Psychopharmacology Practice Questions

Q: Atomoxetine is used in the management of which of the following conditions?

ADHD. ***Correct: ADHD*** * **Atomoxetine** is a **selective norepinephrine reuptake inhibitor (SNRI)** primarily used in the management of **Attention-Deficit/Hyperactivity Disorder (ADHD)**. * It is a **non-stimulant** medication, making it a suitable alternative for patients who do not respond to or cannot tolerate traditional stimulant medications for ADHD. * FDA-approved in 2002, atomoxetine remains an important treatment option, particularly for patients with concerns about stimulant abuse potential or those with comorbid anxiety disorders. *Incorrect: Bipolar disorder* * **Bipolar disorder** is typically treated with mood stabilizers (e.g., lithium, valproate), antipsychotics, and sometimes antidepressants, but atomoxetine is not a first-line or common treatment option. * While some ADHD symptoms can overlap with bipolar disorder, atomoxetine is specifically designed for ADHD and lacks the broad mood-stabilizing effects needed for bipolar disorder. *Incorrect: Schizophrenia* * **Schizophrenia** is a severe mental disorder treated primarily with **antipsychotic medications** that target dopamine and serotonin systems. * Atomoxetine does not have efficacy in treating the positive or negative symptoms of schizophrenia and is not indicated for this condition. *Incorrect: Depression* * While atomoxetine affects **norepinephrine**, some SNRIs (e.g., venlafaxine, duloxetine) are used for depression. However, atomoxetine's primary indication and efficacy profile are not for treating **major depressive disorder**. * Its mechanism of action is more specifically tailored to the neurochemical imbalances seen in ADHD rather than the broader neurotransmitter dysregulation in depression.

Q: Drug of choice for obsessive-compulsive disorder is:

Fluoxetine. ***Fluoxetine*** - **Selective serotonin reuptake inhibitors (SSRIs)** are the first-line pharmacological treatment for **obsessive-compulsive disorder (OCD)**. - **Fluoxetine** was traditionally considered a primary choice for OCD treatment and is FDA-approved for this indication. - It works by selectively inhibiting serotonin reuptake, increasing serotonergic neurotransmission, which is crucial in OCD pathophysiology. - Higher doses are typically required for OCD compared to depression (40-80 mg/day). *Sertraline* - **Sertraline** is also an **SSRI** and equally effective as fluoxetine for OCD treatment. - It is FDA-approved for OCD and considered a first-line option. - In current clinical practice, **all SSRIs (fluoxetine, sertraline, fluvoxamine, paroxetine) are considered equally appropriate first-line choices** with no single "drug of choice." - Selection depends on individual patient factors, side effect profile, and drug interactions. - **Note:** Both fluoxetine and sertraline are correct answers in modern practice; this question reflects historical exam teaching. *Alprazolam* - **Alprazolam** is a **benzodiazepine** used for short-term relief of anxiety and panic attacks. - It does not address the core pathophysiology of OCD (obsessions and compulsions). - Not recommended as monotherapy for OCD; may be used adjunctively for severe anxiety symptoms. *Chlorpromazine* - **Chlorpromazine** is a **first-generation antipsychotic** used primarily for schizophrenia and psychotic disorders. - Not indicated for OCD treatment as monotherapy. - Antipsychotics may be used as **augmentation** in treatment-resistant OCD but only as add-on to SSRIs.

Q: Drug of choice for night terrors:

Clonazepam. ***Clonazepam*** - **Clonazepam**, a benzodiazepine, is the **drug of choice** for night terrors due to its ability to suppress Stage 3 and 4 **slow-wave sleep**, where night terrors occur. - Its sedative and anxiolytic effects help to calm the patient and reduce the frequency and severity of these episodes. *Tricyclic antidepressant* - While some **tricyclic antidepressants** (TCAs) have sedative properties, they are generally not the first-line treatment for night terrors. - Their side effect profile and potential to alter other sleep stages make them less suitable than benzodiazepines for this specific parasomnia. *Meprobamate* - **Meprobamate** is an anxiolytic and sedative drug that is largely historical and has been replaced by safer and more effective alternatives like benzodiazepines. - It has a higher risk of dependence and side effects compared to modern treatments for sleep disorders. *Diazepam* - **Diazepam** is another benzodiazepine, but **clonazepam** is generally preferred for night terrors due to its longer half-life and specific efficacy in suppressing slow-wave sleep. - While diazepam could offer some relief, clonazepam is considered more effective for sustained management of this condition.

Q: A 32-year-old man comes to the physician complaining of excessive sleepiness for the past several months. He reports falling asleep while dealing with customers and had a near accident when he fell asleep while driving. The patient reports that he occasionally hears voices while falling asleep and finds himself "temporarily frozen" and unable to move upon awakening. Which of the following is the most appropriate treatment for this patient?

