Psychopharmacology
1. The following statements are true: | |
A. Drugs must be ionized to be absorbed by passive diffusion | F |
B. In an acid pH, basic drugs will be poorly absorbed | T |
C. Gastric emptying is delayed by MAOIs | T |
D. Food increases the absorption of diazepam | T |
E. Rectal administration results in extensive 1st pass metabolism | F |
2. Regarding some aspects of pharmacokinetics: | |
A. Diazepam is 99% protein-bound | T |
B. Ionized drugs cross the blood-brain barrier easily | F |
C. Phase I reactions convert the drug to non-active metabolites | F |
D. Phase II reactions include glucuronidation and sulphation | T |
E. Hydroxylation is autosomal dominant | T |
3. Regarding Drug interactions: | |
A. Carbamazepine can inhibit the metabolism of TCAs | F |
B. Phenothiazines can induce their own metabolism | T |
C. Haloperidol inhibits the metabolism of TCAs | T |
D. Cytochrome P450 inhibition by cimetidine is an important factor in healthy subjects | F |
E. Slow acetylators predominate in Europe and Japan | F |
4. The following are true: | |
A. In the elderly, there is a reduction in plasma albumin | T |
B. There is a loss of body weight in the elderly | F |
C. In pregnancy, the increase in plasma volume results in an increase in the free fraction of a drug | F |
D. First-order kinetics are exponential | T |
E. Alcohol and aspirin undergo zero-order kinetics | T |
5. The following statements about the distribution of neurotransmitters are correct: | |
A. Acetylcholine is found in the basal ganglia | T |
B. Dopamine cell bodies are found in the limbic system | F |
C. 5-HT predominates in the raphe nuclei in the brainstem | T |
D. Noradrenaline predominates in the locus coeruleus | T |
E. GABA is found in the peri-aqueductal grey matter | F |
6. The following are true statements about receptors: | |
A. 5-HT2A antagonists improve slow-wave sleep | T |
B. 5-HT1A antagonists are anxiolytic | F |
C. D2 receptors are found in the limbic system | T |
D. Antagonism of alpha-2 adrenoceptors leads to reduced NA release | F |
E. Most antipsychotics are D2 agonists | F |
7. Regarding benzodiazepines (BZDs): | |
A. BZDs bind to the gamma-2 subunit of the GABAB supramolecular complex | F |
B. BZDs can inhibit the effects of other neurotransmitters such as 5-HT | T |
C. Oxazepam and Lorazepam are short-acting BZDs | T |
D. The BZ1 receptor mediates the anti-anxiety effect of BZDs | T |
E. The BZ2 receptor is concentrated in the amygdala and septo-hippocampal pathways | T |
8. Regarding Benzodiazepines: | |
A. Tolerance develops in 4-6 weeks of therapy | F |
B. Withdrawal can cause rebound insomnia | T |
C. BZDs are effective in phobic states | F |
D. Zopiclone and Zolpidem act upon the BZ2 receptor in a similar way to BZDs | F |
E. Withdrawal symptoms peak at 7-8 days | T |
9. The following are recognized side effects of BZDs: | |
A. Ataxia | T |
B. Drowsiness | T |
C. Anterograde amnesia | T |
D. Nightmares | F |
E. Insomnia | F |
10. The following are recognized symptoms of the BZD withdrawal syndrome: | |
A. Tremor | T |
B. Depression | T |
C. Tinnitus | T |
D. Blurred vision | T |
E. Sweating | T |
11. Factors associated with dependence and withdrawal problems are: | |
A. Short duration of treatment | F |
B. Passive-dependent personality traits | T |
C. Age < 40 years | F |
D. Concurrent use of Buproprion | T |
E. High dose and rapid withdrawal | T |
12. Regarding Buspirone: | |
A. Buspirone is a 5-HT1A agonist | T |
B. Buspirone has little effect on DA systems | F |
C. Effects are usually evident after 8-12 hours | F |
D. It can cause galactorrhoea | T |
E. Dysphoria has been reported | T |
13. Regarding the pharmacological treatment of anxiety disorders: | |
A. Placebo-response rate is in the region of 20-30 % | F |
B. CBT is much less effective than drugs for anxiety | F |
C. Beta-blockers can cause anxiety | F |
