MCQ Quiz-Psychiatry

MCQ Quiz: Psychiatry

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Psychiatric pharmacy is a complex and rewarding field that requires a nuanced understanding of neurobiology, pharmacology, and patient-centered communication. From selecting the right antidepressant based on a patient’s comorbidities to managing the side effects of antipsychotics, pharmacists are integral members of the mental healthcare team. This quiz, designed for PharmD students, tests your knowledge of key psychotropic medications, treatment principles, and the pathophysiology of common psychiatric disorders.

1. The “monoamine hypothesis” of depression suggests that the condition is caused by a deficiency in which of the following neurotransmitters?

  • Acetylcholine and GABA
  • Serotonin, norepinephrine, and dopamine
  • Glutamate and aspartate
  • Histamine and prostaglandins

Answer: Serotonin, norepinephrine, and dopamine

2. What is the primary mechanism of action for Selective Serotonin Reuptake Inhibitors (SSRIs)?

  • They block the reuptake of dopamine from the synapse.
  • They increase the presynaptic release of norepinephrine.
  • They selectively block the reuptake of serotonin, increasing its concentration in the synapse.
  • They are direct agonists at the serotonin receptor.

Answer: They selectively block the reuptake of serotonin, increasing its concentration in the synapse.

3. When counseling a patient starting an SSRI for depression, what is a crucial point to mention regarding the onset of therapeutic effect?

  • They will feel better within 24 hours.
  • The medication will only work if taken with food.
  • It may take 4-6 weeks to experience the full antidepressant effect.
  • Side effects will not occur until at least one month of therapy.

Answer: It may take 4-6 weeks to experience the full antidepressant effect.

4. The FDA has issued a black box warning for all antidepressant medications regarding the increased risk of what in children, adolescents, and young adults?

  • Weight gain
  • Hepatotoxicity
  • Suicidal thinking and behavior.
  • Severe skin rashes

Answer: Suicidal thinking and behavior.

5. Which of the following is a common, often transient side effect of starting an SSRI?

  • Hypertensive crisis
  • Nausea and gastrointestinal upset.
  • Severe muscle rigidity
  • Significant weight loss

Answer: Nausea and gastrointestinal upset.

6. Benzodiazepines, such as lorazepam and alprazolam, exert their anxiolytic effect by enhancing the activity of which neurotransmitter?

  • Serotonin
  • Dopamine
  • Norepinephrine
  • GABA (gamma-aminobutyric acid)

Answer: GABA (gamma-aminobutyric acid)

7. Due to the risk of tolerance, dependence, and withdrawal, benzodiazepines are generally recommended for:

  • Long-term, indefinite treatment of generalized anxiety disorder.
  • First-line treatment of panic disorder in all patients.
  • Short-term or as-needed (PRN) use for anxiety.
  • Treatment of neuropathic pain.

Answer: Short-term or as-needed (PRN) use for anxiety.

8. First-generation (typical) antipsychotics primarily work by blocking which receptor?

  • Serotonin 5-HT2A receptors
  • Histamine H1 receptors
  • Dopamine D2 receptors
  • Muscarinic M1 receptors

Answer: Dopamine D2 receptors

9. A patient on haloperidol develops muscle stiffness, a shuffling gait, and a pill-rolling tremor. These are characteristic of what type of side effect?

  • Metabolic syndrome
  • Anticholinergic effects
  • Extrapyramidal symptoms (EPS).
  • Serotonin syndrome

Answer: Extrapyramidal symptoms (EPS).

10. A major advantage of second-generation (atypical) antipsychotics over first-generation agents is a:

  • Lower risk of metabolic side effects like weight gain and diabetes.
  • Higher efficacy for treating negative symptoms of schizophrenia.
  • Lower risk of causing extrapyramidal symptoms (EPS).
  • Absence of any black box warnings.

Answer: Lower risk of causing extrapyramidal symptoms (EPS).