Modafinil. ***Modafinil*** - The patient's symptoms of **excessive daytime sleepiness** (EDS), **hypnagogic hallucinations** (hearing voices while falling asleep), and **sleep paralysis** are classic signs of **narcolepsy**. - **Modafinil** is a **non-amphetamine stimulant** that promotes wakefulness and is a first-line treatment for narcolepsy, improving alertness and reducing EDS. *Melatonin* - **Melatonin** is a hormone involved in regulating the **sleep-wake cycle** and is primarily used for **insomnia**, **jet lag**, or **circadian rhythm disorders**. - It is not effective for treating the hallmark symptoms of narcolepsy, such as cataplexy or excessive daytime sleepiness. *Clonazepam* - **Clonazepam** is a **benzodiazepine** that acts as a central nervous system depressant, primarily used for **anxiety disorders**, seizures, and some sleep disorders like **REM sleep behavior disorder**. - While it can help with some parasomnias, it would worsen daytime sleepiness in a patient with narcolepsy and is not a primary treatment for its core symptoms. *Continuous positive airway pressure* - **Continuous positive airway pressure (CPAP)** is the standard treatment for **obstructive sleep apnea (OSA)**, a condition characterized by recurrent upper airway collapse during sleep. - Although OSA can cause excessive daytime sleepiness, the patient's additional symptoms of hypnagogic hallucinations and sleep paralysis are not typical of OSA, making narcolepsy and its specific treatments more appropriate.

Q: Drug most useful in the treatment of obsessive compulsive disorder is

Fluoxetine. ***Fluoxetine*** - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)**, which are considered first-line treatments for **obsessive-compulsive disorder (OCD)**. - SSRIs, including fluoxetine, are effective in **reducing the severity of obsessions and compulsions** by increasing serotonin levels in the brain. *Doxepin* - **Doxepin** is a **tricyclic antidepressant (TCA)** that primarily blocks the reuptake of norepinephrine and serotonin but also has significant anticholinergic and antihistaminic properties. - TCAs are generally **less preferred for OCD** due to their side effect profile and **SSRIs** typically showing greater efficacy. *Dothiepin* - **Dothiepin** is also a **tricyclic antidepressant (TCA)** with similar mechanisms and side effects to doxepin. - Like other TCAs, dothiepin is **not a first-line treatment for OCD**; SSRIs are more commonly used due to better tolerability and efficacy. *Amoxapine* - **Amoxapine** is a **tetracyclic antidepressant** with properties similar to TCAs, also acting as a **norepinephrine and dopamine reuptake inhibitor**. - While it has antidepressant effects, amoxapine is **not typically used for OCD** and carries a risk of inducing extrapyramidal side effects.

Q: Which of the following antidepressants can be safely used in elderly depression?

mirtazapine. ***Mirtazapine*** - Mirtazapine is often a good choice in elderly patients because it has a relatively **favorable side effect profile** in this population, causing less anticholinergic effects and orthostatic hypotension compared to many other antidepressants. - Its **sedating properties** can be beneficial for elderly patients who also suffer from insomnia, and its **appetite-stimulating effects** can help those with poor nutritional intake. *Phenelzine* - Phenelzine is a **monoamine oxidase inhibitor (MAOI)**, which carries a significant risk of **hypertensive crisis** due to interactions with tyramine-rich foods and many medications, making it generally unsafe for elderly use. - It also has a high incidence of other side effects, including **orthostatic hypotension** and **sedation**, which are particularly dangerous in older adults. *Fluoxetine* - Fluoxetine, an **SSRI**, has a very **long half-life** and can accumulate in elderly patients, increasing the risk of side effects like hyponatremia, gastrointestinal upset, and agitation. - While effective, its **activating properties** can exacerbate anxiety or insomnia in some elderly individuals, and there's a risk of **drug-drug interactions** due to its potent CYP2D6 inhibition. *Trazodone* - Trazodone is primarily used off-label at low doses for **insomnia** due to its prominent sedative effects, but it can cause significant **orthostatic hypotension** and cardiac arrhythmias in the elderly at antidepressant doses. - There is also a risk of **priapism** in men, and its strong sedative properties can lead to increased falls risk and daytime sleepiness, which are undesirable in the elderly.

Q: The preferred drug for treating ADHD in a 7-year-old boy, whose father has a history of substance abuse:

Atomoxetine. ***Atomoxetine*** - As a **non-stimulant**, atomoxetine is preferred in patients where stimulant use is contraindicated or when there's a concern for **substance abuse potential**, such as a parental history. - It specifically inhibits the **norepinephrine transporter**, leading to increased norepinephrine levels in the prefrontal cortex, improving ADHD symptoms. *Clonidine* - While clonidine is sometimes used for ADHD, particularly for **hyperactivity** or **tics**, it is not generally considered first-line and can cause **sedation**. - Its mechanism primarily involves stimulating central alpha-2 adrenergic receptors, which can help with impulse control but is distinct from the primary action of atomoxetine. *Dexamphetamine* - This is a **stimulant medication** and is highly effective for ADHD, but it carries a higher potential for **abuse and diversion**, making it less suitable given a family history of substance abuse. - Its mechanism involves increasing dopamine and norepinephrine levels in the brain, which can be reinforcing and contribute to its abuse potential. *Methylphenidate* - Similar to dexamphetamine, methylphenidate is a **stimulant** and a first-line treatment for ADHD, but its potential for **abuse** makes it a less desirable choice in this specific clinical context. - It acts as a norepinephrine-dopamine reuptake inhibitor, increasing the availability of these neurotransmitters, but like other stimulants, its controlled substance status is a concern.

