Psychopharmacology Practice Questions

Q: Which of the following is NOT a use of fluoxetine?

Treatment of delayed ejaculation. Fluoxetine is a **Selective Serotonin Reuptake Inhibitor (SSRI)**. The core pharmacological concept to remember for NEET-PG is that SSRIs increase synaptic serotonin, which leads to a **delay in ejaculation** as a common side effect. **Explanation of the Correct Answer:** * **Option A (Treatment of delayed ejaculation):** This is the correct answer because fluoxetine *causes* delayed ejaculation; it is never used to treat it. Using an SSRI in a patient who already has delayed ejaculation would worsen the condition. **Explanation of Incorrect Options:** * **Option B (Premature ejaculation):** Because SSRIs significantly prolong the ejaculatory latency time, they are used "off-label" to treat premature ejaculation. (Note: **Dapoxetine** is the specific SSRI approved for this due to its short half-life). * **Option C (Impulse control disorder):** SSRIs are first-line treatments for various impulse control disorders (like kleptomania or trichotillomania) and Obsessive-Compulsive Disorder (OCD) by modulating serotonergic pathways in the prefrontal cortex. * **Option D (Paraphilia):** In cases of hypersexuality or paraphilic disorders, fluoxetine is used to reduce libido and compulsive sexual urges. **NEET-PG High-Yield Pearls:** 1. **Half-life:** Fluoxetine has the longest half-life among SSRIs (due to its active metabolite **norfluoxetine**), requiring a 5-week washout period before starting an MAO inhibitor to avoid **Serotonin Syndrome**. 2. **Drug of Choice:** Fluoxetine is the preferred SSRI for **Bulimia Nervosa** and **Depression in children/adolescents**. 3. **Side Effects:** Common side effects include GI upset, insomnia, and sexual dysfunction (decreased libido and anorgasmia).

Q: Which of the following is NOT true about naltrexone?

Is an opioid agonist. **Explanation:** The correct answer is **D (Is an opioid agonist)** because Naltrexone is actually a long-acting **competitive opioid antagonist**. It binds to opioid receptors (primarily the mu-receptor) with high affinity, thereby blocking the effects of exogenous opioids and endogenous endorphins. **Analysis of Options:** * **Option A (Acts on opioid receptors):** This is true. Naltrexone has a high affinity for $\mu$ (mu) and $\kappa$ (kappa) opioid receptors. By blocking these receptors, it prevents the "high" or euphoria associated with opioid use. * **Option B (Used in alcohol dependence):** This is true. In alcohol use disorder, Naltrexone blocks the $\mu$-opioid receptors involved in the reward pathway. This prevents the release of dopamine in the nucleus accumbens that normally occurs when drinking alcohol. * **Option C (Used to reduce craving):** This is true. By modulating the reward circuitry and reducing the reinforcing effects of the substance (the "reward"), Naltrexone effectively reduces the psychological urge or craving to consume alcohol or opioids. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism in Alcoholism:** It reduces the "pleasure" of drinking and decreases the likelihood of a "slip" becoming a full-blown relapse. * **Prerequisite:** Patients must be **opioid-free for at least 7–10 days** before starting Naltrexone to avoid precipitating severe acute withdrawal. * **Contraindication:** It is contraindicated in patients with **acute hepatitis or liver failure** (hepatotoxicity risk). * **Naltrexone vs. Naloxone:** Naltrexone is orally active with a long half-life (used for maintenance), whereas Naloxone has poor oral bioavailability and a short half-life (used for acute overdose reversal).

Q: Which of the following tricyclic antidepressants is used in the management of OCD?

Clomipramine. **Explanation:** **Clomipramine** is the correct answer because it is the only Tricyclic Antidepressant (TCA) specifically indicated and FDA-approved for the treatment of Obsessive-Compulsive Disorder (OCD). **Why Clomipramine?** The pathophysiology of OCD is strongly linked to dysregulation in the serotonergic system. Unlike most other TCAs which primarily inhibit the reuptake of norepinephrine, Clomipramine is a **potent and selective inhibitor of serotonin reuptake (SRI)**. Its metabolite, desmethylclomipramine, affects norepinephrine, but its parent compound’s high affinity for serotonin transporters makes it uniquely effective for obsessive-compulsive symptoms. **Analysis of Incorrect Options:** * **A. Imipramine:** Primarily used for Enuresis in children and Panic Disorder; it lacks the potent serotonergic activity required to treat OCD. * **B. Amitriptyline:** Frequently used for neuropathic pain, migraine prophylaxis, and depression, but it has no proven efficacy in managing OCD. * **C. Amoxapine:** A tetracyclic antidepressant with dopamine-blocking properties (antipsychotic-like effects); it is not used for OCD. **High-Yield NEET-PG Pearls:** * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line pharmacological treatment for OCD due to a better side-effect profile. * **Clomipramine Status:** It is considered the "Gold Standard" in terms of efficacy but is usually reserved for treatment-resistant cases due to TCA-related side effects (anticholinergic, sedative, and cardiotoxic). * **Dosage:** OCD often requires higher doses of antidepressants and a longer duration (10–12 weeks) to show a clinical response compared to Depression. * **Combination:** The most effective management for OCD is a combination of Pharmacotherapy and **Exposure and Response Prevention (ERP)**, a form of Cognitive Behavioral Therapy.

