Psychopharmacology Practice Questions

Q: A 29 year old lady came to psychiatry OPD with symptoms of hypomania. She has a past history of manic episode. Now, she is planning to conceive. Which drug should be avoided for being highly teratogenic to the fetus?

Valproate. ***Valproate*** - **Valproate** is highly **teratogenic** and is associated with multiple birth defects, including **neural tube defects** (e.g., spina bifida), cardiac anomalies, and craniofacial defects. - Due to its significant risks, it is generally **contraindicated** in women of childbearing potential, especially during pregnancy, unless no other suitable alternatives exist. *Oxcarbazepine* - While it has some teratogenic risk (e.g., cleft palate), the risk is generally considered **lower than valproate**. - It is often favored over valproate in pregnant women requiring mood stabilizers, but still requires careful risk-benefit assessment. *Lithium* - **Lithium** is associated with an increased risk of **Ebstein's anomaly**, a specific cardiac defect, if used during the first trimester. - However, the overall risk of major malformations is still **lower than valproate**, and it can be used with careful monitoring if other options are not viable. *Olanzapine* - **Olanzapine** is an **atypical antipsychotic** that can be used as a mood stabilizer and is considered to have a **relatively lower teratogenic risk** compared to anticonvulsants like valproate. - While it's not entirely risk-free (associated with gestational diabetes and fetal growth issues), it's often a safer option in pregnancy for bipolar disorder than valproate.

Q: A patient of schizophrenia is being treated with clozapine. For which rare but serious side effects should he be monitored?

Agranulocytosis. ***Agranulocytosis*** - **Agranulocytosis** is a severe and potentially fatal reduction in white blood cells (specifically neutrophils) that can occur with clozapine use [2, 3]. - This is the **rare but serious side effect** that requires mandatory monitoring, occurring in **0.8-2%** of patients. - Patients on clozapine require routine **complete blood count (CBC)** monitoring: **weekly for the first 6 months**, then biweekly for months 6-12, then monthly thereafter . - This is the primary reason clozapine has restricted use despite being the most effective antipsychotic for treatment-resistant schizophrenia. *Seizures* - While clozapine can lower the **seizure threshold** (especially at higher doses), seizures occur in **1-2%** of patients and are **dose-dependent** . - Seizures are a known side effect that warrants dosage adjustment, but they are **not as rare** as agranulocytosis and do not require the same intensive blood monitoring protocol. - Management involves dose reduction or adding anticonvulsants. *Hepatomegaly* - **Hepatic dysfunction** can occur with clozapine, but **hepatomegaly** (enlarged liver) itself is not one of its rare, life-threatening side effects requiring specific monitoring above other, more severe issues. - Liver enzyme elevation may be monitored, but this is not the primary "rare but serious" concern. *Renal bleed* - **Renal complications** or **renal bleeding** are not recognized as significant or specifically monitored rare side effects of clozapine. - Clozapine's major concerns primarily involve hematologic (agranulocytosis), cardiovascular (myocarditis), and metabolic systems.

Q: Which of the following is not an off-label use of risperidone?

Bipolar disorder. ***Bipolar disorder*** - **Risperidone** is FDA-approved for the treatment of **bipolar I disorder**, both as monotherapy and adjunctive therapy for acute manic or mixed episodes. - This means its use for bipolar disorder is an **on-label indication**, not an off-label use. *PTSD* - The use of risperidone for **post-traumatic stress disorder (PTSD)** is considered an **off-label use**, as it is not specifically approved by the FDA for this condition. - While atypical antipsychotics may be used in some cases for severe PTSD symptoms, especially those involving psychosis or severe agitation, it is not a primary or approved treatment. *OCD* - The use of risperidone as an adjunct in **obsessive-compulsive disorder (OCD)**, particularly in treatment-resistant cases, is an **off-label use**. - While some studies support its use for augmenting SSRIs in OCD, it is not an FDA-approved indication. *Dementia* - Using risperidone for behavioral symptoms associated with **dementia** (e.g., aggression, agitation) is generally considered an **off-label use**. - Although it may be prescribed for these symptoms, there are significant concerns regarding increased mortality risk in elderly patients with dementia-related psychosis, leading to specific warnings and limited official indications.