Q: Drug of choice in Tourette syndrome is -

Haloperidol. ***Haloperidol*** - **Haloperidol**, a **first-generation antipsychotic**, is highly effective in blocking dopamine receptors and reducing the severity of tics in Tourette syndrome. - It is considered a **drug of choice** for managing severe tics due to its strong dopamine antagonism, which helps control **motor and vocal tics**. *Valproate* - **Valproate** is primarily an **anticonvulsant** and **mood stabilizer**, used in epilepsy and bipolar disorder. - While it has some efficacy in reducing tics, it is generally **less effective** than dopamine-blocking agents like haloperidol and is not considered a first-line treatment for Tourette syndrome. *Carbamazepine* - **Carbamazepine** is an **anticonvulsant** used for seizures and trigeminal neuralgia. - It is generally **not efficacious** for the treatment of tics in Tourette syndrome and does not target the dopaminergic pathways involved in tic generation. *Methadone* - **Methadone** is an **opioid analgesic** used for pain management and opioid dependence treatment. - It has **no role** in the management of Tourette syndrome as its mechanism of action is unrelated to the pathophysiology of tics.

Q: OCD treatment is based on -

Serotonergic receptor. ***Serotonergic receptor*** - The efficacy of **selective serotonin reuptake inhibitors (SSRIs)** in treating OCD strongly implicates **serotonin pathways** in its pathophysiology. - Many patients with OCD show improvement in symptoms with medications that enhance **serotonin neurotransmission**. *Glutamate receptor* - While **glutamate** plays a role in neural excitability and learning, it is not the primary target for established OCD treatments. - Research on **glutamate modulators** for OCD is ongoing, but they are not first-line therapies. *Dopaminergic receptor* - **Dopamine pathways** are primarily involved in reward, motivation, and motor control, and are targeted in conditions like schizophrenia and Parkinson's disease. - Treatments directly targeting dopamine receptors are not primary for OCD, although **dopamine antagonists** may be used as augmentation in some refractory cases. *NA receptor* - **Norepinephrine (NA)** is involved in alertness, stress, and mood regulation, and is targeted in depression and anxiety disorders. - While some **tricyclic antidepressants** with NA effects can be used, medications primarily targeting NA receptors are not the mainstay for OCD.

Question 1

Atomoxetine is used in the management of which of the following conditions?

Accepted Answer

ADHD

Answer

Bipolar disorder

Answer

Schizophrenia

Answer

Depression

Question 2

Drug of choice for obsessive-compulsive disorder is:

Accepted Answer

Fluoxetine

Answer

Sertraline

Answer

Alprazolam

Answer

Chlorpromazine

Question 3

Drug of choice for night terrors:

Accepted Answer

Clonazepam

Answer

Tricyclic antidepressant

Answer

Meprobamate

Answer

Diazepam

Question 4

A 32-year-old man comes to the physician complaining of excessive sleepiness for the past several months. He reports falling asleep while dealing with customers and had a near accident when he fell asleep while driving. The patient reports that he occasionally hears voices while falling asleep and finds himself "temporarily frozen" and unable to move upon awakening. Which of the following is the most appropriate treatment for this patient?

Accepted Answer

Modafinil

Answer

Melatonin

Answer

Clonazepam

Answer

Continuous positive airway pressure

Question 5

Drug most useful in the treatment of obsessive compulsive disorder is

Accepted Answer

Fluoxetine

Answer

Doxepin

Answer

Dothiepin

Answer

Amoxapine

Question 6

Which of the following antidepressants can be safely used in elderly depression?

Accepted Answer

mirtazapine

Answer

phenelzine

Answer

fluoxetine

Answer

trazodone

Question 7

The preferred drug for treating ADHD in a 7-year-old boy, whose father has a history of substance abuse:

Accepted Answer

Atomoxetine

Answer

Clonidine

Answer

Dexamphetamine

Answer

Methylphenidate

Question 8

Drug of choice in Tourette syndrome is -

Accepted Answer

Haloperidol

Answer

Valproate

Answer

Carbamazepine

Answer

Methadone

Question 9

OCD treatment is based on -

Accepted Answer

Serotonergic receptor

Answer

Glutamate receptor

Answer

Dopaminergic receptor

Answer

NA receptor

Question 10

An elderly housewife lost her husband who died suddenly of Myocardial infarction. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. Over the past couple of years since his death, this has continued and provokes anxiety and sadness of mood when she is preoccupied with his thought. She should be treated with:

Accepted Answer

Sertraline

Answer

Benztropine

Answer

Risperidone

Answer

Lorazepam

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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