PSYCHOPHARMACOLOGY ULTIMATE EXAM Questions with 100% corrrect answers + rationales

Where is dopamine produced?

Substantia nigra and ventral tegmental area.

Where is serotonin produced?

Mostly in the Raphe nucleus.

Where is norepinephrine produced?

Locus ceruleus of the pons.

Where is epinephrine produced?

Adrenal glands.

Where is acetylcholine synthesized?

Basal Nucleus of Meynart.

What is the role of the cell body (soma) in a neuron?

Maintains the neuron and synthesizes proteins.

What is the function of dendrites?

Receive incoming signals from other neurons.

What is the function of the axon?

Transmits electrical impulses away from the cell body.

What is the role of the myelin sheath?

Insulates the axon and speeds up signal transmission.

What is the function of synaptic terminals?

Release neurotransmitters to send signals to the next neuron.

What is the G-protein linked system?

A signal transduction mechanism where a neurotransmitter activates a receptor linked to a G-protein, which in turn triggers intracellular events.

What are the key components of the G-protein linked system?

Receptor, G-protein, effector enzyme, and second messengers.

What is pharmacokinetics?

The study of how a drug is absorbed, distributed, metabolized, and excreted.

What is pharmacodynamics?

The study of how a drug affects the body, including receptor binding, post-receptor effects, and chemical interactions.

What factors affect pharmacokinetics?

Age, weight, liver function, kidney function, genetic factors, and drug interactions.

What factors affect pharmacodynamics?

Receptor sensitivity, genetic factors, tolerance, and the presence of other medications.

What is an agonist?

A substance that binds to a receptor and activates it, producing a biological response.

What is an antagonist?

A substance that binds to a receptor but does not activate it, blocking the action of an agonist.

What is a partial agonist?

A drug that binds to a receptor and produces a weaker, or partial, response compared to a full agonist.

What is an inverse agonist?

A drug that binds to the same receptor as an agonist but induces the opposite effect.

What is depolarization?

A change in a cell's membrane potential that makes it more positive, leading to the firing of an action potential.

What is repolarization?

The process of returning the membrane potential back to its resting state after depolarization.

What are the indications for methadone?

Opioid use disorder, chronic pain.

What are the contraindications for methadone?

Respiratory depression, acute asthma, and paralytic ileus.

What are the side effects of methadone?

Respiratory depression, constipation, nausea, and sedation.

What pharmacological agents are used for opioid withdrawal?

Buprenorphine, methadone, clonidine.

What non-pharmacological treatments are used for substance withdrawal?

Cognitive behavioral therapy, counseling, support groups.

What are common signs of alcohol withdrawal?

Tremors, agitation, sweating, hallucinations, seizures.

What are common signs of opioid withdrawal?

Muscle aches, insomnia, sweating, anxiety, yawning, runny nose.

What are the indications for Campral (Acamprosate)?

Maintenance of abstinence from alcohol in patients who are already abstinent.

What are the contraindications for Disulfiram?

Severe cardiac disease, psychosis, pregnancy.

What is a key side effect of Naltrexone?

Hepatotoxicity.

What patient education is needed for Disulfiram?

Avoid all alcohol-containing products (even in sauces, mouthwash, etc.) to prevent a disulfiram reaction.

What is Vivitrol indicated for?

Alcohol and opioid use disorder.

What are the contraindications for Vivitrol?

Acute hepatitis, liver failure, current opioid use.

What medications are used to treat cravings in substance use disorders?

Naltrexone, Acamprosate, Methadone, Buprenorphine.

What are P450 inducers?

Rifampin, carbamazepine, St. John's Wort.

What are P450 inhibitors?

Fluoxetine, grapefruit juice, ciprofloxacin.

What are typical (1st generation) antipsychotics used for?

Treatment of positive symptoms of schizophrenia (e.g., delusions, hallucinations).

What are atypical (2nd generation) antipsychotics used for?

Treatment of both positive and negative symptoms of schizophrenia.

What is a key side effect of typical antipsychotics?

Extrapyramidal symptoms (EPS).

What is a special consideration for atypical antipsychotics?

Risk of metabolic syndrome (weight gain, hyperglycemia, dyslipidemia).

What is the treatment for positive symptoms of schizophrenia?

Antipsychotics (dopamine antagonists).

What is the treatment for negative symptoms of schizophrenia?

Atypical antipsychotics, cognitive behavioral therapy.

What are the symptoms of EPS?

Tremors, rigidity, bradykinesia, tardive dyskinesia.

What treatments are available for EPS?

Anticholinergics like benztropine, dopamine agonists like amantadine.

What are the risk factors for developing EPS?

Use of typical antipsychotics, higher doses, prolonged use.

What is the FDA-approved medication for treating Tardive Dyskinesia?

Tetrabenazine.

How does tetrabenazine work in treating Tardive Dyskinesia?

It inhibits vesicular monoamine transporter 2 (VMAT2), reducing dopamine storage and release.

What are the key signs of Neuroleptic Malignant Syndrome (NMS)?

Hyperthermia, muscle rigidity, altered mental status, autonomic dysfunction.

What lab abnormalities are seen in NMS?

Increased creatine phosphokinase (CPK), white blood cell count (WBC), and liver function tests (LFTs).

What are the risk factors for NMS?

Use of antipsychotics, dehydration, agitation, rapid dose increases.

What are the treatments for NMS?

Bromocriptine, dantrolene, cooling measures, and hydration.

How does NMS differ from Serotonin Syndrome?

