MCQ Quiz: Mood Disorders

Welcome to your comprehensive MCQ quiz on Mood Disorders, an essential topic for every aspiring clinical pharmacist. This quiz is designed to challenge and enhance your understanding of the complex pharmacotherapy involved in managing conditions like Major Depressive Disorder (MDD) and Bipolar Disorder. Covering everything from pathophysiology and medicinal chemistry to the latest treatment guidelines and patient counseling points, these 50 questions will help you solidify your knowledge base. Whether you’re preparing for an exam or looking to sharpen your clinical skills, this quiz serves as a vital tool for PharmD students. Dive in to test your expertise on antidepressants, mood stabilizers, and the nuances of patient care in mood disorders.

1. A patient with Major Depressive Disorder (MDD) is being started on fluoxetine. Which of the following best describes the mechanism of action for this medication?

• A. Serotonin and norepinephrine reuptake inhibition
• B. Selective serotonin reuptake inhibition
• C. Monoamine oxidase inhibition
• D. Dopamine and norepinephrine reuptake inhibition

Answer: B. Selective serotonin reuptake inhibition

2. Which of the following mood stabilizers has a narrow therapeutic index and requires routine monitoring of serum drug levels, as well as renal and thyroid function?

• A. Valproic acid
• B. Lamotrigine
• C. Lithium
• D. Carbamazepine

Answer: C. Lithium

3. A patient taking phenelzine for treatment-resistant depression should be counseled to avoid which of the following foods?

• A. Aged cheese and red wine
• B. Leafy green vegetables
• C. Grapefruit juice
• D. Dairy products

Answer: A. Aged cheese and red wine

4. The “black box warning” for all antidepressant medications involves an increased risk of what in children, adolescents, and young adults?

• A. Serotonin syndrome
• B. Suicidal thoughts and behaviors
• C. Hypertensive crisis
• D. Stevens-Johnson syndrome

Answer: B. Suicidal thoughts and behaviors

5. Which of the following antidepressants is known for its dual mechanism as a serotonin antagonist and reuptake inhibitor (SARI) and is often used off-label for insomnia due to its sedating effects?

• A. Sertraline
• B. Mirtazapine
• C. Trazodone
• D. Bupropion

Answer: C. Trazodone

6. A patient with bipolar I disorder is experiencing an acute manic episode. Which of the following would be an appropriate first-line treatment?

• A. Lamotrigine
• B. Lithium or Valproate
• C. An SSRI alone
• D. Buspirone

Answer: B. Lithium or Valproate

7. From a medicinal chemistry perspective, the tricyclic antidepressants (TCAs) like amitriptyline have a three-ring nucleus. This structure is responsible for its action on which receptors, leading to side effects like dry mouth, constipation, and blurred vision?

• A. Beta-adrenergic receptors
• B. GABA receptors
• C. Muscarinic acetylcholine receptors
• D. NMDA receptors

Answer: C. Muscarinic acetylcholine receptors

8. A patient is being switched from fluoxetine to a monoamine oxidase inhibitor (MAOI). What is the minimum required washout period to prevent serotonin syndrome?

• A. 1 week
• B. 2 weeks
• C. 3 weeks
• D. 5 weeks

Answer: D. 5 weeks

9. Which mood stabilizer requires a slow dose titration to reduce the risk of Stevens-Johnson syndrome (SJS), a serious and potentially life-threatening skin reaction?

• A. Lithium
• B. Valproic acid
• C. Lamotrigine
• D. Topiramate

Answer: C. Lamotrigine

10. Bupropion is an atypical antidepressant that is distinct from SSRIs. Its mechanism of action primarily involves the reuptake inhibition of which neurotransmitters?

• A. Serotonin and acetylcholine
• B. Dopamine and norepinephrine
• C. GABA and glutamate
• D. Histamine and serotonin

Answer: B. Dopamine and norepinephrine

11. Which of the following is a common and often dose-dependent side effect of lithium therapy?

• A. Agranulocytosis
• B. Alopecia
• C. Tremor
• D. Lactic acidosis

Answer: C. Tremor

12. Mirtazapine is an atypical antidepressant with a unique mechanism of action that includes antagonism of which receptors, leading to enhanced serotonin and norepinephrine release?