D. Beta-blockers are associated with nightmares | T |
E. The effect of Beta-blockers usually takes up to a month to develop | F |
14. The following statements about antidepressants are true: | |
A. Mianserin is an SSRI | F |
B. Reboxetine is a NaSSA | F |
C. Mirtazapine is a NARI | F |
D. Trazodone is an SNRI | F |
E. Nefazodone is an SSRI | T |
15. Regarding Tricyclic Antidepressants (TCAs): | |
A. Treatment results in subsensitivity of NA and 5-HT receptors on cell bodies | T |
B. Tertiary amines have a higher affinity for the 5-HT uptake site | T |
C. Tertiary amines are less sedating | F |
D. Secondary amines have more anticholinergic side effects | F |
E. Tertiary amines have a quicker peak plasma level | T |
16. The following are true: | |
A. Amoxapine has D2 antagonist properties | T |
B. Amitriptyline is a secondary amine | F |
C. Lofepramine is a tertiary amine | T |
D. Maprotiline is the most selective NA uptake inhibitor of the TCAs | T |
E. Imipramine is more selective for 5-HT than Nortriptyline | T |
17. Side effects of TCAs include: | |
A. Sinus bradycardia | F |
B. Impairment of memory | T |
C. Postural hypotension due to alpha-1 adrenoceptor antagonism | T |
D. Weight gain due to histamine H1 agonism | F |
E. Negative inotropism | T |
18. Side effects of TCAs include: | |
A. Prolongation of the PR interval | T |
B. Flattening of T waves | T |
C. Coarse tremor | F |
D. Raising of the seizure threshold | F |
E. Cholestatic jaundice | T |
19. Contraindications to TCAs include: | |
A. Narrow angle glaucoma | T |
B. Elderly | F |
C. Heart block | T |
D. Previous MI | F |
E. Prostatic hypertrophy | T |
20. Regarding SSRIs: | |
A. They reach peak levels within 1 hour of ingestion | F |
B. Long-term use results in reduced 5-HT2 function | T |
C. Fluoxetine has a half-life of around 7 days | F |
D. OCD is an indication for their use | T |
E. They should be avoided in people with cardiac disease | F |
21. Common side effects of SSRIs include: | |
A. Diarrhoea | T |
B. Constipation | T |
C. Loss of appetite | T |
D. Weight gain | F |
E. Tremor | T |
22. Common side effects of SSRIs include: | |
A. Anorgasmia | T |
B. Hypertension | F |
C. Tachycardia | F |
D. Alopecia | F |
E. Sweating | T |
23. Interactions of SSRIs include: | |
A. Use with MAOIs can result in the 5-HT toxicity syndrome | T |
B. Lithium | T |
C. Diazepam and fluoxetine | T |
D. Warfarin | T |
E. Anti-convulsants | T |
24. Regarding MAOIs: | |
A. Most are selective for MAOI-A | F |
B. Phenelzine has fewer side effects than isocarboxacid | F |
C. Hypotension is a major problem with tranycypramine | F |
D. Fast acetylators metabolize MAOIs at the same rate as slow acetylators | F |
E. It is said that atypical depression responds best to MAOIs | T |
25. Recognized side effects of MAOIs include: | |
A. Mania | T |
B. Seizures | T |
C. Blurred vision | T |
D. Peripheral neuropathy | T |
E. Alopecia | F |
26. Important interactions with MAOIs can occur with: | |
A. Some cough medicines | T |
B. Oral hypoglycaemics | T |
C. NSAIDs | F |
D. Cheese | T |
E. Calcium antagonists | F |
27. Contraindications for MAOIs include: | |
A. Renal failure | F |
B. Congestive cardiac failure | T |
C. Concurrent use of TCAs | F |
D. Asthma | F |
E. Phaochromocytoma | T |
28. Mianserin: | |
A. Is a weak NA reuptake inhibitor | T |
B. Is cardiotoxic | F |
C. Is an antagonist at histamine receptors and can cause weight gain | T |
D. Has no effect on the seizure threshold | F |
E. Can cause agranulocytosis | T |
29. Mirtazapine: | |
A. Has little effect on histamine receptors | F |
B. Blocks alpha-2 autoreceptors | T |
C. Is alerting in its profile | F |
D. Can reduce appetite | F |
E. Can cause neutropenia | T |
30. Trazodone: | |
A. Is non-sedating | F |
B. Has 5-HT agonist properties | T |
C. Should be taken with food | T |
D. Can cause priapism | T |
