Psychopharm

Question 1

Haloperidol and ____ used in combo in some patients can cause an encephalopathic syndrome resembling NMS as well as prolong QT interval

Answer 1

Lithium

Question 2

Fluoxetine and paroxetine inhibit __________

Answer 2

CPY2D6

Question 3

_____ has evidence in tx of trichotillomania

Answer 3

N-acetylcysteine

Question 4

Ramelteon MOA is ______, with significant binding to _____. FDA approved for insomnia

Answer 4

melatonin receptor agonist; MT1 and MT2

Question 5

____, a salt of gamma hydroxybutyrate, is thought to improve daytime alertness in narcolepsy

Answer 5

Sodium oxybate

Question 6

___, used for tx of hepatitis C, can induce depressive disorder in 10% to 40% of pts; can also induce mania/hypomania

Answer 6

Interferon

Question 7

Lorazepam, oxazepam and temazepam are primarily metabolized by ___, a capacity maintained even with severe hepatic compromise

Answer 7

glucuronidation (phase 2 metabolism)

Question 8

Alprazolam, clonazepam, diazepam, and triazolam require microsomal oxidation via ___, and are thus subject to metabolism in competition with other substrates and to reduced elimination in the presence of liver disease

Answer 8

the cytochrome P450 enzyme system

Question 9

Concurrent use of ___ can result in lithium toxicity is inhibition of prostaglandin synthesis resulting in vasoconstriction and decreased lithium excretion

Answer 9

NSAID’s (ibuprofen)

Question 10

Valproic acid ___ levels of lamotrigene by ___

Answer 10

Increases; inhibition of glucuronidation pathway (3a4)

Question 11

Cochrane Systematic Review found evidence supporting the use of ___ and ___ for prolonging abstinence from cocaine among cocaine dependent users

Answer 11

bupropion and dextroamphetamine

Question 12

only FDA-approved medication for treatment of psychosis in Parkinson’s disease

Answer 12

Pimavanserin

Question 13

Atomoxetine carries an FDA black box warning in the package insert for increasing risk of which one of the following conditions

Answer 13

Suicidal ideation

Question 14

The manufacturers’ package inserts for clozapine, paliperidone, risperidone, and lurasidone have recommended dosage adjustments based on ___

Answer 14

Renal function

Question 15

Low dose ____ has been shown helpful to improve cancer-related fatigue

Answer 15

Methylphenidate

Question 16

Itraconazole antifungals inhibit hepatic oxidative metabolism via ____

Answer 16

CYP 3A4

Question 17

Fluvoxamine is both a potent inhibitor of the ___ isoform and a substrate for it

Answer 17

CYP 1A2

Question 18

Anti-epileptic medication most often associated with hyponatremia

Answer 18

Oxcarbazepine

Question 19

__ and __ are first-line treatments for Restless Leg Syndrome

Answer 19

Dopamine agonists (e.g., pramipexole,) and calcium channel alpha-2-delta antagonists (e.g., gabapentin)

Question 20

Which combo of meds has the best evidence for maintenance treatment to prevent relapse of MDD following a course of ECT?

Answer 20

Nortriptyline and lithium

Question 21

___ associated photopigmentation/photosensitivity occurs due to an unknown mechanism. It is known to bind to melanin-containing tissues and toxic accumulation over time may lead to photosensitivity

Answer 21

Lamotrigene

Question 22

The risk of developing ___ (of which hirsutism is a common symptom) is increased during treatment with valproic acid

Answer 22

polycystic ovary syndrome

Question 23

Fluoxetine and Paroxetine are strong ___ in comparison to other SSRIs and can inhibit the metabolism of commonly used cardiovascular medications (e.g., S-metoprolol)

Answer 23

2D6 inhibitors

Question 24

___ is the only mediction listed that is FDA approved for sleep initiation and maintenance, having a half life of about 6 hours

Answer 24

Eszopiclone (Lunesta)

Question 25

___ are the only neuroleptic agents in this list that are FDA approved for treatment of Tourette syndrome

Answer 25

Pimozide and haloperidol

Question 26

Mechanism of action of memantine is ___

Answer 26

N-methyl-D-aspartate (NMDA) receptor antagonism

Question 27

Mechanism of action of atomoxetine (Strattera) is ___

Answer 27

Selective norepinephrine reuptake inhibitor

Question 28

Patients with a history of asthma or COPD potentially can experience increased airway reactivity following use of what medications?

Answer 28

Cholinesterase inhibitors (donepezil, galantamine, Rivastygmine)

Question 29

Minimum duration of methadone maintenance treatment should be what length of time?

