NU643 Advance Psychopharmacology
Week 15 Quiz
Question 1 A 28 y.o. male presents with a severe alcohol abuse problem and you are discussing pharmacotherapy as part of his treatment plan. You advise naltrexone and use which of the following statements to help with you explanation?
Select one:
a.Naltrexone blocks mu-opioid receptors to reduce the euphoria you might normally experience with heavy drinking.
b.Naltrexone blocks metabotropic glutamate receptors to reduce the euphoria you might normally experience with heavy drinking.
c.Naltrexone stimulates mu-opioid receptors to the euphoria you might normally experience with heavy drinking.
d.Naltrexone stimulates metabotropic glutamate receptors to the euphoria you might normally experience with heavy drinking.
: Blocking the mu-opioid receptors is thought to reduce the desire to engage in heavy drinking activity, because doing so will be associated with a reduced reward.
Question 2A 73-year-old male presents as a new patient with a history of long-term use of clonazepam 1mg QID. Which of the following actions is appropriate in the first visit?
Select one:
a.Continue with treatment plan already established by previous provider.
b.Initiate an immediate benzodiazepine taper.
c.Begin cross taper from clonazepam to dose equivalent diazepam.
d.Assess for safety, educate about the associated risks of benzodiazepines, begin discussion about tapering the medication, obtain and document informed consent.
Question 3A clinician is considering treatment options for a 28-year-old female with ADHD who has a history of alcohol and marijuana abuse. Which of the following statements accurately explains the effects of different stimulant formulations on neuronal firing?
Select one:
a.Pulsatile stimulation amplifies undesirable phasic dopamine and norepinephrine firing, which can lead to euphoria and abuse.
b.Immediate-release stimulants lead to tonic firing, which can lead to euphoria and abuse.
c.Tonic firing is the result of rapid receptor occupancy and fast onset of action as see with extended-release formulations
d.Extended-release formulations result in phasic stimulation of norepinephrine and dopamine signals, but this does not result in euphoria and abuse.
Question 4According to DSM-5 criteria, what is the maximum age threshold for symptom onset when determining a diagnosis of ADHD?
Select one:
a.5
b.7
c.12
d.15
Question 5 Based on the Carlat reading, "Diet and Mental Health," what dietary recommendations would be most useful for mental health patients?
Select one:
a.Recommendations to eliminate dietary fat.
b.Recommendations that patients choose foods that are labeled sugar free or fat free.
c.Recommendations that patients eliminate carbohydrates.
d.Specific suggestions for following a whole-food diet.
Question 6Buspirone is indicated for which anxiety disorder?
Select one:
a.Generalized anxiety disorder
b.Panic disorder
c.Posttraumatic stress disorder
d.Social phobia
Question 7Carbamazepine has a half-life of approximately 12 hours. The clinical implications of this are ________.
Select one:
a.Carbamazepine will be 50% less effective 12 hours after taking the medication.
b.Carbamazepine requires once daily dosing.
c.therapeutic blood monitoring of carbamazepine should not occur before 2½ days of starting the medication.
d.one-half of the dose of carbamazepine will be excreted from the kidneys in 12 hours.
Question 8Elimination of a drug can be impacted by all of the following scenarios EXCEPT ________.
Select one:
a.a low-fat diet
b.metabolic acidosis, in which plasma pH is lowered
c.concurrent use of loop diuretics
d.dehydration
Question 9Nootropics are best described as ________.
Select one:
a.supplements that are believed to inhibit glutamate and be neuroprotective
b.supplements that are believed to enhance cognition
c.supplements that are used illicitly for their euphoric effects
d.supplements that newly developed without problematic side effects
Question 10Problems with selective attention associated with ADHD are hypothetically regulated by the:
Select one:
a.anterior cingulate cortex
b.orbital frontal cortex
c.prefrontal motor cortex
d.dorsolateral prefrontal cortex
Question 11The medication side effect mostly to result in aggression or violence is ________.
Select one:
a.akathisia
b.tardive dyskinesia
c.hyperreflexia
d.insomnia
Question 12The psychiatric disorder(s) most likely to result in aggression or violence is (are) ________.
Select one:
a.psychotic disorders
b.substance use disorders
c.personality disorders
d.bipolar disorder
Question 13Use the following CYP450 table to hypothesize drug interactions and their clinical significance for a patient on sertraline who begins regularly taking over-the-counter ibuprofen.