11. Patients taking second-generation antipsychotics like olanzapine or clozapine must be monitored for:

  • Weight loss and hypoglycemia.
  • Weight gain, dyslipidemia, and hyperglycemia.
  • Renal failure.
  • Severe hair loss.

Answer: Weight gain, dyslipidemia, and hyperglycemia.

12. Lithium is a first-line mood stabilizer for bipolar disorder but has a narrow therapeutic index. Its use requires regular monitoring of:

  • Serum drug levels, renal function, and thyroid function.
  • Liver function tests only.
  • Complete blood count only.
  • Blood pressure and heart rate.

Answer: Serum drug levels, renal function, and thyroid function.

13. A patient taking an MAOI (monoamine oxidase inhibitor) should be counseled to avoid foods high in tyramine, such as aged cheeses and cured meats, to prevent:

  • A severe skin rash.
  • A hypertensive crisis.
  • Serotonin syndrome.
  • Kidney stones.

Answer: A hypertensive crisis.

14. What is the primary mechanism of action for stimulant medications like methylphenidate and amphetamine used to treat ADHD?

  • They increase the synaptic levels of dopamine and norepinephrine.
  • They are agonists at the GABA receptor.
  • They block the reuptake of serotonin.
  • They are antagonists at the histamine receptor.

Answer: They increase the synaptic levels of dopamine and norepinephrine.

15. Pharmacogenomic testing for CYP2D6 and CYP2C19 can be useful when prescribing which class of medications to predict patient response and risk of side effects?

  • Antibiotics
  • Statins
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Proton-pump inhibitors

Answer: Selective Serotonin Reuptake Inhibitors (SSRIs)

16. Tardive dyskinesia is a serious, potentially irreversible adverse drug reaction characterized by involuntary movements, most commonly associated with long-term use of:

  • Benzodiazepines
  • Antipsychotics.
  • SSRIs
  • Mood stabilizers

Answer: Antipsychotics.

17. Which of the following is a key non-pharmacologic approach that can be used to help manage stress and anxiety?

  • Increasing caffeine intake.
  • Mindfulness meditation and breathing techniques.
  • Avoiding all social interaction.
  • Watching more television.

Answer: Mindfulness meditation and breathing techniques.

18. A patient on citalopram (an SSRI) is also prescribed tramadol for pain. The pharmacist should be vigilant for signs and symptoms of:

  • Agranulocytosis
  • Hepatotoxicity
  • Serotonin syndrome.
  • A hypertensive crisis

Answer: Serotonin syndrome.

19. When managing perinatal depression, the clinical decision to use an antidepressant during pregnancy is based on:

  • The assumption that all antidepressants are completely safe.
  • A careful risk-benefit analysis, weighing the risks of medication exposure against the risks of untreated depression for both mother and child.
  • The patient’s preference for a specific brand name.
  • The cost of the medication.

Answer: A careful risk-benefit analysis, weighing the risks of medication exposure against the risks of untreated depression for both mother and child.

20. Motivational interviewing is a counseling technique used to:

  • Confront the patient about their poor choices.
  • Help a patient explore and resolve their ambivalence about making a behavior change.
  • Provide a quick list of instructions to the patient.
  • Assess a patient’s cognitive function.

Answer: Help a patient explore and resolve their ambivalence about making a behavior change.

21. A patient with bipolar disorder who is prescribed valproic acid should be monitored for:

  • Hypotension.
  • Hepatotoxicity and thrombocytopenia.
  • Weight loss.
  • Renal failure.

Answer: Hepatotoxicity and thrombocytopenia.

22. Which of the following is a potentially life-threatening rash associated with the mood stabilizer lamotrigine, requiring slow dose titration?

  • Acne vulgaris
  • Psoriasis
  • Stevens-Johnson Syndrome (SJS).
  • Contact dermatitis

Answer: Stevens-Johnson Syndrome (SJS).