Q: A 22-year-old woman presents with a complaint of low energy levels for the past 6 months. She feels as if she has no energy to do anything and has lost interest in photography, which she was previously passionate about. Feelings of hopelessness occupy her mind and she can no longer focus at work. She says she forces herself to hang out with her friends at weekends but would rather stay home. She denies any suicidal ideation. Her past medical history is significant for bulimia nervosa, which was diagnosed when she was a teen and was controlled with cognitive behavioral therapy. In addition, she has gastroesophageal reflux, which is being treated with esomeprazole. The patient has a 10-pack-year smoking history but denies any alcohol or recreational drug use. On examination, she is afebrile and vital signs are within normal limits. Her BMI is 24 kg/m2. Further physical examination is unremarkable. Which of the following aspects of this patient’s history is a contraindication to using bupropion as an antidepressant?

History of bulimia nervosa. ***History of bulimia nervosa*** - Bupropion is **contraindicated** in patients with a history of **eating disorders** such as bulimia nervosa or anorexia nervosa due to an increased risk of **seizures**. - This risk is thought to be related to **electrolyte imbalances** and metabolic abnormalities often seen in eating disorders, which significantly lower the seizure threshold. *BMI of 24 kg/m2* - A BMI of 24 kg/m2 is within the **healthy weight range** (18.5-24.9 kg/m2) and therefore does not pose a contraindication to bupropion use. - Bupropion is sometimes used to aid in **weight loss**, so a healthy BMI would not typically be a concern. *Smoking cessation* - Bupropion is **approved for smoking cessation** (as Zyban) and can be beneficial in patients trying to quit smoking. - This aspect of the patient's history is an **indication** for bupropion, not a contraindication. *Age of 22 years* - Bupropion is generally **safe and effective** for use in adults, including young adults like a 22-year-old. - There are no specific age-related contraindications for bupropion in this age group, though caution is advised in adolescents due to increased risk of suicidality.

Q: Drug of choice for treatment of akathisia is:-

Propranolol. ***Propranolol*** - **Beta-blockers** like propranolol are considered first-line for treating **akathisia**, especially in cases induced by antipsychotics. - They work by reducing the **adrenergic hyperactivity** and the sensation of inner restlessness characteristic of akathisia. *Haloperidol* - Haloperidol is a **first-generation antipsychotic** that is a common cause of drug-induced **akathisia**. - Administering it would likely **worsen** rather than treat the condition. *Fluoxetine* - Fluoxetine is a **selective serotonin reuptake inhibitor (SSRI)** used to treat depression and anxiety disorders. - It is not indicated for the treatment of **akathisia** and can sometimes induce or worsen motor restlessness. *Lithium* - Lithium is a **mood stabilizer** primarily used for bipolar disorder. - It is not a treatment for **akathisia** and can itself cause various neurological side effects, though akathisia is less common.

Q: All are used in attention deficit hyperactivity disorder (ADHD) except:

Phenobarbitone. ***Phenobarbitone*** - **Phenobarbitone** (phenobarbital) is a **barbiturate** primarily used as an **anticonvulsant** and for sedation. - It works as a **CNS depressant** and would worsen, not improve, symptoms of ADHD, which include inattention, hyperactivity, and impulsivity. - **Not indicated** for ADHD management and may cause sedation, cognitive impairment, and paradoxical hyperactivity in children. *Dextro-amphetamine* - **Dextro-amphetamine** is a **stimulant medication** commonly used in ADHD. - It works by increasing levels of **dopamine** and **norepinephrine** in the brain, improving focus and reducing hyperactivity. - Approved for ADHD treatment in both children and adults. *Methylphenidate* - **Methylphenidate** is a **stimulant** widely prescribed for ADHD and considered a first-line treatment. - It acts as a **norepinephrine-dopamine reuptake inhibitor**, thereby increasing the availability of these neurotransmitters. - Available in immediate-release and extended-release formulations. *Atomoxetine* - **Atomoxetine** is a **non-stimulant** selective norepinephrine reuptake inhibitor (SNRI) used for ADHD. - It is particularly useful in patients who cannot tolerate stimulants or have comorbid anxiety disorders. - Preferred when there is concern about substance abuse or tic disorders.