Select one:
a.Sertraline levels would decrease, placing the patient at risk for re-emergence of depressive symptoms.
b.Sertraline levels would increase, placing the patient at risk for worsening side effects.
c.Ibuprofen levels would decrease, decreasing the amount of pain relief.
d.Ibuprofen levels would increase, placing the patient at the risk for side effects.
e.There is no theoretical interaction between these two medications.
Question 14What pathway mediates prolactin and is involved in changes in prolactin levels?
Select one:
a.Nigrostriatal
b.Mesocortical
c.Mesolimbic
d.Tuberoinfundibular
Question 15When a patient achieves remission of depression, what is the recommended length of time that treatment should continue?
Select one:
a.The recommended length of treatment depends on the number of depressive episodes that a patient has had.
b.A patient should continue treatment for a minimum of six months.
c.A patient should continue treatment for a minimum of one year.
d.A patient should continue treatment indefinitely.
Question 16When comparing naltrexone with acamprosate for alcohol dependence, which of the following statements is TRUE?
Select one:
a.Acamprosate is preferred for patients with renal disease.
b.Acamprosate is preferred for patients with co-occurring opiate use.
c.Naltrexone is preferred for patients with low alcohol use.
d.Acamprosate and naltrexone are equally effective with similar side effect profiles.
Question 17When comparing serotonin syndrome to hypertensive crisis, which of the follow statements is TRUE?
Select one:
a.Only serotonin syndrome involves hypertension.
b.Only hypertensive crisis is considered life threatening.
c.Both syndromes can be managed with outpatient treatment.
d.Although both syndromes have muscular symptoms, only serotonin syndrome has hyperreflexia and myoclonus.
Question 18When considering length of action of benzodiazepines, which of the following statements is TRUE?
Select one:
a.The length of action of a benzodiazepine is a direct relationship to its half-life.
b.Long-acting benzodiazepines are more habituating and put patients at greater risk for dependence than short-acting benzodiazepines.
c.Short-acting benzodiazepines are preferred over long-acting benzodiazepines for scheduled use.
d.Both short-acting and long-acting benzodiazepines have been associated with increased risk for the development of dementia.
Question 19When considering metabolic risk associated with atypical antipsychotics, which of the following statements is TRUE?
Select one:
a.Metabolic risk is due to weight gain which is secondary to increased appetite and caloric intake.
b.Patients taking atypical antipsychotics are at increased risk for diabetes and cardiovascular disease.
c.Metabolic syndrome is a rare side effect of atypical antipsychotics.
d.If a patient does not have metabolic risk factors at the initiation of an atypical antipsychotic, they are unlikely to develop metabolic syndrome later in treatment.
Question 20When considering the neuroscience of addiction, which of the following statements is true?
Select one:
a.Most addiction is the result of stimulation of serotonergic pathways in the brain.
b. Compulsive behaviors in the dorsal regions of the brain often precede impulsivity in the ventral regions of the brain.
c.Dopamine pathways are implicated in all substances of abuse.
d.Glutamate pathways are associated with the reward aspects of substance abuse.
Question 21When documenting the objective portion of a psychiatric treatment note, which if the following is included?
Select one:
a.Statements made by the patient
b.Behaviors witnessed by the clinician
c.Collateral information obtained from family members
d.Collateral information obtained from chart review
Question 22When monitoring patients on psychostimulants, which of the following is NOT a consideration?
Select one:
a.Glucose
b.Weight
c.Blood pressure
d.EKG
Question 23When prescribing atypical antipsychotic medications, which of the following statements is MOST true?
Select one:
a.There is elevated risk of cerebrovascular events for all patient populations.
b.The FDA has issued a black box warning for metabolic syndrome on all atypical antipsychotics.
c.Atypical antipsychotics are not approved for the treatment of geriatric dementia-related psychosis and carry increased risk of mortality in this population.
d.Atypical antipsychotics do not require monitoring for tardive dyskinesia.
Question 24When prescribing for preschool-aged children, which of the following statements is TRUE?
Select one:
a.Research on the very young has led to several FDA-approved medications for psychiatric disorders.
b.SSRIs are first-line treatment for depression in very young children
c.SSRIs are first-line treatment for anxiety disorders in very young children.
d.Behavioral and psychotherapeutic interventions are first-line treatment for all psychiatric disorders in preschool-aged children.