NMS presents with mutism, muscle rigidity, dysphagia, and abnormal labs, whereas Serotonin Syndrome includes hyperreflexia, clonus, and no abnormal labs.

What are the off-label uses of Abilify?

Treatment of depression (adjunctive therapy), bipolar disorder, and irritability associated with autism.

What is a notable benefit of Abilify compared to other antipsychotics?

It has the lowest risk of sedation among all antipsychotics.

Which second-generation antipsychotic is least likely to cause weight gain?

Latuda.

What are the second and third best options for minimizing weight gain among second-generation antipsychotics?

Abilify (second), Geodon (third).

What is metabolic syndrome?

A cluster of conditions including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

What are the risk factors for developing metabolic syndrome?

Use of atypical antipsychotics, obesity, sedentary lifestyle.

What patient education is essential for managing metabolic syndrome?

Encourage regular physical activity, a healthy diet, and regular monitoring of blood glucose, cholesterol, and blood pressure.

Which medications increase the risk of galactorrhea?

Second-generation antipsychotics, especially Risperidone.

What is important to know about transitioning to Invega Long-Acting Injectable?

Follow specific guidelines for dosing and monitoring when transitioning from oral formulations to LAIs.

What are some examples of long-acting injectables used in psychiatry?

Relprevv, Risperdal Consta, Invega Sustenna, Invega Trinza, Aristada.

Which psychiatric medications carry black box warnings?

Antidepressants (for risk of suicide), antipsychotics (for increased mortality in elderly patients with dementia), and mood stabilizers like Lithium (toxicity risk).

What are the indications for SSRIs?

Depression, anxiety disorders, OCD, PTSD, panic disorder.

What are common side effects of SSRIs?

Sexual dysfunction, weight gain, nausea, insomnia.

What is the black box warning for SSRIs?

Increased risk of suicidal thoughts and behaviors in young adults.

What are contraindications for SSRIs?

Concurrent use of MAOIs, hypersensitivity to the drug.

What are the indications for SNRIs?

Depression, generalized anxiety disorder, chronic pain (fibromyalgia).

What are common side effects of SNRIs?

Increased blood pressure, sweating, insomnia, dizziness.

What is the black box warning for SNRIs?

Increased risk of suicidal thoughts and behaviors in young adults.

What are the key signs of Serotonin Syndrome?

Hyperreflexia, clonus, agitation, sweating, hyperthermia.

What is the treatment for Serotonin Syndrome?

Stop serotonergic drugs, administer cyproheptadine, supportive care.

What are the indications for MAOIs?

Atypical depression, treatment-resistant depression.

What are the contraindications for MAOIs?

Concurrent use of SSRIs, SNRIs, TCAs, and foods high in tyramine (e.g., aged cheeses, smoked meats).

What are common side effects of MAOIs?

Hypertensive crisis, orthostatic hypotension, insomnia.

What patient education is necessary for MAOIs?

Avoid foods high in tyramine, avoid over-the-counter decongestants, and recognize signs of hypertensive crisis.

What are the signs of a hypertensive crisis due to MAOIs?

Severe headache, nausea, vomiting, stiff neck, palpitations, elevated blood pressure.

What is the treatment for hypertensive crisis caused by MAOIs?

Stop the medication, administer phentolamine, and stabilize the patient's temperature.

What is the EMSAM transdermal patch?

A transdermal patch formulation of an MAOI (selegiline) used to treat depression.

What are the indications for TCAs?

Depression, chronic pain, insomnia, OCD (clomipramine).

What are the common side effects of TCAs?

Sedation, anticholinergic effects (dry mouth, constipation), weight gain, orthostatic hypotension.

What are the contraindications for TCAs?

History of cardiac arrhythmias, concurrent use of MAOIs.

What are the indications for Bupropion?

Depression, smoking cessation, ADHD (off-label).

What are common side effects of Bupropion?

Insomnia, dry mouth, weight loss, seizures (dose-dependent).

What are the contraindications for Bupropion?

Seizure disorders, bulimia, anorexia nervosa, abrupt discontinuation of alcohol or benzodiazepines.

What are the off-label uses of Bupropion?

ADHD, bipolar depression.

What are the FDA-approved medications for OCD?

Anafranil (Clomipramine) and Fluvoxamine.

What are the indications for Lithium?

Bipolar disorder, particularly in the prevention of manic and depressive episodes.

What are the side effects of Lithium?

Tremors, polyuria, hypothyroidism, weight gain.

What are the signs of early and late Lithium toxicity?

Early: nausea, vomiting, diarrhea. Late: confusion, ataxia, seizures.

What baseline labs should be obtained before starting Lithium?

Thyroid function tests, renal function tests, pregnancy test.

What is the therapeutic range for Lithium?

0.6-1.2 mEq/L.

How often should Lithium levels be monitored?

Every 4-5 days after starting or adjusting dose, then every 3-6 months.

Why is Lithium considered the gold standard for suicidality in bipolar disorder?

It reduces the risk of suicide in patients with bipolar disorder.

What medications are contraindicated with Lithium?

NSAIDs, ACE inhibitors, diuretics (can increase Lithium levels).

What labs need monitoring while on Lithium?

Leukocytosis (WBC), Creatinine, BUN, Sodium (Na+), thyroid function, urine protein, pregnancy test.

What are the indications for Depakote?

Bipolar disorder, epilepsy, migraine prevention.

What are the side effects of Depakote?

Weight gain, sedation, hair loss, hepatotoxicity, thrombocytopenia.