23. “Negative symptoms” of schizophrenia include:

  • Hallucinations and delusions.
  • Disorganized speech.
  • Apathy, social withdrawal, and lack of motivation.
  • Agitation and aggression.

Answer: Apathy, social withdrawal, and lack of motivation.

24. The concept of “diathesis-stress” in psychiatry suggests that mental illness develops from:

  • A purely genetic predisposition.
  • A purely environmental cause.
  • An interaction between a pre-existing vulnerability (diathesis) and a stressful life event.
  • A random, unpredictable event.

Answer: An interaction between a pre-existing vulnerability (diathesis) and a stressful life event.

25. A common side effect of tricyclic antidepressants (TCAs) like amitriptyline, due to their anticholinergic properties, is:

  • Diarrhea
  • Excessive salivation
  • Dry mouth and constipation.
  • Weight loss

Answer: Dry mouth and constipation.

26. Which of the following is considered a first-line treatment for generalized anxiety disorder?

  • Alprazolam
  • Sertraline
  • Quetiapine
  • Diazepam

Answer: Sertraline

27. A patient wants to stop taking their paroxetine (SSRI) after being on it for a year. The pharmacist should counsel the patient on:

  • The importance of tapering the dose slowly to avoid discontinuation syndrome.
  • The ability to stop the medication abruptly without any issues.
  • The need to switch to a different antidepressant immediately.
  • The fact that they will need to be on the medication for life.

Answer: The importance of tapering the dose slowly to avoid discontinuation syndrome.

28. A patient on clozapine must undergo regular blood testing to monitor for which potentially fatal adverse effect?

  • Anemia
  • Agranulocytosis.
  • Thrombocytopenia
  • Hepatotoxicity

Answer: Agranulocytosis.

29. What is a primary role of dopamine in the central nervous system?

  • Regulating sleep-wake cycles.
  • Controlling pain signals.
  • Modulating movement, motivation, and reward pathways.
  • Regulating body temperature.

Answer: Modulating movement, motivation, and reward pathways.

30. Buspirone is an anxiolytic agent that is different from benzodiazepines because it:

  • Has a high potential for abuse and dependence.
  • Works immediately upon the first dose.
  • Lacks sedative effects and has a low abuse potential, but has a delayed onset of action.
  • Primarily works on the GABA system.

Answer: Lacks sedative effects and has a low abuse potential, but has a delayed onset of action.

31. In the pathophysiology of schizophrenia, which pathway is thought to be associated with the “positive” symptoms like hallucinations?

  • Mesocortical pathway (hypoactive)
  • Mesolimbic pathway (hyperactive)
  • Nigrostriatal pathway
  • Tuberoinfundibular pathway

Answer: Mesolimbic pathway (hyperactive)

32. The pharmacist’s role in psychiatric care includes:

  • Counseling on medication adherence and management of side effects.
  • Identifying potential drug-drug interactions.
  • Serving as an accessible resource for patient education.
  • All of the above.

Answer: All of the above.

33. Which of the following is a non-stimulant medication approved for the treatment of ADHD?

  • Dextroamphetamine
  • Lisdexamfetamine
  • Methylphenidate
  • Atomoxetine

Answer: Atomoxetine

34. Akathisia, a feeling of inner restlessness and a compelling need to be in constant motion, is a type of:

  • Metabolic side effect.
  • Anticholinergic side effect.
  • Extrapyramidal symptom (EPS).
  • Withdrawal symptom.

Answer: Extrapyramidal symptom (EPS).

35. A key principle of treating bipolar disorder is:

  • Using antidepressant monotherapy for all depressive episodes.
  • Prioritizing mood stabilization to prevent both manic and depressive episodes.
  • Focusing only on treating the manic episodes.
  • Avoiding all medications and using therapy alone.

Answer: Prioritizing mood stabilization to prevent both manic and depressive episodes.

36. A patient who is a CYP2D6 ultrarapid metabolizer is prescribed a standard dose of nortriptyline (a TCA). What is the likely result?

