Psychopharmacology

Topics in this chapter

• Antipsychotic Drugs and Uses
• Antipsychotic Adverse Effects
• Clozapine Use and Monitoring
• Antidepressant Classes and Uses
• Antidepressant Toxicity and Interactions
• Lithium and Mood Stabilizer Management

Practice questions

1. Question 1Q-55D786

   A 35-year-old male with treatment-resistant schizophrenia is started on clozapine. Which of the following baseline investigations is mandatory before initiating this medication, according to standard safety monitoring guidelines?

   1. A.Serum creatinine and blood urea nitrogen
   2. B.Absolute neutrophil count (ANC) and total leukocyte count (TLC)
   3. C.Thyroid function tests (TSH and free T4)
   4. D.Serum lithium levels
   See the answer and solution
2. Question 2Q-3DF455

   A 45-year-old woman with bipolar disorder type I is brought to the emergency department with coarse tremors, ataxia, vomiting, and confusion. Her serum lithium level is found to be 2.2 mEq/L. Which of the following is the most definitive management step in severe lithium toxicity when conservative measures fail or levels are extremely high?

   1. A.Administer intravenous normal saline and furosemide
   2. B.Perform hemodialysis
   3. C.Administer sodium polystyrene sulfonate (Kayexalate)
   4. D.Administer flumazenil intravenously
   See the answer and solution
3. Question 3Q-B80E66

   A 28-year-old man is prescribed a high-potency first-generation antipsychotic (e.g., haloperidol) for acute psychosis. Three days later, he presents with painful, involuntary sustained upward deviation of the eyes and arching of the back. Which of the following is the most appropriate initial pharmacological treatment?

   1. A.Intravenous or intramuscular benztropine or diphenhydramine
   2. B.Oral lithium carbonate
   3. C.Intravenous fluoxetine
   4. D.Oral propranolol
   See the answer and solution
4. Question 4Q-4E2ADD

   Which of the following antidepressants is classified as a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) and is also FDA-approved for the management of generalized anxiety disorder, neuropathic pain, and fibromyalgia?

   1. A.Sertraline
   2. B.Duloxetine
   3. C.Bupropion
   4. D.Escitalopram
   See the answer and solution
5. Question 5Q-F4C309

   A 32-year-old male initiated on a new psychiatric medication develops hyperthermia, 'lead-pipe' muscle rigidity, autonomic instability (fluctuating blood pressure, tachycardia), and altered mental status. Laboratory workup shows a markedly elevated creatine phosphokinase (CPK). Which condition is most likely, and what is the primary neurotransmitter deficit involved?

   1. A.Serotonin syndrome; Excess serotonin
   2. B.Neuroleptic malignant syndrome; Central dopamine blockade
   3. C.Anticholinergic toxicity; Peripheral acetylcholine excess
   4. D.Malignant hyperthermia; NMDA receptor hypofunction
   See the answer and solution