Q: Drug of choice for obsessive-compulsive disorder

Fluoxetine. ***Fluoxetine*** - **Selective serotonin reuptake inhibitors (SSRIs)** like fluoxetine are considered **first-line pharmacological treatment for Obsessive-Compulsive Disorder (OCD)** due to their effectiveness in modulating serotonin pathways implicated in the disorder. - Multiple SSRIs (fluoxetine, fluvoxamine, paroxetine, sertraline) and clomipramine are equally effective first-line agents, but **SSRIs are preferred initially** due to better tolerability and safety profile. - Among the given options, fluoxetine is the appropriate choice as an established first-line SSRI for reducing the frequency and intensity of obsessions and compulsions. - **OCD typically requires higher doses and longer duration** (8-12 weeks) compared to depression treatment. *Haloperidol* - **Haloperidol** is a **first-generation antipsychotic** primarily used to treat psychotic disorders (e.g., schizophrenia) and severe behavioral disturbances. - It works by blocking **dopamine D2 receptors** and is not a first-line treatment for OCD, though it might be used as an **augmentation strategy** in severe, treatment-refractory cases, particularly when tic disorders coexist. *Buspirone* - **Buspirone** is an **anxiolytic** primarily used for generalized anxiety disorder (GAD). It acts as a **serotonin 5-HT1A receptor partial agonist**. - While it helps with generalized anxiety, it is **generally ineffective** for the specific obsessions and compulsions characteristic of OCD and is not recommended as monotherapy. *Olanzapine* - **Olanzapine** is a **second-generation antipsychotic** primarily used for schizophrenia and bipolar disorder. It blocks dopamine and serotonin receptors. - It is not a first-line treatment for OCD but can be used as an **adjunct to SSRIs** in severe, treatment-resistant cases, particularly when there is partial response to adequate SSRI trials or comorbid psychotic symptoms.

Q: Drugs used in ADHD are:

All of the options. ***All of the options*** - **Methylphenidate**, **dextro-amphetamine**, and **atomoxetine** are all commonly used medications for the treatment of **Attention-Deficit/Hyperactivity Disorder (ADHD)** [1]. - These drugs work through different mechanisms to improve symptoms such as inattention, hyperactivity, and impulsivity. *Methylphenidate* - This is a **stimulant medication** that works by increasing the levels of **dopamine** and **norepinephrine** in the brain [2]. - It is one of the most frequently prescribed drugs for ADHD, available in various formulations (short-acting, long-acting) [1]. *Dextro-amphetamine* - This is also a **stimulant medication** that enhances the release of **dopamine** and **norepinephrine**, similar to methylphenidate [1]. - It is another highly effective treatment for ADHD and is available in forms like Adderall (mixed amphetamine salts) and Vyvanse (lisdexamfetamine) [1]. *Atomoxetine* - This is a **non-stimulant medication** that acts as a selective **norepinephrine reuptake inhibitor (SNRI)**. - It is an alternative for individuals who do not respond to stimulants, cannot tolerate them, or have coexisting anxiety disorders; it has a slower onset of action compared to stimulants.

Q: Which of the following drugs are used in the treatment of Attention-Deficit Hyperactivity Disorder (ADHD)?

All of the options. ***All of the options*** - **Atomoxetine**, **dexmethylphenidate**, and **methylphenidate** are all approved and commonly used medications for managing Attention-Deficit Hyperactivity Disorder (ADHD) [1]. - They represent different classes or formulations of drugs targeting neurotransmitter systems involved in ADHD. *Atomoxetine* - This is a **selective norepinephrine reuptake inhibitor** used for ADHD. - It is a **non-stimulant** option, often preferred for patients who do not tolerate stimulants or have co-existing anxiety disorders. *Dexmethylphenidate* - This is the **dextro-isomer** of methylphenidate, and it is a **central nervous system (CNS) stimulant** [1]. - It is known for its **potency** and faster onset of action due to only containing the active isomer. *Methylphenidate* - This is a **CNS stimulant** medication that works by blocking the reuptake of norepinephrine and dopamine [1]. - It is available in various formulations (short-acting, intermediate-acting, long-acting) to suit individual patient needs [1].

