Antimanic drugs MCQs With Answer provides B. Pharm students a focused review of pharmacology, mechanisms, pharmacokinetics, therapeutic monitoring and adverse effects of antimanic agents. Key topics include lithium’s unique mood‑stabilizing actions, valproate and carbamazepine use in acute mania and maintenance, atypical antipsychotics for rapid control, pharmacodynamic targets (GSK‑3, inositol pathways), narrow therapeutic index, renal and hepatic monitoring, drug interactions (NSAIDs, thiazides, enzyme inducers), teratogenic risks, and management of toxicity including hemodialysis. The set also covers drug selection, initiation, maintenance strategies, laboratory monitoring schedules, patient counselling and pregnancy considerations to build practical clinical competence. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. What is a primary molecular mechanism implicated in lithium’s antimanic action?
- Blockade of dopamine D2 receptors
- Inhibition of inositol monophosphatase and glycogen synthase kinase‑3 (GSK‑3)
- Inhibition of monoamine oxidase
- Enhancement of acetylcholinesterase activity
Correct Answer: Inhibition of inositol monophosphatase and glycogen synthase kinase‑3 (GSK‑3)
Q2. What is the usual therapeutic serum lithium concentration range for maintenance therapy?
- 0.1–0.3 mEq/L
- 0.6–1.2 mEq/L
- 2.0–3.0 mEq/L
- 5–10 mEq/L
Correct Answer: 0.6–1.2 mEq/L
Q3. How is lithium primarily eliminated from the body?
- Hepatic metabolism to inactive metabolites
- Renal excretion unchanged by glomerular filtration and tubular handling
- Pulmonary exhalation
- Biliary excretion after hepatic conjugation
Correct Answer: Renal excretion unchanged by glomerular filtration and tubular handling
Q4. Which of the following drug classes is known to increase serum lithium concentrations?
- Nonsteroidal anti‑inflammatory drugs (NSAIDs)
- Angiotensin‑converting enzyme (ACE) inhibitors
- Thiazide diuretics
- All of the above
Correct Answer: All of the above
Q5. Which adverse effect is most characteristic of chronic lithium therapy?
- Nephrogenic diabetes insipidus (polyuria and polydipsia)
- Severe hepatic necrosis
- Marked hyperglycemia
- Pulmonary fibrosis
Correct Answer: Nephrogenic diabetes insipidus (polyuria and polydipsia)
Q6. Exposure to lithium during the first trimester is most strongly associated with which fetal cardiac abnormality?
- Transposition of the great arteries
- Ebstein anomaly (tricuspid valve malformation)
- Tetralogy of Fallot
- Ventricular septal defect
Correct Answer: Ebstein anomaly (tricuspid valve malformation)
Q7. For a patient with severe acute mania and prominent psychosis, which agent is commonly utilized as initial rapid control?
- Lithium monotherapy
- Valproate monotherapy
- Atypical antipsychotic (e.g., olanzapine)
- Fluoxetine
Correct Answer: Atypical antipsychotic (e.g., olanzapine)
Q8. What is a major safety concern with valproate that is essential for B. Pharm students to remember?
- Severe renal impairment is common
- High risk of pulmonary hypertension
- Hepatotoxicity and teratogenicity including neural tube defects
- Marked hyperkalemia in all patients
Correct Answer: Hepatotoxicity and teratogenicity including neural tube defects
Q9. Which pharmacologic action contributes to valproate’s antimanic properties?
- Inhibition of GABA transaminase and increased brain GABA levels
- Pure dopamine D2 receptor antagonism
- Direct serotonin reuptake inhibition
- NMDA receptor agonism
Correct Answer: Inhibition of GABA transaminase and increased brain GABA levels
Q10. Carbamazepine’s antimanic effect is primarily related to which mechanism?
- Monoamine oxidase inhibition
- Blockade of voltage‑gated sodium channels and neuronal stabilization
- Alpha‑2 adrenergic agonism
- Inhibition of COMT enzyme
Correct Answer: Blockade of voltage‑gated sodium channels and neuronal stabilization
Q11. Which baseline and ongoing monitoring is essential for a patient on carbamazepine?
- Only serum sodium
- Complete blood count (CBC) and liver function tests (LFTs)
- Thyroid function tests only
- No monitoring needed
Correct Answer: Complete blood count (CBC) and liver function tests (LFTs)
Q12. Which antimanic drug carries the highest known risk of neural tube defects when used in early pregnancy?
- Lithium
- Valproate (valproic acid)
- Carbamazepine
- Haloperidol
Correct Answer: Valproate (valproic acid)
Q13. Which endocrine adverse effect is commonly associated with long‑term lithium therapy?
