CNS stimulants, or “uppers,” encompass a broad range of substances from caffeine and prescription ADHD medications to illicit drugs. Pharmacists play a crucial role in managing the therapeutic use of stimulants like methylphenidate and amphetamines, counseling on their risks, and ensuring their safe dispensing. This quiz, designed for PharmD students, will test your knowledge on the pharmacology, clinical application, adverse effects, and regulation of these powerful medications.
1. Prescription stimulants like amphetamine and methylphenidate primarily exert their therapeutic effect in ADHD by increasing the synaptic levels of which two neurotransmitters?
- Serotonin and GABA
- Acetylcholine and histamine
- Dopamine and norepinephrine
- Glutamate and aspartate
Answer: Dopamine and norepinephrine
2. According to the U.S. Drug Enforcement Administration (DEA), most prescription stimulants (e.g., methylphenidate, lisdexamfetamine) are classified into which controlled substance schedule?
- Schedule I
- Schedule II
- Schedule III
- Schedule IV
Answer: Schedule II
3. What is a common and expected side effect of starting a stimulant medication for ADHD?
- Sedation and fatigue
- Increased appetite and weight gain
- Decreased appetite and insomnia
- Bradycardia
Answer: Decreased appetite and insomnia
4. A key counseling point for a patient taking an extended-release stimulant medication is to:
- Crush or chew the capsule for faster effect.
- Take the dose in the late evening to help with sleep.
- Take the dose in the morning to minimize its effect on sleep.
- Take the medication on an as-needed basis only.
Answer: Take the dose in the morning to minimize its effect on sleep.
5. Which of the following is a non-stimulant medication approved for the treatment of ADHD?
- Dextroamphetamine
- Methylphenidate
- Lisdexamfetamine
- Atomoxetine
Answer: Atomoxetine
6. The sympathomimetic effects of stimulants can lead to which cardiovascular adverse effects?
- A decrease in heart rate and blood pressure.
- An increase in heart rate and blood pressure.
- No effect on the cardiovascular system.
- A narrowing of the QRS complex on an ECG.
Answer: An increase in heart rate and blood pressure.
7. Due to their status as Schedule II controlled substances, prescriptions for stimulants like Adderall® or Ritalin® are subject to which federal regulation?
- They can be refilled up to 5 times in 6 months.
- They cannot be refilled; a new prescription is required each time.
- They can be called into the pharmacy by a patient.
- They do not require a prescriber’s signature.
Answer: They cannot be refilled; a new prescription is required each time.
8. The high potential for abuse and diversion is a major concern for which class of medications?
- Antibiotics
- Statins
- Prescription stimulants
- Proton pump inhibitors
Answer: Prescription stimulants
9. What is a primary therapeutic goal when treating a child with ADHD with a stimulant?
- To improve symptoms of inattention, hyperactivity, and impulsivity.
- To cure the underlying cause of ADHD.
- To improve the child’s appetite.
- To ensure the child sleeps more during the day.
Answer: To improve symptoms of inattention, hyperactivity, and impulsivity.
10. A patient presenting to the emergency department with severe agitation, tachycardia, hypertension, and paranoia after using an illicit substance is likely experiencing:
- Opioid overdose.
- Benzodiazepine withdrawal.
- Acute stimulant intoxication.
- Anticholinergic toxicity.
Answer: Acute stimulant intoxication.
11. The mechanism of action of cocaine involves:
- Potentiation of GABA receptors.
- Blockade of dopamine, norepinephrine, and serotonin reuptake transporters.
- Agonism at the mu-opioid receptor.
- Inhibition of the enzyme monoamine oxidase.
Answer: Blockade of dopamine, norepinephrine, and serotonin reuptake transporters.
12. The primary difference between the mechanism of amphetamine and methylphenidate is that:
- Methylphenidate primarily blocks reuptake, while amphetamine both blocks reuptake and promotes the release of catecholamines.
- Amphetamine only affects serotonin.
- Methylphenidate is not a CNS stimulant.
- There is no difference in their mechanism of action.
Answer: Methylphenidate primarily blocks reuptake, while amphetamine both blocks reuptake and promotes the release of catecholamines.
13. A “drug holiday” from stimulant medication is a practice sometimes used to:
- Increase the risk of side effects.
- Assess if the medication is still needed or to mitigate side effects like growth suppression in children.
- Ensure the patient becomes tolerant to the medication.
- Fulfill a legal requirement for dispensing.
Answer: Assess if the medication is still needed or to mitigate side effects like growth suppression in children.
14. Before initiating a stimulant, it is a best practice to screen for a patient’s personal and family history of:
- Gastrointestinal issues.
- Serious cardiovascular disease or arrhythmias.
- Seasonal allergies.
- Dermatological conditions.
Answer: Serious cardiovascular disease or arrhythmias.
15. Lisdexamfetamine (Vyvanse®) is a prodrug of:
- Methylphenidate
- Dextroamphetamine
- Atomoxetine
- Guanfacine
Answer: Dextroamphetamine
16. The prodrug formulation of lisdexamfetamine is designed to:
- Provide a rapid, intense euphoric effect.