Question 25When prescribing guanfacine, the clinician should consider which of the following?
Select one:
a.Guanfacine can worsen motor tics.
b.Rebound hypertension can occur when abruptly stopping Guanfacine.
c.If a patient forgets to take their medication for a few days, they should resume their previous dose.
d.Patients should be advised to take the guanfacine in the morning, because it may contribute to insomnia with qHS dosing.
Question 26When tapering someone from long-term benzodiazepine use, which of the following is TRUE?
Select one:
a.The clinician should present as a firm and directive authority when initiating benzodiazepine tapers.
b.Patients who resist benzodiazepine tapers are likely misusing the medication.
c.It is best begin a benzodiazepine taper with a long-acting benzodiazepine for increased tolerance to the taper.
d.Most benzodiazepine tapers can be achieved quickly, by reducing dose 25% per week over the course of a month.
Question 27When treating acute aggression, which of the following medication combinations is a suggested treatment:
Select one:
a.Sertraline + quetiapine
b.Propranolol + buspirone
c.Paroxetine + buspirone
d.Haldol +lorazepam
Question 28When, in the course of psychiatric care, should safety be assessed?
Select one:
a.At the beginning of treatment
b.Once a therapeutic alliance is formed
c.At every appointment
d.Safety is best addressed by case managers and therapists
Question 29Which ADHD symptoms most commonly present in adults?
Select one:
a.Hyperactivity
b.Impulsivity
c.Inattention
d.Depressed mood
Question 30Which antidepressant is LEAST likely to cause sexual side effects?
Select one:
a.Paroxetine
b.Fluoxetine
c.Bupropion
d.Mirtazapine
Question 31Which antipsychotic carries the HIGHEST risk of QTc prolongation?
Select one:
a.Clozapine
b.Olanzapine
c.Ziprasidone
d.Perphenazine
Question 32Which atypical antipsychotic carries the HIGHEST risk for EPS?
Select one:
a.Clozapine
b.Olanzapine
c.Risperidone
d.Ziprasidone
Question 33Which medication is NOT considered appropriate for the treatment of acute bipolar mania?
Select one:
a.Valproic acid
b.Lithium carbonate
c.Lamotrigine
d.Olanzapine
Question 34Which of following statements is TRUE about the use of clonidine and propranolol in the treatment of anxiety?
Select one:
a.Clonidine and propranolol should be scheduled twice daily to be effective anti-anxiety agents.
b.Clonidine and propranolol target the physiologic symptoms associated with anxiety.
c.Clonidine and propranolol are effective for the treatment of worry associated with anxiety.
d.Clonidine and propranolol are well tolerated in individuals with a history of hypotension.
Question 35Which of the follow statements is TRUE about antidepressant side effects?
Select one:
a.Side effects rarely resolve on their own.
b.The most common side effects are also the most bothersome to patients.
c.Discussing possible side effects before starting medication is associated with patients staying on medications longer.
d.Patients are likely to self-report side effects.
Question 36Which of the follow foods would be considered safe when consumed concurrently with a monoamine oxidase inhibitor?
Select one:
a.A pint of craft beer
b.A platter of aged cheese
c.A bowl of ice cream
d.A ham sandwich
Question 37Which of the following statements about metabolic syndrome is TRUE?
Select one:
a.Diagnosis of metabolic syndrome is determined by change in BMI.
b.Elevated fasting blood glucose is rarely an indicator of the development of metabolic syndrome.
c.Thyroid (TSH/T4) monitoring should occur at baseline and every six months.
d.Diet and lifestyle education should be included as a strategy for reducing risk of metabolic syndrome.
Question 38Which of the following BEST describes history of presenting illness?
Select one:
a.Current symptoms and the environment in which they present
b.A quote from the patient describing the reason for seeking treatment
c.A comprehensive review of the patient’s psychiatric history
d.Current laboratory and diagnostic findings
Question 39Which of the following is NOT considered relevant to choosing a psychiatric medication?
Select one:
a.The patient's medication preference
b.Past psychiatric medications
c.The insurance formulary
d.The patient's marital status
Question 40Which of the following BEST describes the mental status exam?