- Hyperthyroidism
- Hypothyroidism
- Hyperparathyroidism
- Adrenal insufficiency
Correct Answer: Hypothyroidism
Q14. Which clinical manifestation is an early sign of lithium toxicity?
- Coarse tremor and ataxia
- Profound bradycardia only
- Isolated hyperreflexia without tremor
- Asymptomatic elevation of liver enzymes
Correct Answer: Coarse tremor and ataxia
Q15. What is the definitive treatment for severe, life‑threatening lithium toxicity?
- Oral activated charcoal
- Intravenous flumazenil
- Hemodialysis
- Forced diuresis with mannitol
Correct Answer: Hemodialysis
Q16. Approximately how long after starting or changing a lithium dose should a steady‑state serum level be measured?
- 12 hours
- 24 hours
- 5 days
- 4 weeks
Correct Answer: 5 days
Q17. Which clinical condition is a relative contraindication to initiating lithium therapy?
- Controlled hypothyroidism on stable replacement
- Severe renal impairment (reduced creatinine clearance)
- Mild seasonal allergies
- Well‑controlled type 2 diabetes
Correct Answer: Severe renal impairment (reduced creatinine clearance)
Q18. Which atypical antipsychotics have demonstrated antimanic efficacy in clinical trials?
- Risperidone
- Olanzapine
- Quetiapine
- All of the above
Correct Answer: All of the above
Q19. When obtaining a serum lithium level to assess the trough concentration, when should the blood sample be drawn?
- 2 hours after a dose
- 6 hours after a dose
- 12 hours after the last dose (trough)
- Immediately before the first dose
Correct Answer: 12 hours after the last dose (trough)
Q20. What is a commonly accepted therapeutic plasma concentration range for valproate in acute mania?
- 5–15 µg/mL
- 50–125 µg/mL
- 200–400 µg/mL
- 0.6–1.2 µg/mL
Correct Answer: 50–125 µg/mL
Q21. Carbamazepine may reduce plasma concentrations of concurrent drugs primarily because it is a:
- CYP450 enzyme inhibitor
- CYP450 enzyme inducer
- P‑glycoprotein inhibitor
- Monoamine oxidase inhibitor
Correct Answer: CYP450 enzyme inducer
Q22. Which laboratory abnormality is commonly monitored and can be caused by valproate therapy?
- Marked hyperkalemia
- Thrombocytopenia
- Persistent hypoglycemia
- Severe hyponatremia
Correct Answer: Thrombocytopenia
Q23. Which antimanic agent is generally considered relatively safer in pregnancy regarding teratogenic risk?
- Lithium
- Valproate
- Carbamazepine
- Haloperidol
Correct Answer: Haloperidol
Q24. Lithium renal handling is closely linked to the reabsorption pathways of which ion in the proximal tubule?
- Sodium
- Potassium
- Calcium
- Magnesium
Correct Answer: Sodium
Q25. Abrupt discontinuation of maintenance lithium in stabilized bipolar disorder most commonly leads to which outcome?
- Improved long‑term remission
- Relapse of mania or rapid recurrence
- Permanent cure
- Immediate normalization of thyroid function
Correct Answer: Relapse of mania or rapid recurrence
Q26. Which antimanic drug is most associated with hyponatremia due to SIADH?
- Carbamazepine
- Lithium
- Valproate
- Quetiapine
Correct Answer: Carbamazepine
Q27. A woman of childbearing potential is found to be pregnant while on valproate for bipolar disorder. The safest immediate clinical recommendation is:
- Continue valproate unchanged throughout pregnancy
- Discontinue valproate and discuss switching to a safer alternative with specialist input
- Double the valproate dose to prevent relapse
- Stop all psychotropic medication without replacement
Correct Answer: Discontinue valproate and discuss switching to a safer alternative with specialist input
Q28. Which antimanic drug is a potent hepatic enzyme inducer and causes many drug–drug interactions?
- Lithium
- Valproate
- Carbamazepine
- Lamotrigine
Correct Answer: Carbamazepine
Q29. For rapid short‑term control of severe agitation in acute mania, which agent is commonly used as adjunctive therapy?
- Lithium
- Lorazepam (benzodiazepine)
- Valproate
- Fluoxetine
Correct Answer: Lorazepam (benzodiazepine)
Q30. Before initiating lithium therapy, which baseline investigations are routinely recommended?
- Only thyroid‑stimulating hormone (TSH)
- Only serum creatinine
- Renal function (serum creatinine) and thyroid function tests (TSH)
- No baseline tests are required
Correct Answer: Renal function (serum creatinine) and thyroid function tests (TSH)
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