Q: Which of the following is used in the management of Electroconvulsive Therapy (ECT)?

Succinylcholine. **Explanation:** In modern **Modified Electroconvulsive Therapy (ECT)**, the goal is to induce a therapeutic seizure in the brain while preventing the physical complications of a generalized tonic-clonic convulsion. **A. Succinylcholine (Correct):** This is a short-acting depolarizing neuromuscular blocking agent. It is the drug of choice in ECT to produce skeletal muscle relaxation. By blocking the nicotinic acetylcholine receptors at the neuromuscular junction, it prevents forceful muscle contractions that could otherwise lead to bone fractures, joint dislocations, or tongue bites during the induced seizure. Its rapid onset and short duration of action make it ideal for the brief nature of ECT. **B. Cefepime:** This is a fourth-generation cephalosporin antibiotic. It has no role in ECT management and is used for treating bacterial infections. **C. Clozapine:** An atypical antipsychotic used for treatment-resistant schizophrenia. While ECT is sometimes used adjunctively with Clozapine, the drug itself is not a component of the ECT procedure. Notably, Clozapine lowers the seizure threshold, which can be a risk factor if not monitored. **D. Chlorpromazine:** A low-potency typical antipsychotic. Like Clozapine, it is used to treat psychosis but is not part of the standard ECT premedication protocol. **High-Yield Clinical Pearls for NEET-PG:** * **Standard ECT Premedication:** 1. **Atropine/Glycopyrrolate:** Anticholinergic to reduce secretions and prevent vagally-mediated bradycardia. 2. **Methohexital/Propofol:** Short-acting anesthetic agents to induce unconsciousness. 3. **Succinylcholine:** Muscle relaxant. * **Gold Standard Indication:** Severe depression with suicidal ideation or catatonia. * **Absolute Contraindication:** Increased intracranial pressure (ICP).

Q: A 19-year-old boy with chronic schizophrenia is treated with haloperidol 20 mg/day. One week after starting the medication, he exhibits restlessness, fidgeting, irritability, and an inability to remain still. What is the most appropriate management strategy?

Add a beta-blocker. ### Explanation **Diagnosis: Akathisia** The patient is presenting with classic symptoms of **Akathisia**, a common Extrapyramidal Side Effect (EPS) associated with high-potency first-generation antipsychotics like Haloperidol. It is characterized by subjective feelings of inner restlessness and objective signs of motor agitation (fidgeting, pacing, inability to sit still). **Why Option C is Correct:** The first-line pharmacological treatment for antipsychotic-induced akathisia is a **lipophilic beta-blocker**, specifically **Propranolol**. Propranolol crosses the blood-brain barrier effectively and acts on central receptors to alleviate the restlessness. Other options include benzodiazepines or reducing the antipsychotic dose. **Why Other Options are Incorrect:** * **Option A (Increase dose):** This would worsen the condition. Akathisia is dose-dependent; increasing Haloperidol would increase D2 receptor blockade, exacerbating the EPS. * **Option B (Add an anticholinergic):** While anticholinergics (e.g., Benztropine, Trihexyphenidyl) are the treatment of choice for *Acute Dystonia* and *Parkinsonian symptoms*, they are generally **ineffective** for Akathisia. * **Option D (Add another antipsychotic):** Polypharmacy increases the side-effect burden and does not address the underlying movement disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline of EPS:** 1. **Acute Dystonia:** Hours to days (Treatment: Anticholinergics). 2. **Akathisia:** Days to weeks (Treatment: Beta-blockers). 3. **Drug-induced Parkinsonism:** Weeks to months (Treatment: Anticholinergics). 4. **Tardive Dyskinesia:** Months to years (Treatment: Switch to Clozapine/VMAT2 inhibitors). * **Propranolol Dosage:** Usually 30–90 mg/day is effective for akathisia. * **Key Differentiator:** Akathisia is often mistaken for worsening psychosis/agitation. Always check for "inner restlessness" before increasing antipsychotic doses.

