schizophrenia - A) clozapine

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 - 5.34.1 - leukopenia

PSY - 5.34.2 - acute dystonia

PSY - 5.34.3 - QT prolongation

PSY - 5.34.4 - tardive dyskinesia

PSY - 5.34.5 - metabolic syndrome

PSY - 5.34.1 - leukopenia - B) clozapine

PSY - 5.34.2 - acute dystonia - D) haloperidol

PSY - 5.34.3 - QT prolongation - C) sertindole

PSY - 5.34.4 - tardive dyskinesia - D) haloperidol

PSY - 5.34.5 - metabolic syndrome - B) clozapine

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 - 5.35.3 - quetiapine

PSY - 5.35.7 - haloperidol

PSY - 5.35.6 - amisulpride

PSY - 5.35.5 - trazodone

PSY - 5.35.4 - paroxetine

PSY - 5.35.2 - alprazolam

PSY - 5.35.1 - risperidone

PSY - 5.35.3 - quetiapine - B) second generation (atypical) antipsychotics

PSY - 5.35.7 - haloperidol - A) first generation (typical) antipsychotics

PSY - 5.35.6 - amisulpride - B) second generation (atypical) antipsychotics

PSY - 5.35.5 - trazodone - C) antidepressants

PSY - 5.35.4 - paroxetine - C) antidepressants

PSY - 5.35.2 - alprazolam - D) anxiolytics

PSY - 5.35.1 - risperidone - B) second generation (atypical) antipsychotics

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 movement, 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

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.

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 movement, 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

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.

Cognitive symptoms of secondary dementias improve greatly with the following therapy:

A) treating behavioural symptoms

B) memantine therapy

C) Vitamin C

D) treating the underlying disease

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. Memantine can be recommended in moderate to severe Alzheimer's disease.

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.

C) answers 2, and 4 are correct.

2) acetylcholinesterase inhibitors (donepezil, rivastigmine)

4) partial NMDA-receptor antagonist (memantine)

EXPLANATION

The progression of Alzheimer's disease can be effectively slowed by acetylcholinesterase inhibitors and memantine.

In the presence of age-related mental decline and to improve the quality of life, mild dementia can be recommended:

1) alprazolam

2) memantine

3) clonazepam

4) ginkgo biloba

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.

D) only answer 4 is correct.

4) ginkgo biloba

EXPLANATION

Ginkgo biloba can be recommended for age-related mental decline and to improve the quality of life in the presence of mild dementia. Memantine can be recommended in moderate to severe Alzheimer's disease.

Match the diagnoses with the therapies.

A) AChE inhibitors

B) L-DOPA

C) L-thyroxin

D) nootropics

PSY - 5.52.1 - Parkinson's disease

PSY - 5.52.2 - vascular dementia

PSY - 5.52.3 - Alzheimer's disease

PSY - 5.52.4 - dementia in hypothyroidism

PSY - 5.52.1 - Parkinson's disease - B) L-DOPA

PSY - 5.52.2 - vascular dementia - D) nootropics

PSY - 5.52.3 - Alzheimer's disease - A) AChE inhibitors

PSY - 5.52.4 - dementia in hypothyroidism - C) L-thyroxin