• A. Postsynaptic serotonin 5-HT2 receptors
• B. Presynaptic alpha-2 adrenergic autoreceptors
• C. Dopamine D2 receptors
• D. Muscarinic M1 receptors

Answer: B. Presynaptic alpha-2 adrenergic autoreceptors

13. A patient being treated for bipolar depression with lamotrigine reports a new rash. What is the most appropriate immediate action for the pharmacist to recommend?

• A. Advise the patient to apply a topical corticosteroid and continue the medication.
• B. Suggest taking an antihistamine and monitoring the rash.
• C. Tell the patient to stop the medication immediately and contact their prescriber.
• D. Reassure the patient that the rash is a common, benign side effect.

Answer: C. Tell the patient to stop the medication immediately and contact their prescriber.

14. Venlafaxine, an SNRI, requires monitoring for which dose-related cardiovascular side effect?

• A. Bradycardia
• B. Hypertension
• C. Orthostatic hypotension
• D. QTc prolongation

Answer: B. Hypertension

15. Which of the following is a key counseling point for a patient starting an SSRI for depression?

• A. The medication will work within the first few days.
• B. Therapeutic effects may take 4-6 weeks to become fully apparent.
• C. The dose can be adjusted daily based on mood.
• D. The medication can be stopped abruptly once symptoms improve.

Answer: B. Therapeutic effects may take 4-6 weeks to become fully apparent.

16. Valproic acid, used as a mood stabilizer, has a black box warning for which of the following severe adverse effects?

• A. Nephrotoxicity
• B. Cardiotoxicity
• C. Hepatotoxicity and pancreatitis
• D. Pulmonary fibrosis

Answer: C. Hepatotoxicity and pancreatitis

17. What is the primary advantage of escitalopram over citalopram from a medicinal chemistry standpoint?

• A. It has a longer half-life.
• B. It is the therapeutically active S-enantiomer, leading to fewer off-target effects.
• C. It does not undergo hepatic metabolism.
• D. It has a broader spectrum of neurotransmitter activity.

Answer: B. It is the therapeutically active S-enantiomer, leading to fewer off-target effects.

18. A patient complains of sexual dysfunction shortly after starting paroxetine. Which antidepressant has a lower incidence of this side effect and could be considered as an alternative?

• A. Sertraline
• B. Fluvoxamine
• C. Bupropion
• D. Citalopram

Answer: C. Bupropion

19. What is the primary mechanism through which St. John’s Wort, an herbal supplement, is thought to exert its antidepressant effects?

• A. Inhibition of GABA transaminase
• B. Inhibition of catechol-O-methyltransferase (COMT)
• C. Weak inhibition of serotonin, norepinephrine, and dopamine reuptake
• D. Antagonism of NMDA receptors

Answer: C. Weak inhibition of serotonin, norepinephrine, and dopamine reuptake

20. A patient with bipolar disorder who is stabilized on lithium becomes pregnant. Lithium use during the first trimester of pregnancy is associated with an increased risk of which congenital anomaly?

• A. Neural tube defects
• B. Gastroschisis
• C. Cleft palate
• D. Ebstein’s anomaly

Answer: D. Ebstein’s anomaly

21. Which antidepressant class is generally considered third-line therapy for MDD due to its significant drug-drug, drug-food interactions, and side effect profile?

• A. SSRIs
• B. SNRIs
• C. TCAs
• D. MAOIs

Answer: D. MAOIs

22. Serotonin syndrome is a potentially life-threatening condition. Which of the following symptom clusters is characteristic of this syndrome?

• A. Bradycardia, hypotension, and sedation
• B. Urinary retention, dry mouth, and blurred vision
• C. Autonomic instability, altered mental status, and neuromuscular hyperactivity
• D. Hypothermia, respiratory depression, and pinpoint pupils

Answer: C. Autonomic instability, altered mental status, and neuromuscular hyperactivity

23. For which of the following medications is it most critical to monitor for drug-drug interactions involving the CYP2D6 enzyme?

• A. Lithium
• B. Amitriptyline
• C. Valproic acid
• D. Gabapentin

Answer: B. Amitriptyline

24. Which of the following atypical antipsychotics is approved for the treatment of bipolar depression and is often used as an adjunctive therapy in MDD?

• A. Haloperidol
• B. Chlorpromazine
• C. Quetiapine
• D. Ziprasidone

Answer: C. Quetiapine

25. A patient on a TCA presents with confusion, flushing, hyperthermia, and blurred vision. This presentation is consistent with toxicity related to which property of the drug?