Select one:
a.The mental status exam is a clinical snapshot of the patient's presentation at the time of assessment.
b.The mental status exam is a formalized cognition test.
c.The mental status exam is only recorded on initial assessments.
d.The mental status exam assesses fixed features of a patient's personality and behaviors.
Question 41Which of the following is NOT a red flag for prescription drug misuse?
Select one:
a.The Prescription Monitoring Program shows a patient has prescriptions filled at multiple pharmacies.
b.A patient requests to decrease the dose of his controlled substance.
c.A patient reports that her prescription has been stolen and requests an early refill.
d.A patient requesting a controlled substance reports having two previous providers in the past year.
Question 42Which of the following statements is TRUE about psychotherapy and the treatment of depression?
Select one:
a.Psychotherapies do not create epigenetic changes in the brain.
b.Psychotherapy can work synergistically with psychotropic medication.
c.CBT has poor evidence as an adjunctive treatment for depression.
d.Evidence for psychotherapy in depression is limited to mild depression.
Question 43Which of the following statements about telepsychiatry is TRUE?
Select one:
a.Research evidence has shown that telepsychiatry is less effective than face-to-face visits.
b.Insurance is required to reimburse telepsychiatry visits.
c.State practice laws regarding telepsychiatry vary.
d.Video conferencing applications such as Skype and Google Hangout are verified as HIPPA compatible.
Question 44Which of the following helps improve patient adherence to treatment?
Select one:
a.Prescribing a medication regimen that requires frequent daily doses.
b.Brief, simplified patient instruction.
c.Involving the patient in the plan of care.
d.Avoiding discussions about adherence.
Question 45Which of the following methods of drug delivery is slowest to reach the bloodstream?
Select one:
a.Sublingual formulations
b.Oral pills
c.IM route
d.IV route
Question 46Which of the following statements about disulfiram is true?
Select one:
a.Disulfiram works by blocking the action of acetaldehyde dehydrogenase.
b.Disulfiram increases abstinence rates when compared to placebo.
c.Disulfiram decreases alcohol craving when compared to placebo.
d.Disulfiram is considered a safe medication with few contraindications.
Question 47Which of the following statements is true about drug distribution?
Select one:
a.Most psychotropic medications are lipophobic and water soluble.
b.Psychotropic medications are most highly concentrated in plasma.
c.Body composition does not impact drug distribution.
d.Protein binding of psychotropic drugs can impact their availability at receptor sites.
Question 48Which of the following statements is TRUE about neuronal gene expression?
Select one:
a.Environmental factors can alter a neuron's gene expression.
b.Gene expression is determined in development.
c.Inactive genes remain inactive throughout a neuron's lifetime.
d.Only active genes can be targets of psychotropic medications.
Question 49Which of the following statements about genetic testing for psychiatry is TRUE?
Select one:
a.Gene expression and pharmacokinetics are consistent between individuals with a given gene.
b.Genetic testing is proven effective in predicting response to antidepressant treatment.
c.Genetic testing has shown modest benefit in predicting response to antidepressant treatment.
d.Genetic testing has been shown to be no better than treatment as usual in predicting response to antidepressants.
Question 50Which of the following describes a component of pharmacodynamics?
Select one:
a.The effects of taking a medication with an antacid
b.The percent fat content in the body
c.The receptor binding site of the drug
d.Kidney function
Question 51Which of the following statements is TRUE about mirtazapine?
Select one:
a.Mirtazapine is a serotonin and norepinephrine reuptake inhibitor.
b.Mirtazapine is a poor choice for patients with comorbid anxiety.
c.Mirtazapine has side effects of weight gain and sedation.
d.Mirtazapine carries risks for hepatotoxicity and should be avoided in patients with liver disease.
Question 52Which of the following antipsychotics is LEAST likely to cause significant weight gain?
Select one:
a.Clozapine
b.Olanzapine
c.Risperidone
d.Ziprasidone
Question 53Which of the following statements is TRUE about tardive dyskinesia?
Select one:
a.Tardive dyskinesia is a movement disorder characterized by slow, shuffling gait.
b.Tardive dyskinesia is an acute (short duration) side effect of antipsychotic medication.
c.Elderly patients may develop tardive dyskinesia sooner in treatment than younger patients.
d.The FDA-approved drug, Valbenazine, is an affordable treatment option for most patients.