Q: A 38-year-old woman with bipolar disorder has been stable on lithium for the past 2 years. She presents with a 2-week history of depressed mood, poor concentration, loss of appetite, and passive suicidal ideation. Which of the following steps should be taken next?

Start the patient on a second mood stabilizer. ### Explanation **Correct Option: A (Start the patient on a second mood stabilizer)** The patient is experiencing a breakthrough depressive episode while on Lithium maintenance. In Bipolar Disorder, the management of breakthrough depression involves optimizing the current dose or adding a second mood stabilizer with proven antidepressant properties. **Quetiapine, Lurasidone, or Lamotrigine** are the preferred agents. Adding a second stabilizer provides synergistic effects and prevents a switch into mania. **Analysis of Incorrect Options:** * **B. Start a long-acting benzodiazepine:** Benzodiazepines are used for acute agitation or insomnia; they have no role in treating the core symptoms of depression or suicidal ideation. * **C. Stop lithium and start an antidepressant:** Lithium should never be stopped abruptly during a breakthrough episode as it increases the risk of relapse and suicide. Antidepressant monotherapy is contraindicated in Bipolar Disorder due to the high risk of inducing a "manic switch." * **D. Start an antidepressant and continue lithium:** While antidepressants can be used as adjuncts, they are generally avoided as a first-line step in bipolar depression due to the risk of rapid cycling. A second mood stabilizer (like Quetiapine) is preferred over an SSRI. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice for Bipolar Depression:** Quetiapine (monotherapy) or Lithium/Valproate + Fluoxetine/Olanzapine combination. * **The "Manic Switch":** TCAs have the highest risk of inducing mania, followed by SNRIs and SSRIs. * **Lithium’s Unique Property:** It is one of the few psychiatric drugs proven to reduce the risk of suicide in patients with mood disorders. * **Lamotrigine:** Excellent for preventing future depressive episodes but requires slow titration to avoid Stevens-Johnson Syndrome.

Q: What is the drug of choice for depression in elderly patients?

Fluoxetine. **Explanation:** The drug of choice for depression in elderly patients is a **Selective Serotonin Reuptake Inhibitor (SSRI)**, such as **Fluoxetine** or Sertraline. SSRIs are preferred because they have a superior safety profile, better tolerability, and a lower risk of side effects compared to older antidepressants. **Why Fluoxetine is correct:** In the elderly, physiological changes necessitate drugs with minimal cardiovascular and anticholinergic effects. Fluoxetine effectively treats depressive symptoms without causing significant sedation or orthostatic hypotension, which are major risks for falls in this age group. **Why the other options are incorrect:** * **Amitriptyline & Imipramine (TCAs):** These Tricyclic Antidepressants are generally avoided in the elderly due to their potent **anticholinergic effects** (causing confusion, urinary retention, and constipation) and **quinidine-like cardiotoxicity**. They also cause orthostatic hypotension, significantly increasing the risk of hip fractures. * **Buspirone:** This is an **anxiolytic** (5-HT1A partial agonist) used for Generalized Anxiety Disorder (GAD). It is not an antidepressant and is not used as a primary treatment for depression. **High-Yield Clinical Pearls for NEET-PG:** * **First-line for Elderly:** SSRIs (Sertraline is often preferred over Fluoxetine if drug-drug interactions are a concern due to its shorter half-life). * **Hyponatremia:** Elderly patients on SSRIs should be monitored for **SIADH**, a common side effect in this population. * **Pseudodementia:** Always rule out "Depressive Pseudodementia" in elderly patients presenting with cognitive decline; it is reversible with antidepressants. * **TCA Side Effects:** Remember the mnemonic "3 Cs" for TCA toxicity: Coma, Convulsions, and Cardiotoxicity (Arrhythmias).

Q: A 50-year-old chronic smoker presents with a history of major depressive disorder and ischemic heart disease. He has not received any psychiatric treatment. Which of the following medications is the best option to help him to quit smoking?