• A. Dopaminergic blockade
• B. Anticholinergic effects
• C. Serotonergic agonism
• D. Alpha-adrenergic blockade

Answer: B. Anticholinergic effects

26. What is the primary goal of the continuation phase of treatment for MDD, which typically lasts 4 to 9 months after remission is achieved?

• A. To find the minimum effective dose
• B. To prevent relapse of the current depressive episode
• C. To switch to a different class of antidepressant
• D. To taper the patient off medication completely

Answer: B. To prevent relapse of the current depressive episode

27. A patient with bipolar disorder is being considered for treatment with carbamazepine. Which of the following is a crucial baseline and ongoing monitoring parameter for this drug?

• A. Serum creatinine
• B. Complete blood count (CBC)
• C. Liver function tests (LFTs)
• D. Both B and C

Answer: D. Both B and C

28. Which of the following is a key characteristic of Bipolar II Disorder?

• A. At least one full manic episode
• B. Presence of psychotic symptoms during depressive episodes only
• C. At least one hypomanic episode and at least one major depressive episode
• D. A chronic, fluctuating mood state that does not meet criteria for a full episode

Answer: C. At least one hypomanic episode and at least one major depressive episode

29. Duloxetine is an SNRI that is also FDA-approved for the management of what other condition, making it a potential choice for a patient with comorbid depression and this disorder?

• A. Migraine prophylaxis
• B. Neuropathic pain
• C. Smoking cessation
• D. Weight loss

Answer: B. Neuropathic pain

30. Pharmacogenomic testing for which CYP450 enzyme is most relevant when initiating therapy with many SSRIs and TCAs?

• A. CYP1A2
• B. CYP3A4
• C. CYP2C19 and CYP2D6
• D. CYP2E1

Answer: C. CYP2C19 and CYP2D6

31. What is the mechanism of action of esketamine (Spravato), a nasal spray approved for treatment-resistant depression?

• A. Serotonin 5-HT1A partial agonist
• B. N-methyl-D-aspartate (NMDA) receptor antagonist
• C. Alpha-2 adrenergic antagonist
• D. Voltage-gated calcium channel blocker

Answer: B. N-methyl-D-aspartate (NMDA) receptor antagonist

32. A patient experiences significant nausea and GI upset with immediate-release sertraline. What counseling point could help mitigate this side effect?

• A. Take the medication on an empty stomach.
• B. Take the medication with food.
• C. Cut the tablet in half.
• D. Take the medication every other day.

Answer: B. Take the medication with food.

33. In the management of bipolar disorder, which of the following medications is generally considered more effective for preventing depressive relapse rather than manic relapse?

• A. Aripiprazole
• B. Valproate
• C. Risperidone
• D. Lamotrigine

Answer: D. Lamotrigine

34. A patient discontinuing paroxetine abruptly is at high risk for which of the following?

• A. Anticholinergic rebound
• B. Discontinuation syndrome (e.g., dizziness, “brain zaps,” nausea)
• C. Paradoxical hypertension
• D. Acute renal failure

Answer: B. Discontinuation syndrome (e.g., dizziness, “brain zaps,” nausea)

35. Which of the following is a primary reason that TCAs are used cautiously in elderly patients?

• A. High risk of hepatotoxicity
• B. Potent anticholinergic and antihistaminic side effects
• C. Lack of efficacy in this population
• D. High cost compared to newer agents

Answer: B. Potent anticholinergic and antihistaminic side effects

36. A patient presents with a tyramine-induced hypertensive crisis from an MAOI. What is the immediate pharmacological management?

• A. Administer a beta-blocker like propranolol
• B. Administer a calcium channel blocker like nifedipine
• C. Administer an alpha-adrenergic antagonist like phentolamine
• D. Administer a diuretic like furosemide

Answer: C. Administer an alpha-adrenergic antagonist like phentolamine

37. Which of the following is NOT a primary target for medications used to treat mood disorders?

• A. Serotonin transporter (SERT)
• B. Norepinephrine transporter (NET)
• C. Histamine H1 receptor
• D. Voltage-gated ion channels

Answer: C. Histamine H1 receptor

38. When counseling a patient with bipolar disorder, what is a critical non-pharmacological strategy to emphasize for mood stability?