- Have a lower potential for abuse via snorting or injection compared to immediate-release amphetamine.
- Be administered intravenously.
- Be less effective than other stimulants.
Answer: Have a lower potential for abuse via snorting or injection compared to immediate-release amphetamine.
17. The use of a state’s Prescription Drug Monitoring Program (PDMP) is a key tool for a pharmacist to:
- Check for potential “doctor shopping” or overlapping stimulant prescriptions.
- Order medications for the pharmacy.
- Bill for MTM services.
- Counsel a patient on how to use their inhaler.
Answer: Check for potential “doctor shopping” or overlapping stimulant prescriptions.
18. Which common dietary substance is also a CNS stimulant?
- Tryptophan
- Caffeine
- Calcium
- Vitamin C
Answer: Caffeine
19. A patient taking a stimulant for ADHD complains of trouble falling asleep. The most appropriate initial recommendation would be:
- To take an extra dose at bedtime.
- To ensure the medication is being taken as early in the day as possible.
- To add a prescription hypnotic to their regimen.
- To stop the ADHD medication completely.
Answer: To ensure the medication is being taken as early in the day as possible.
20. The desired effects of stimulants in ADHD are mediated by their action in which part of the brain?
- The brainstem
- The cerebellum
- The prefrontal cortex
- The hippocampus
Answer: The prefrontal cortex
21. A common physical sign of acute stimulant use is:
- Miosis (pupil constriction)
- Bradycardia
- Mydriasis (pupil dilation)
- Drowsiness
Answer: Mydriasis (pupil dilation)
22. Why is it important to monitor height and weight in children being treated with stimulants for ADHD?
- Because stimulants commonly cause rapid weight gain.
- Because appetite suppression can lead to slowing of growth.
- It is a requirement for insurance reimbursement.
- It is not important to monitor these parameters.
Answer: Because appetite suppression can lead to slowing of growth.
23. Atomoxetine, a non-stimulant for ADHD, has a black box warning for:
- Increased risk of suicidal ideation in children and adolescents.
- Severe liver injury.
- Cardiotoxicity.
- Agranulocytosis.
Answer: Increased risk of suicidal ideation in children and adolescents.
24. The term “sympathomimetic” means that a drug:
- Mimics the effects of the parasympathetic nervous system.
- Mimics the effects of the sympathetic nervous system (e.g., “fight or flight” response).
- Blocks all nerve transmission.
- Has no effect on the autonomic nervous system.
Answer: Mimics the effects of the sympathetic nervous system (e.g., “fight or flight” response).
25. A pharmacist receives a prescription for methylphenidate 10mg written by a prescriber from another state. The pharmacist should first:
- Fill the prescription without question.
- Refuse to fill the prescription because it is from out of state.
- Verify that they can legally fill an out-of-state Schedule II prescription according to their state’s laws.
- Tell the patient the medication is not effective.
Answer: Verify that they can legally fill an out-of-state Schedule II prescription according to their state’s laws.
26. A patient with pre-existing hypertension who starts a stimulant medication should be monitored for:
- A decrease in blood pressure.
- An increase in blood pressure.
- The development of a rash.
- No change in any vital signs.
Answer: An increase in blood pressure.
27. Which of the following is NOT a therapeutic use for CNS stimulants?
- ADHD
- Narcolepsy
- Binge eating disorder
- Insomnia
Answer: Insomnia
28. The pathophysiology of ADHD is thought to involve dysregulation of which neurotransmitter systems?
- GABA and glycine
- Acetylcholine and histamine
- Dopamine and norepinephrine
- Endorphins and enkephalins
Answer: Dopamine and norepinephrine
29. A major risk of combining stimulants with monoamine oxidase inhibitors (MAOIs) is:
- A severe drug-drug interaction leading to a hypertensive crisis.
- A reduction in the efficacy of the stimulant.
- An increased risk of sedation.
- The development of a tolerance to the MAOI.
Answer: A severe drug-drug interaction leading to a hypertensive crisis.
30. The role of the pharmacist in managing stimulant therapy involves:
- Counseling on appropriate administration and side effects.
- Monitoring for efficacy and safety.
- Being vigilant for signs of misuse or diversion.
- All of the above.
Answer: All of the above.
31. Long-term, high-dose use of illicit stimulants like methamphetamine is associated with severe:
- Dental problems (“meth mouth”).
- Cardiovascular complications.
- Neurotoxicity.
- All of the above.
Answer: All of the above.
32. The “catecholamine” neurotransmitters affected by stimulants include:
- Serotonin and GABA.
- Dopamine, norepinephrine, and epinephrine.
- Acetylcholine.
- Glutamate.
Answer: Dopamine, norepinephrine, and epinephrine.
33. What is a key difference between immediate-release (IR) and extended-release (ER) stimulant formulations?
- ER formulations are designed to be taken multiple times per day.
- IR formulations have a slower onset of action.
- ER formulations are designed for once-daily dosing and provide a longer duration of effect.
- IR formulations have a lower abuse potential.