  • Increased side effects due to high drug levels.
  • A good therapeutic response.
  • Subtherapeutic drug levels and a lack of efficacy.
  • No effect on the drug’s metabolism.

Answer: Subtherapeutic drug levels and a lack of efficacy.

37. What is a common counseling point for patients taking lithium?

  • To vary their salt intake daily.
  • To maintain consistent salt and fluid intake to keep lithium levels stable.
  • To avoid all fluids while on the medication.
  • That lithium is not affected by hydration status.

Answer: To maintain consistent salt and fluid intake to keep lithium levels stable.

38. The “cheese effect” is associated with which class of antidepressants?

  • SSRIs
  • SNRIs
  • TCAs
  • MAOIs

Answer: MAOIs

39. A patient taking an antipsychotic develops a high fever, severe muscle rigidity, and altered mental status. These symptoms are indicative of which medical emergency?

  • Serotonin syndrome
  • Neuroleptic Malignant Syndrome (NMS).
  • Agranulocytosis
  • Anaphylaxis

Answer: Neuroleptic Malignant Syndrome (NMS).

40. The stigma associated with mental illness is a significant barrier to:

  • Medication adherence.
  • Patients seeking treatment.
  • Open communication with healthcare providers.
  • All of the above.

Answer: All of the above.

41. Which of the following is considered a first-line pharmacotherapy for panic disorder?

  • Propranolol
  • Clonazepam
  • Fluoxetine
  • Buspirone

Answer: Fluoxetine

42. The pathophysiology of anxiety is thought to involve dysregulation in which key brain region?

  • The cerebellum
  • The amygdala
  • The brainstem
  • The visual cortex

Answer: The amygdala

43. A common side effect associated with stimulants used for ADHD is:

  • Sedation
  • Increased appetite and weight gain
  • Decreased appetite and insomnia.
  • Bradycardia

Answer: Decreased appetite and insomnia.

44. What is the primary difference in mechanism between SSRIs and SNRIs?

  • SSRIs are more effective than SNRIs.
  • SNRIs inhibit the reuptake of both serotonin and norepinephrine, while SSRIs are selective for serotonin.
  • SSRIs have more side effects.
  • There is no difference in their mechanism.

Answer: SNRIs inhibit the reuptake of both serotonin and norepinephrine, while SSRIs are selective for serotonin.

45. Building a strong therapeutic alliance with a patient with mental illness is critical for:

  • Improving treatment adherence and outcomes.
  • Meeting a billing requirement.
  • Making the pharmacist’s job more difficult.
  • Violating patient privacy.

Answer: Improving treatment adherence and outcomes.

46. Which mood stabilizer is also widely used as an anti-epileptic drug?

  • Lithium
  • Lurasidone
  • Valproic Acid.
  • Aripiprazole

Answer: Valproic Acid.

47. A “washout period” is required when switching from an SSRI to which other class of antidepressant to avoid a dangerous interaction?

  • Another SSRI
  • An SNRI
  • An MAOI.
  • Mirtazapine

Answer: An MAOI.

48. Trazodone is often used at low doses off-label for which condition?

  • Hypertension
  • Anxiety
  • Insomnia.
  • Neuropathic pain

Answer: Insomnia.

49. Empathy and active listening are key skills for a pharmacist to use when:

  • A patient is describing their mood and response to treatment.
  • A patient expresses concerns about side effects.
  • A patient is ambivalent about starting a medication.
  • All of the above.

Answer: All of the above.

50. The ultimate goal of psychiatric pharmacotherapy is to:

  • Eliminate all symptoms immediately.
  • Find a single medication that works for every patient.
  • Reduce symptoms, improve functioning, and enhance the patient’s quality of life.
  • Keep the patient on medication indefinitely, regardless of need.

Answer: Reduce symptoms, improve functioning, and enhance the patient’s quality of life.

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