Answer 29

12 months

Question 30

Treatment for hepatic encephalopathy

Answer 30

Lactulose

Question 31

The exact MOA of valbenazine in the treatment of tardive dyskinesia is not known, but is may be mediated through ___

Answer 31

Reversible inhibition of vesicular monoamine transporter 2 (VMAT2)

Question 32

___, an oxazolidinone antibiotic, has antidepressant effects through mild reversible nonselective inhibition of monoamine oxidase inhibitors. In combo w/ SSRI, there is a documented risk for serotonin syndrome

Answer 32

Linezolid

Question 33

___ is FDA approved for the treatment of narcolepsy with excessive daytime sleepiness and cataplexy. MOA is ___

Answer 33

sodium oxybate, a salt of GHB; agonist at GABA-B

Question 34

NSAIDs act by inhibiting ___, an essential enzyme in the formation of prostaglandins. For individuals with congestive heart failure, ascites, hypovolemia, or chronic renal diseaseconditions which often occur in the elderlyNSAIDs can adversely affect renal blood flow and glomerular filtration rate:

Answer 34

cyclooxygenase (COX)

Question 35

Clozapine metabolism is typically ___ by tobacco smoke causing levels after cessation to be relatively ___

Answer 35

induced; increased

Question 36

The two TCAs with the lowest anticholinergic activity are ___

Answer 36

nortriptyline and desipramine

Question 37

A pregnant female is requesting detoxification from heroin. Assuming good adherence, which treatment for opioid use disorder would be most likely to result in the best maternal outcome and the lowest risk of neonatal abstinence syndrome for the newborn?

Answer 37

buprenorphine

Question 38

Most common adverse effects of naltrexone?

Answer 38

nausea (10%), headache (7%)

Question 39

The dose of acamprosate should be reduced in patients with ___

Answer 39

moderate renal impairment

Question 40

Methadone withdrawal begins ___ after the last dose, and ends in 10 to 14 days. Buprenorphine withdrawal has been observed to peak at about ___ after the last dose and is generally mild, although symptoms may persist for weeks.

Answer 40

1-3 days ; 5 days

Question 41

___, a non-specific 5HT1A and 5HT2A serotonin antagonist, is an FDA-recognized antidote for serotonin syndrome

Answer 41

Cyproheptadine

Question 42

___ is the commonest drug causing hypernatraemia; serum sodium levels as high as 196 mmol/L have been reported

Answer 42

Lithium (Li)

Question 43

Isoenzyme ___ is induced by smoking

Answer 43

CYP1A2

Question 44

___ is an FDA-approved drug for the treatment of delusions and hallucinations associated with Parkinson's disease psychosis (PDP). It has antagonistic actions at serotonin 5HT2A receptors with a weaker antagonist/inverse agonist actions at 5HT2C receptors

Answer 44

Pimvanserin

Question 45

___ is the first drug approved in the US for the treatment of adults with tardive dyskinesia (TD), and its MOA is ___

Answer 45

Valbenazine; reversible vesicular monoamine transporter 2 (VMAT2) inhibitor

Question 46

Which antipsychotics do not appear to cause consistent, congenital harm to the fetus in pregnant women?

Answer 46

Olanzapine

Question 47

A 23 y/o F is brought to the ED for overdosing on tricyclic antidepressants and is minimally responsive to painful stimuli with seizures and is hypotension. What is the best way to manage this patient?

Answer 47

IV sodium bicarbonate, lipid emulsion, and plasmapheresis

Question 48

cytochrome P450 ___ metabolizes about 95% of the caffeine ingested. This enzyme is ___ by fluvoxamine

Answer 48

1A2; inhibited

Question 49

___ is the most widely studied drug indicated for cannabis abstinence in adolescents. The drug has shown to reduce cravings and promote abstinence

Answer 49

N-acetylcysteine

Question 50

A 79 y.o. female nursing home resident is found unresponsive. Her nephew, who visited that day, is called and admits to giving the patient some ‘generic Benadryl’ for her allergies. Which medication is most likely to reverse the patient’s delirium

Answer 50

Physostigmine

Question 51

The mainstay of treatment of lithium-induced nephrogenic diabetes insipidus (polyuria, polydipsia in the setting of low osmolarity urine despite increased plasma osmolality, and a low urine specific gravity) is ___

Answer 51

amiloride, a potassium-sparing diuretic

Question 52

What anti-emetic is used to treat post-operative delirium and what is its MOA?

Answer 52

Ondansetron - selective serotonin type-receptor 5HT3 antagonist (acts via inhibition of vagal nerves)

Question 53

Which acetylcholinesterase inhibitor is FDA-approved for treatment of anticholinergic delirium?