Q: First agent shown to be effective in manic phase of Bipolar Disorder -

Lithium. ***Lithium*** - **Lithium** was the first mood stabilizer specifically demonstrating efficacy in treating the **manic phase of bipolar disorder**, revolutionizing its management. - Its discovery in the 1940s and subsequent clinical trials established it as the **gold standard** for acute mania and maintenance therapy. *Valproate* - While effective in treating **acute mania** and bipolar depression, **valproate** was introduced later than lithium as a mood stabilizer. - It works by **enhancing GABAergic transmission** and modulating voltage-sensitive sodium channels. *Lamotrigine* - Primarily indicated for the treatment of **bipolar depression** and as a maintenance therapy to prevent depressive episodes. - It has **limited efficacy** in treating acute manic episodes. *Carbamazepine* - An **anticonvulsant** that also possesses mood-stabilizing properties, effective in some cases of acute mania and rapid cycling. - Its use in bipolar disorder followed the introduction of lithium, and it is considered a **second-line treatment**.

Question 1

A 29 year old lady came to psychiatry OPD with symptoms of hypomania. She has a past history of manic episode. Now, she is planning to conceive. Which drug should be avoided for being highly teratogenic to the fetus?

Accepted Answer

Valproate

Answer

Oxcarbazepine

Answer

Lithium

Answer

Olanzapine

Question 2

A patient of schizophrenia is being treated with clozapine. For which rare but serious side effects should he be monitored?

Accepted Answer

Agranulocytosis

Answer

Seizures

Answer

Hepatomegaly

Answer

Renal bleed

Question 3

Which of the following is not an off-label use of risperidone?

Accepted Answer

Bipolar disorder

Answer

PTSD

Answer

OCD

Answer

Dementia

Question 4

A 22-year-old woman presents with a complaint of low energy levels for the past 6 months. She feels as if she has no energy to do anything and has lost interest in photography, which she was previously passionate about. Feelings of hopelessness occupy her mind and she can no longer focus at work. She says she forces herself to hang out with her friends at weekends but would rather stay home. She denies any suicidal ideation. Her past medical history is significant for bulimia nervosa, which was diagnosed when she was a teen and was controlled with cognitive behavioral therapy. In addition, she has gastroesophageal reflux, which is being treated with esomeprazole. The patient has a 10-pack-year smoking history but denies any alcohol or recreational drug use. On examination, she is afebrile and vital signs are within normal limits. Her BMI is 24 kg/m2. Further physical examination is unremarkable. Which of the following aspects of this patient’s history is a contraindication to using bupropion as an antidepressant?

Accepted Answer

History of bulimia nervosa

Answer

BMI of 24 kg/m2

Answer

Smoking cessation

Answer

Age of 22 years

Question 5

Drug of choice for treatment of akathisia is:-

Accepted Answer

Propranolol

Answer

Haloperidol

Answer

Fluoxetine

Answer

Lithium

Question 6

All are used in attention deficit hyperactivity disorder (ADHD) except:

Accepted Answer

Phenobarbitone

Answer

Dextro-amphetamine

Answer

Methylphenidate

Answer

Atomoxetine

Question 7

Drug of choice for obsessive-compulsive disorder

Accepted Answer

Fluoxetine

Answer

Haloperidol

Answer

Buspirone

Answer

Olanzapine

Question 8

Drugs used in ADHD are:

Accepted Answer

All of the options

Answer

Methylphenidate

Answer

Dextro-amphetamine

Answer

Atomoxetine

Question 9

Which of the following drugs are used in the treatment of Attention-Deficit Hyperactivity Disorder (ADHD)?

Accepted Answer

All of the options

Answer

Atomoxetine

Answer

Dexmethylphenidate

Answer

Methylphenidate

Question 10

First agent shown to be effective in manic phase of Bipolar Disorder -

Accepted Answer

Lithium

Answer

Valproate

Answer

Lamotrigine

Answer

Carbamazepine

Psychopharmacology — MCQs

Psychopharmacology — MCQs

On this page

Practice by Chapter

Want unlimited practice?