• A. Increasing caffeine intake for energy
• B. Maintaining a regular sleep-wake cycle
• C. Engaging in high-intensity exercise right before bed
• D. Avoiding all social interactions to reduce stress

Answer: B. Maintaining a regular sleep-wake cycle

39. Olanzapine/fluoxetine combination (Symbyax) is FDA-approved for which condition?

• A. Treatment-resistant MDD
• B. Acute depressive episodes associated with Bipolar I Disorder
• C. Generalized Anxiety Disorder
• D. Obsessive-Compulsive Disorder

Answer: B. Acute depressive episodes associated with Bipolar I Disorder

40. A patient taking lithium develops coarse tremors, confusion, ataxia, and slurred speech. Their serum level is likely to be in which range?

• A. 0.6 – 1.2 mEq/L
• B. 1.2 – 1.5 mEq/L
• C. > 1.5 mEq/L
• D. < 0.6 mEq/L

Answer: C. > 1.5 mEq/L

41. Which mood stabilizer is also an antiepileptic drug that works by blocking voltage-gated sodium channels and is a known autoinducer of its own metabolism?

• A. Lamotrigine
• B. Topiramate
• C. Carbamazepine
• D. Valproic acid

Answer: C. Carbamazepine

42. A patient with depression and significant weight loss and insomnia might benefit most from which antidepressant due to its side effect profile?

• A. Fluoxetine
• B. Bupropion
• C. Mirtazapine
• D. Venlafaxine

Answer: C. Mirtazapine

43. The neurotrophic hypothesis of depression suggests that antidepressants work by increasing levels of which protein in the brain?

• A. Amyloid-beta
• B. Brain-Derived Neurotrophic Factor (BDNF)
• C. Tau protein
• D. C-reactive protein

Answer: B. Brain-Derived Neurotrophic Factor (BDNF)

44. What is a significant risk of using antidepressant monotherapy in a patient with undiagnosed bipolar disorder?

• A. It can induce a switch into mania or hypomania.
• B. It will have no effect on their mood.
• C. It leads to severe anticholinergic side effects.
• D. It causes immediate tolerance to the medication.

Answer: A. It can induce a switch into mania or hypomania.

45. Which of the following is a key component of the pathophysiology of mood disorders, often referred to as the “monoamine hypothesis”?

• A. An excess of acetylcholine in the synaptic cleft
• B. A deficiency in the brain concentrations of norepinephrine, serotonin, and dopamine
• C. Overactivity of the HPA axis leading to glutamate excess
• D. A blockage of histamine receptors in the central nervous system

Answer: B. A deficiency in the brain concentrations of norepinephrine, serotonin, and dopamine

46. Which SSRI has the longest half-life, making it a better option for patients with poor adherence but also requiring a longer washout period?

• A. Paroxetine
• B. Sertraline
• C. Fluvoxamine
• D. Fluoxetine

Answer: D. Fluoxetine

47. From a medicinal chemistry standpoint, what structural feature of Selective Serotonin Reuptake Inhibitors (SSRIs) differentiates them from Tricyclic Antidepressants (TCAs)?

• A. They all contain a piperidine ring.
• B. They lack the rigid tricyclic ring system, allowing for more specific binding.
• C. They are all chiral molecules with only one active enantiomer.
• D. They are formulated as prodrugs to enhance absorption.

Answer: B. They lack the rigid tricyclic ring system, allowing for more specific binding.

48. What is the primary counseling point regarding alcohol consumption for a patient taking any CNS depressant, including many antidepressants and mood stabilizers?

• A. Alcohol can enhance the therapeutic effects of the medication.
• B. Alcohol can increase the risk of CNS depression and impair judgment.
• C. Alcohol consumption is only a concern with MAOIs.
• D. Moderate alcohol consumption is generally safe and recommended.

Answer: B. Alcohol can increase the risk of CNS depression and impair judgment.

49. A patient with bipolar disorder has failed trials of lithium and valproate for mania prevention. Which of the following would be a reasonable next step, often used as an adjunctive or monotherapy?

• A. Citalopram
• B. An atypical antipsychotic like aripiprazole or olanzapine
• C. Trazodone
• D. Buspirone

Answer: B. An atypical antipsychotic like aripiprazole or olanzapine

50. What is a critical aspect of “treatment-resistant depression”?

• A. The patient has not responded to one adequate trial of an antidepressant.
• B. The patient has not responded to adequate trials of at least two different antidepressants.
• C. The patient refuses to take any medication.
• D. The patient’s depression is caused by a medical condition.

Answer: B. The patient has not responded to adequate trials of at least two different antidepressants.

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