Answer 53

Physostigmine

Question 54

Giving ___ is contraindicated when a person is on an MAOI

Answer 54

meperidine

Question 55

MAO of memantine is ___

Answer 55

antagonist at NMDA receptors

Question 56

Sumatriptan MOA is ___; Contraindicated in patients with ___

Answer 56

serotonin 5-HT1A and 5HT-1B agonist; uncontrolled HTN or coronary ischemic heart disease

Question 57

Benzo's that are safe for patients with compromised liver functioon (no active metabolites, no need for oxidation by liver)

Answer 57

"Lorazepam, Oxazepam, Temazepam (""LOT"")"

Question 58

What two psychotropic medication classes increase TCA levels through interaction with the cytochrome P450 system?

Answer 58

Antipsychotics + methylphenidate

Question 59

Psychotropic drug that decreases TCA levels

Answer 59

Lithium

Question 60

Adverse effects for this medication include hirsutism in women, facial dysmorphism, and gingival hypertrophy

Answer 60

Phenytoin

Question 61

Psychotropic medications contraindicated with levodopa/carbidopa repletion there as they are postsynaptic enzymatic metabolizers of dopamine

Answer 61

MAO-A type inhibitors

Question 62

Valproate is a classic inhibitor of ___, which causes inhibition of enzymatic clearance of lamotrigene

Answer 62

cytochrome P450 3A4

Question 63

MOA of Ropinirole, used to treat restless legs syndrome

Answer 63

Dopamine agonist

Question 64

What antipsychotic inhibits serotonin (5-HT 1A) and norepinephrine reuptake

Answer 64

Ziprasidone

Question 65

Treatment of choice for Wilson's disease

Answer 65

Penicillamine

Question 66

Reserpine interferes with Mg and ATP-dependent uptake of biogenic amines, which results in ___. In this way, it can relieve sx of dystonia and also causes depression, sedation, and a Parkinson's like syndrome

Answer 66

depletion of DA, NE, serotonin neurotransmitters

Question 67

Medications that should be stopped prior to ECT

Answer 67

Lithium (--> postictal delirium), Clozapine, Bupropion

Question 68

Carbamazepine is an inducer of what CYP450 enzymes?

Answer 68

2C19 and 3A4 (auto inducer)

Question 69

MOA for Buspirone

Answer 69

full agonist on the serotonin 1A (5HT1A) autoreceptor and as a partial agonist on the postsynaptic 5-HT1A receptor.

Question 70

Tricyclic antidepressants that are secondary amines:

Answer 70

Desipramine, Nortriptyline, Protriptyline

Question 71

Tricyclic antidepressants that are tertiary amines:

Answer 71

Doxepin, Imipramine, Amitriptyine, Clomipramine, Trimipramine

Question 72

Tricyclic antidepressants are metabolized by ___?

Answer 72

CYP 2D6

Question 73

Tricyclic antidepressant used to treat childhood enuresis

Answer 73

Imipramine - not v effective

Question 74

___ block peripheral degradation of peripheral levodopa and central degradation of I-DOPA and dopamine, thereby increasing I-DOPA and dopamine levels centrally. Given concomitant with each dose of carbidopa-levodopa throughout the day to improve parkinsonian symptoms

Answer 74

Entacapone (Comtan) and Tolcapone (Tasmar) = catechol-O-methyltransferance (COMT) inhibitors

Question 75

___ can be used to treat lithium-induced neprogenic diabetes insipidus

Answer 75

Amiloride

Question 76

Drugs that can increase lithium levels

Answer 76

ibuprofen, naproxen, ACE inhibitors, thiazide diuretics

Question 77

MOA for Atomoxatine is ___. Useful when trying to treat both tics and ADHD, as it does not worsen the tic condition

Answer 77

norepinephrine reuptake inhibition

Question 78

Clonidine's MOA is ___, reducing the amount of norepinpehrine that is released from the synaptic bouton. THis effect decreases sympathetic tone and bodily arousal and activation

Answer 78

presynaptic a2-receptor agonist

Question 79

MOA for sildenafil, vardenafil, and tadalafil

Answer 79

phosphodiesterase 5 (PDE5) inhibiton

Question 80

Tricyclic antidepressant that has a metabolite with dopamine-blocking actiity (can possibly cause parkinsonian symptoms)

Answer 80

Amoxapine

Question 81

Lithium toxicity occurs at levels above ___. IF the level is above ___, or the patient shows serious signs of toxicity (nephrotoxicity, convulsions, coma), patient must have hemodialysis

Answer 81

2.5 mEq/L; 4 mEq/L

Question 82

Meperidine (Demerol) can never be given with ___

Answer 82

an MAOI

Question 83

MOA of Bromocriptine, used to treat Parkinson's

Answer 83

mixed dopamine agonist-antagonist

Question 84

Zaleplon (Sonata) has MOA of ___ and half life of ___

Answer 84

benzodiazepine receptor agonist; half life 1 hr

Question 85

Of sleeping agents, ___ as half life of about 6 hours, making it most likely to cause next-day drowsiness