E. Has no effect on cognitive function | F |
31. Nefazodone: | |
A. Has sedating properties due to alpha-1 adrenoceptor antagonism | F |
B. Dry mouth and dizziness can occur | T |
C. Has a long half-life | F |
D. Can affect the action of propanolol | T |
E. Can increase haloperidol levels | T |
32. Venlafaxine: | |
A. Is an SNRI | T |
B. Lacks anticholinergic effects | T |
C. Has no effect on the seizure threshold | F |
D. Can be given with MAOIs | F |
E. Can cause hypotension | T |
33. L-Tryptophan: | |
A. Is an effective antidepressant by itself | F |
B. Should not be used with MAOIs | F |
C. Can cause agranulocytosis | F |
D. Peripheral neuropathy may be a rare side effect | T |
E. Skin sclerosis can occur rarely | T |
34. Regarding the phenothiazines: | |
A. Group one drugs include thioridazine | F |
B. Group three drugs include trifluoperazine | T |
C. Group two drugs have high levels of antimuscarinic side effects | T |
D. Group three drugs have low levels of extrapyramidal side effects | F |
E. Other classes of drugs tend to resemble group one phenothiazines | F |
34. Regarding other antipsychotic drugs: | |
A. Droperidol is a butyrophenone | T |
B. Zuclopenthixol is a thioxanthene | T |
C. Olanzapine is a dibenzodiazepine | F |
D. Risperidone is a dibenzothiazepine | F |
E. Sulpiride is a substituted benzamied | T |
35. The following are true of movement disorders: | |
A. Young females are at highest risk of acute dystonic reactions | F |
B. Extrapyramidal symptoms tend to occur within a few hours of drug administration | F |
C. Extrapyramidal symptoms are due to blockage of D2 receptors in the basal ganglia | T |
D. Increasing the dose can sometimes help extrapyramidal side effects | F |
E. Tardive dyskinesia is due to D2 receptor hypersensitivity | T |
36. The following are at increased risk of tardive dyskinesia: | |
A. Female | T |
B. Affective disorders | T |
C. Continuous treatment | F |
D. Organic brain disease | T |
E. Increasing age | T |
37. Recognized side effects of antipsychotics include: | |
A. Sedation due to muscarinic blockade | F |
B. Nasal congestion | T |
C. Impotence | T |
D. Psoriasis | F |
E. Hypertension | F |
38. Recognized side effects of antipsychotics include: | |
A. Retinal pigmentation | T |
B. Leucocytosis | F |
C. Prolonged QT interval | T |
D. Weight loss | F |
E. Torsade de pointes | T |
39. Regarding neuroleptic malignant syndrome: | |
A. Onset occurs after 1-2 months of treatment | F |
B. Onset is slow and insidious | F |
C. Symptoms include hypertonicity, stupor, and autonomic instability | T |
D. Mortality is 50 % | F |
E. Secondary conditions include thromboembolism, renal failure, and cardivascular collapse | T |
40. Risperidone: | |
A. Has high affinity for the 5-HT2A receptor | T |
B. Can cause hyperprolacinaemia | T |
C. Weight loss is frequent | F |
D. Is less effective than conventional antipsychotics | F |
E. Headache and anxiety may occur | T |
41. Clozapine: | |
A. Has low affinity for D2 receptors | T |
B. Has low affinity for D1 and D4 receptors | F |
C. Has few effects on adrenoceptors | F |
D. Can increase blood levels of warfarin and digoxin | T |
E. Metabolism by the cytochrome P450 system is not significant | F |
42. Side effects of Clozapine include: | |
A. Bradycardia | F |
B. Weight gain | T |
C. Hypersalivation | T |
D. Increase in seizure threshold | F |
E. Neutropenia and agranulocytosis | T |
43. Olanzapine: | |
A. Has lower affinity for the D2 and 5-HT2A receptors than Clozapine | F |
B. Has higher affinity for the D1 receptor than Clozapine | F |
C. Causes negligible weight gain | F |
D. Has high levels of Extra-pyramidal side effects | F |
E. Can cause marked sedation | T |
44. Quetiapine: | |
A. Has a similar binding profile to clozapine | T |
B. Has a high affinity for muscarinic receptors | F |
C. Has lower affinity for all receptors than clozapine | T |
