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 1^st 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-HT_2A antagonists improve slow-wave sleep	T
B. 5-HT_1A 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 GABA_B 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-HT_1A 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-HT_2A 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-HT_2A 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-HT_2A 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