Answer 85

Eszopiclone (Lunesta)

Question 86

The least anticholinergic of the tricyclic antidepressants

Answer 86

Desipramine

Question 87

___ has been shown to be helpful in some cases of Exhibitionistic D/O and can be useful in any sexual disorder in which the patients are extremely hypersexual to the point of being out of control or dangerous

Answer 87

Medroxyprogesterone acetate

Question 88

MOA for Gabapentin ___

Answer 88

GABA-modulating agent

Question 89

___ is a selective GABA reuptake inhibitor, FDA-approved as an adjunctive treatment for partial complex seizures

Answer 89

Tiagabine (Gabitril)

Question 90

MOA for Memantine is ___, used to treat ___

Answer 90

NMDA antagonist; moderate to severe Alzheimer's dementia

Question 91

Benzodiazapines bind to ___ receptors, which is a chloride ion channel

Answer 91

GABA-A

Question 92

MOA of Naltrexone

Answer 92

opioid antagonist

Question 93

MOA of Methadone

Answer 93

opioid agonist

Question 94

MOA of buprenorphine

Answer 94

mixed opioid agonist/antagonist mixed opioid agonist/antagonist

Question 95

___ can be used to treat urinary hesitancy or retention in patients having anticholinergic side effects from psychotropics

Answer 95

Bethanechol

Question 96

What antibiotic, when given with carbamazepine, causes carbamazepine levels to increase?

Answer 96

Erythromycin

Question 97

MOA of triptans (abortive agents for migraines)

Answer 97

Agonists at 5-HT 1B and 5-HT 1D receptors

Question 98

FDA approved for treatment of chorea in Huntington's Disease

Answer 98

Tetrabenazine

Question 99

FDA approved for postherpetic neuralgia

Answer 99

Gabapentin

Question 100

Liothyronin (Cytomel) can be used as augmenting agent for depressive d/o. It should not be taken by patients with ___

Answer 100

cardiac disease, angina, or HTN

Question 101

MOA for Ramelteon (Rozerem)

Answer 101

melatonin agonist

Question 102

Differences in metabolism of Risperidone vs Paliperidone

Answer 102

Risperdal is hepatically cleared; Paliperidone is 80% metabolized through kidney

Question 103

MOA of Varenicline (Chantix)

Answer 103

partial nicotine agonist 4alpha2

Question 104

Treatment for organophosphate insectivide exposure and poisoning

Answer 104

IV pralidoxime (accelerates reactivation of inhibited acetylcholinesterase) with atropine (counteracts muscarinic effects)

Question 105

Thiazide diuretic increases ___

Answer 105

lithium level

Question 106

MOA of Botulinism toxin

Answer 106

blocks release of acetylcholine at neuromuscular junction

Question 107

What benzodiazepines are metabolized via hepativ glucoronidation rather hepatic oxidation?

Answer 107

"Lorazepam, Oxazepam, Temazepam (""LOT"")"

Question 108

Carbamazepine has autoinduction of its own metabolism via hepatic ___ enzymes

Answer 108

CYP 3A4

Question 109

Most common side effects of donepezil

Answer 109

nausea, abdominal cramping

Question 110

___, can be used to treat hypertensive emergencies, most notably due to pheochromocytoma as well as hypertensive crisis 2/2 MAOI. Mechanism of action is ___

Answer 110

Phenoxybenzamine, Alpha-blocker

Question 111

For pt on clozapine who develops ANC between ___, the correct action is to stop the clozapine

Answer 111

500-999

Question 112

For a pt whose ANC on clozapine is between 1000-1499, you can ___

Answer 112

switch to 3x weekly monitoring until it is back above 1500

Question 113

Phenelzine has less _______ than tranylcypromine because tranylcyprome has significant inhibitory effects on the uptake of norepinephrine, dopamine, and serotonin. Phenelzine is more sedating due to the following reasons: It does not stimulate release of norepinephrine and dopamine, it increases levels of GABA, and it has greater H1 antihistaminergic properties.

Answer 113

activation

Question 114

_____ of patients treated with lamotrigine develop a benign rash that is non-confluent, non-tender, and spotty, and usually resolves in 10 to 14 days.

Answer 114

8-10%

Question 115

Cimetidine has what effect on CYP enzymes?

Answer 115

Inhibits CYP 2D6 (leads to higher levels of substrate) Also inhibits 1A4, 2C19

Question 116

MOA of ondansetron

Answer 116

potent 5-HT3 antagonist

Question 117

MOA of metaclopromide

Answer 117

D2 antagonist