Answer: ER formulations are designed for once-daily dosing and provide a longer duration of effect.
34. For acute management of severe agitation from stimulant toxicity, which class of medication may be used?
- Another stimulant
- An opioid
- A benzodiazepine.
- An NSAID
Answer: A benzodiazepine.
35. A pharmacist providing a “first response” to a person with suspected stimulant abuse should prioritize:
- Obtaining a detailed medication history.
- Ensuring their own safety and calling for emergency medical services.
- Counseling the person on their life choices.
- Administering a reversal agent.
Answer: Ensuring their own safety and calling for emergency medical services.
36. A patient says they take their friend’s ADHD medication to help them study for exams. The pharmacist should recognize this as:
- A good study strategy.
- A safe use of the medication.
- Misuse and diversion of a controlled substance.
- A therapeutic use of the drug.
Answer: Misuse and diversion of a controlled substance.
37. Tolerance to a stimulant medication means that:
- The patient experiences fewer side effects over time.
- A higher dose is needed to achieve the same therapeutic effect.
- The patient develops an allergic reaction.
- The medication lasts longer in the body.
Answer: A higher dose is needed to achieve the same therapeutic effect.
38. Which of the following is a potential psychiatric adverse effect of stimulant use?
- Depression
- Anxiety, irritability, or psychosis.
- Sedation
- Mental clarity
Answer: Anxiety, irritability, or psychosis.
39. A patient being treated for ADHD with a stimulant should be counseled that combining it with large amounts of caffeine can:
- Decrease the effects of the stimulant.
- Have no effect.
- Increase the risk of cardiovascular side effects like palpitations and tachycardia.
- Help them sleep better.
Answer: Increase the risk of cardiovascular side effects like palpitations and tachycardia.
40. The legal and ethical responsibility for ensuring a controlled substance prescription is valid and issued for a legitimate medical purpose lies with:
- The patient.
- The prescriber only.
- The pharmacist only.
- Both the prescriber and the pharmacist.
Answer: Both the prescriber and the pharmacist.
41. An extended-release alpha-2 adrenergic agonist, like guanfacine ER or clonidine ER, can be used in ADHD to:
- Increase dopamine release.
- Help manage symptoms, particularly hyperactivity and impulsivity, and can be used as monotherapy or with a stimulant.
- Replace the need for behavioral therapy.
- Treat comorbid anxiety only.
Answer: Help manage symptoms, particularly hyperactivity and impulsivity, and can be used as monotherapy or with a stimulant.
42. The primary reason for the strict regulation of Schedule II drugs is their:
- High potential for abuse and dependence.
- Low cost.
- Lack of any accepted medical use.
- Ease of manufacturing.
Answer: High potential for abuse and dependence.
43. A pharmacist counseling the parent of a child starting a stimulant should discuss:
- The importance of medication security at home to prevent diversion.
- The expected therapeutic benefits.
- Common side effects to monitor for.
- All of the above.
Answer: All of the above.
44. The use of stimulants for narcolepsy is intended to:
- Improve nighttime sleep.
- Promote wakefulness during the day.
- Treat cataplexy.
- Reduce the number of dreams.
Answer: Promote wakefulness during the day.
45. Which of the following is NOT a common street name for an illicit “upper”?
- Speed
- Coke
- Ice
- Downer
Answer: Downer
46. A patient with a history of substance use disorder who is diagnosed with ADHD presents a clinical challenge. A potential first-line option might be:
- An immediate-release amphetamine.
- A long-acting stimulant with a lower abuse potential or a non-stimulant medication.
- No treatment for their ADHD.
- A benzodiazepine.
Answer: A long-acting stimulant with a lower abuse potential or a non-stimulant medication.
47. A “drug-food” interaction with stimulants can occur when:
- The medication is taken with acidic foods or juices, which can decrease the absorption of amphetamines.
- The medication is taken with high-fat meals, which can improve absorption.
- The medication is taken with dairy products.
- There are no drug-food interactions with stimulants.
Answer: The medication is taken with acidic foods or juices, which can decrease the absorption of amphetamines.
48. The long-term management of ADHD often involves:
- Pharmacotherapy only.
- Behavioral therapy only.
- A multimodal approach combining pharmacotherapy and behavioral interventions.
- A gradual increase in the dose of stimulants over the patient’s lifetime.
Answer: A multimodal approach combining pharmacotherapy and behavioral interventions.
49. A pharmacist’s knowledge of medicinal chemistry is useful for understanding:
- Why small structural changes can differentiate drugs like amphetamine and methamphetamine.
- The billing codes for different stimulants.
- The legal schedule of a controlled substance.
- The marketing strategy for a new drug.
Answer: Why small structural changes can differentiate drugs like amphetamine and methamphetamine.
50. The ultimate goal of using stimulant therapy for a legitimate medical condition like ADHD is to:
- Create a dependency on the medication.
- Improve the patient’s functioning and quality of life.
- Ensure the patient remains on the medication for their entire life.
- Eliminate all symptoms of the disorder completely.
Answer: Improve the patient’s functioning and quality of life.
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com