Bupropion. **Explanation:** The patient is a chronic smoker with comorbid **Major Depressive Disorder (MDD)** and **Ischemic Heart Disease (IHD)**. The best choice here is **Bupropion**, as it addresses both smoking cessation and the underlying depression simultaneously. **1. Why Bupropion is correct:** Bupropion is an atypical antidepressant that acts as a **Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)**. It is FDA-approved for both MDD and smoking cessation. It reduces the severity of nicotine withdrawal symptoms and the "reward" associated with smoking. In this clinical scenario, it is preferred because it treats the patient's untreated depression while helping him quit smoking. **2. Why other options are incorrect:** * **Naltrexone:** This is an opioid antagonist primarily used in the management of **Alcohol Use Disorder** and Opioid Use Disorder. It has no established role in smoking cessation. * **Sertraline:** While an effective SSRI for depression, Sertraline is **not** indicated for smoking cessation. It does not significantly reduce nicotine cravings. * **Nicotine Replacement Therapy (NRT):** While NRT is a first-line aid for quitting, it must be used with **extreme caution** in patients with recent myocardial infarction, unstable angina, or severe arrhythmias due to its sympathomimetic effects. Given the patient's IHD and untreated MDD, Bupropion is a more comprehensive therapeutic choice. **High-Yield Clinical Pearls for NEET-PG:** * **Varenicline** (a partial α4β2 nicotinic agonist) is generally the most effective monotherapy for smoking cessation but was not an option here. * **Contraindication for Bupropion:** It is strictly contraindicated in patients with **Seizure Disorders** or **Eating Disorders** (Bulimia/Anorexia) as it lowers the seizure threshold. * **Weight Gain:** Bupropion is often preferred for smokers concerned about post-cessation weight gain.

Question 1

Which of the following is NOT a use of fluoxetine?

Accepted Answer

Treatment of delayed ejaculation

Answer

Treatment of premature ejaculation

Answer

Treatment of impulse control disorder

Answer

Treatment of paraphilia

Question 2

Which of the following is NOT true about naltrexone?

Accepted Answer

Is an opioid agonist

Answer

Acts on opioid receptors

Answer

Is used in the treatment of alcohol dependence

Answer

Is used to reduce craving in dependence

Question 3

Which of the following tricyclic antidepressants is used in the management of OCD?

Accepted Answer

Clomipramine

Answer

Imipramine

Answer

Amitriptyline

Answer

Amoxapine

Question 4

Which of the following is used in the management of Electroconvulsive Therapy (ECT)?

Accepted Answer

Succinylcholine

Answer

Cefepime

Answer

Clozapine

Answer

Chlorpromazine

Question 5

A 19-year-old boy with chronic schizophrenia is treated with haloperidol 20 mg/day. One week after starting the medication, he exhibits restlessness, fidgeting, irritability, and an inability to remain still. What is the most appropriate management strategy?

Accepted Answer

Add a beta-blocker

Answer

Increase the dose of haloperidol

Answer

Add an anticholinergic drug

Answer

Add another antipsychotic drug

Question 6

A 40-year-old female patient presents with a history of early morning awakening, loss of appetite, and lack of interest in her routines and activities for the past 3 months. Her husband died 8 months ago, contributing to her loneliness. Which of the following statements is TRUE regarding the management of this patient?

Accepted Answer

Antidepressant treatment should be considered based on the side effect profile.

Answer

No treatment is necessary.

Answer

Manage with combination therapy of 2 antidepressant drugs.

Answer

SSRIs are the most efficacious among the available antidepressant drugs.

Question 7

A 38-year-old woman with bipolar disorder has been stable on lithium for the past 2 years. She presents with a 2-week history of depressed mood, poor concentration, loss of appetite, and passive suicidal ideation. Which of the following steps should be taken next?

Accepted Answer

Start the patient on a second mood stabilizer

Answer

Start the patient on a long-acting benzodiazepine

Answer

Stop the lithium and start an antidepressant

Answer

Start an antidepressant and continue the lithium

Question 8

A schizophrenic patient exhibits avolition, anhedonia, flat affect, and alogia. He neglects personal hygiene and shows limited engagement with daily activities, although he has chronic delusions of persecution that have less impact on his functioning. Which of the following antipsychotics would be most appropriate to use in treating this patient?

Accepted Answer

Olanzapine

Answer

Molindone

Answer

Haloperidol decanoate

Answer

Chlorpromazine

Question 9

What is the drug of choice for depression in elderly patients?

Accepted Answer

Fluoxetine

Answer

Buspirone

Answer

Amitriptyline

Answer

Imipramine

Question 10

A 50-year-old chronic smoker presents with a history of major depressive disorder and ischemic heart disease. He has not received any psychiatric treatment. Which of the following medications is the best option to help him to quit smoking?

Accepted Answer

Bupropion

Answer

Naltrexone

Answer

Sertraline

Answer

Nicotine replacement therapy

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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