D. Causes less weight gain than olanzapine and clozapine | T |
E. Can cause constipation | T |
45. Sertindole: | |
A. Has low affinity for the 5-HT2A receptor | F |
B. Specifically targets D2 receptors in the limbic region | T |
C. Causes high levels of EPS | F |
D. May cause orthostatic hypotension | T |
E. Has been linked to sudden cardiac death | T |
46. Amisulpride: | |
A. Is a D2/ D3 agonist | F |
B. Blocks autoreceptors at low doses and can increase synaptic dopamine levels | T |
C. Does not increase prolactin levels | F |
D. Has a similar level of EPS across the whole dose range | F |
E. Is clinically effective for negative symptoms of schizophrenia at low doses (<300mg/ day) | T |
47. Lithium: | |
A. Has its main effects on noradrenaline systems in the brain | F |
B. Works by affecting secondary messenger systems in the cell | T |
C. Increases the rate of formation of cAMP | F |
D. Works best with rapid-cycling patients | F |
E. Is reabsorbed from the kidney | T |
48. Side effects of Lithium include: | |
A. Tremor | T |
B. Muscle weakness | T |
C. Decreased urine output | F |
D. Dysgeusia | T |
E. Weight gain more in men | F |
49. Side effects of lithium include: | |
A. Cranial diabetes insipidus | F |
B. Hypothyroidism | T |
C. Shrinkage of the thyroid gland | F |
D. Hypoparathryoidism | F |
E. Females have thyroid side effects more commonly than men | T |
50. Side effects of lithium include: | |
A. Leucocytosis | T |
B. Acne | T |
C. Alopecia | T |
D. T wave inversion and QRS narrowing | F |
E. Memory impairment | T |
51. The following statements are true: | |
A. A rise in plasma sodium results in a rise in plasma lithium levels | F |
B. Dehydration results in a fall in plasma lithium levels | F |
C. Although lithium can treat bipolar illness, it has no effect on the number of relapses | F |
D. Thyroid gland disorders do not respond to thryoxine | F |
E. Lithium is distributed widely in the body | T |
52. Regarding lithium toxicity: | |
A. Fine tremor is an early sign | F |
B. GI upset tends to occur early | T |
C. Neurological signs tend to appear later | T |
D. Hyporeflexia frequently occurs | F |
E. Coma may occur at high levels | T |
53. The following statements are true: | |
A. Lithium inhibits the release of iodine, and thyroid hormones | T |
B. Lithium induces thyroid autoantibodies | T |
C. Lithium does not cross the placenta | F |
D. Lithium is excreted in breat milk | T |
E. Long term treatment does not seem to affect GFR | T |
54. Increased lithium levels occur with: | |
A. Bendrofluazide | T |
B. Aspirin | F |
C. Metronidazole | T |
D. NSAIDs | T |
E. ACE-inhibitors | T |
55. Carbamazepine: | |
A. Is a GABA agonist | T |
B. Affects calcium channels | T |
C. Induces its own metabolism | T |
D. Has a short half life | F |
E. Affects brain 5-HT function | T |
56. Side effects of carbamazepine include: | |
A. Ataxia | T |
B. Diplopia | T |
C. SIADH | T |
D. Agranulocytosis | T |
E. Leucocytosis | F |
57. Interactions with carbamazepine include: | |
A. Increased metabolism of tricyclic antidepressants | T |
B. Decreased metabolism of other anticonvulsants | F |
C. Neurotoxicity with lithium | T |
D. Reduced carbamazepine levels with SSRIs | T |
E. Higher levels of oral contraceptives | F |
58. Sodium Valproate: | |
A. Is a GABA transaminase inhibitor | T |
B. Is absorbed slowly from the GI tract | F |
C. Should be given with caution in patients with liver disease | T |
D. Has no effects on the foetus | F |
E. Can increase the levels of phenytoin | T |
59. Side effects of Valproate include: | |
A. GI upset | T |
B. Weight gain | T |
C. Ataxia | T |
D. Thrombocytosis | F |
E. Impaired platelet function | T |
60. Side effects of Valproate include: | |
A. Acute pancreatitis | T |
B. Renal failure | F |
C. Hepatic enzyme changes | T |
D. Hepatic toxicity and death | T |
E. Valproate should be stopped if jaundice occurs | T |