MCQ Quiz: Other Neuropsychiatric Disorders

The scope of neuropsychiatric pharmacy extends beyond major mood and psychotic disorders to include common and impactful conditions like Attention-Deficit/Hyperactivity Disorder (ADHD) and migraine. The Patient Care VII: Brain and Behavior curriculum dedicates a specific module to these “Other Neuropsychiatric Disorders,” emphasizing their unique pathophysiology and management strategies. This quiz will test your knowledge on the pharmacology of stimulants and non-stimulants for ADHD, the mechanisms of abortive and prophylactic migraine therapies, and the pharmacist’s role in managing these complex conditions.

1. The pathophysiology of Attention-Deficit/Hyperactivity Disorder (ADHD) is thought to involve the dysregulation of which two neurotransmitters in the prefrontal cortex?

• A. Serotonin and Acetylcholine
• B. GABA and Glutamate
• C. Dopamine and Norepinephrine
• D. Histamine and Substance P

Answer: C. Dopamine and Norepinephrine

2. Stimulant medications like methylphenidate and amphetamine are first-line in the management of ADHD. What is their primary mechanism of action?

• A. They are antagonists at the dopamine and norepinephrine receptors.
• B. They increase the synaptic levels of dopamine and norepinephrine by blocking their reuptake and/or promoting their release.
• C. They are selective inhibitors of serotonin reuptake.
• D. They modulate the GABA-A receptor complex.

Answer: B. They increase the synaptic levels of dopamine and norepinephrine by blocking their reuptake and/or promoting their release.

3. The pathophysiology of migraine is now understood to heavily involve the trigeminal nerve and the release of which potent vasodilator and pain-sensitizing neuropeptide?

• A. Brain-Derived Neurotrophic Factor (BDNF)
• B. Calcitonin Gene-Related Peptide (CGRP)
• C. Neuropeptide Y
• D. Substance P

Answer: B. Calcitonin Gene-Related Peptide (CGRP)

4. The “triptans” (e.g., sumatriptan) are used for the acute/abortive treatment of migraine. What is their mechanism of action?

• A. They are antagonists at CGRP receptors.
• B. They are agonists at serotonin 5-HT1B/1D receptors, leading to vasoconstriction and reduced neuroinflammation.
• C. They are non-selective beta-blockers.
• D. They are potent non-steroidal anti-inflammatory drugs.

Answer: B. They are agonists at serotonin 5-HT1B/1D receptors, leading to vasoconstriction and reduced neuroinflammation.

5. Atomoxetine is a non-stimulant medication for ADHD. It works by selectively inhibiting the reuptake of:

• A. Serotonin
• B. Dopamine
• C. GABA
• D. Norepinephrine

Answer: D. Norepinephrine

6. Which of the following is a common and important counseling point for a patient starting a stimulant medication for ADHD?

• A. The medication should be taken at bedtime to aid sleep.
• B. Appetite suppression and insomnia are potential side effects.
• C. The medication has no abuse potential.
• D. Weight gain is the most common side effect.

Answer: B. Appetite suppression and insomnia are potential side effects.

7. Newer migraine therapies include monoclonal antibodies (e.g., erenumab, fremanezumab). These agents are used for:

• A. The acute treatment of a migraine attack.
• B. The prophylactic (preventive) treatment of migraine.
• C. Both acute and prophylactic treatment.
• D. The treatment of medication-overuse headache.

Answer: B. The prophylactic (preventive) treatment of migraine.

8. The “gepants” (e.g., ubrogepant, rimegepant) represent a class of small molecule drugs for the acute treatment of migraine. They work by:

• A. Agonizing serotonin 5-HT1B/1D receptors.
• B. Blocking voltage-gated sodium channels.
• C. Antagonizing CGRP receptors.
• D. Inhibiting COX-1 and COX-2 enzymes.

Answer: C. Antagonizing CGRP receptors.

9. A key counseling point for any abortive migraine medication like a triptan is to:

• A. Wait until the headache is severe before taking it.
• B. Take it at the first sign of a migraine attack for best results.
• C. Use it every day to prevent migraines.
• D. Take it with a large meal to enhance absorption.

Answer: B. Take it at the first sign of a migraine attack for best results.

10. What is a major contraindication for the use of triptans?

• A. A history of depression.
• B. A history of or significant risk factors for cardiovascular or cerebrovascular disease (e.g., uncontrolled hypertension, ischemic heart disease).
• C. A history of seasonal allergies.
• D. Co-administration with an NSAID.

Answer: B. A history of or significant risk factors for cardiovascular or cerebrovascular disease (e.g., uncontrolled hypertension, ischemic heart disease).

11. The alpha-2 adrenergic agonists, guanfacine and clonidine, are non-stimulant options for ADHD that are thought to work by:

• A. Increasing the release of dopamine.
• B. Modulating norepinephrine signaling in the prefrontal cortex to improve focus and impulse control.
• C. Blocking serotonin reuptake.
• D. Antagonizing histamine receptors.

Answer: B. Modulating norepinephrine signaling in the prefrontal cortex to improve focus and impulse control.

12. The management of ADHD and migraine are specific topics covered in which Patient Care course module?

• A. Module 5: Anxiety and Sleep-Wake Disorders
• B. Module 6: Epilepsy
• C. Module 7: Other Neuropsychiatric Disorders
• D. Module 3: Psychotic Spectrum Disorders

Answer: C. Module 7: Other Neuropsychiatric Disorders

13. A patient who uses an acute migraine medication (like a triptan or NSAID) more than 10-15 days per month is at risk for developing:

• A. A complete cure of their migraines.
• B. Medication-overuse headache.
• C. Tachyphylaxis to all medications.
• D. Severe liver damage.

Answer: B. Medication-overuse headache.

14. Which of the following is a common prophylactic medication for migraines?

• A. Sumatriptan
• B. Ibuprofen
• C. Propranolol
• D. Oxycodone

Answer: C. Propranolol

15. A key part of the “Assess” step of the PPCP for a patient with ADHD would be to:

• A. Only check their blood pressure.
• B. Use standardized rating scales to evaluate symptoms and assess for comorbidities and side effects.
• C. Ask them if they like the medication.
• D. Check the pharmacy’s stock of stimulants.

Answer: B. Use standardized rating scales to evaluate symptoms and assess for comorbidities and side effects.

16. From a medicinal chemistry perspective, the amphetamine molecule is a __________, which forms the basis for many CNS stimulants.

• A. Phenethylamine
• B. Benzodiazepine
• C. Carboxylic acid
• D. Sulfonamide

Answer: A. Phenethylamine

17. Why are long-acting stimulant formulations often preferred for the management of ADHD in children and adults?

• A. They are less expensive.
• B. They provide smoother coverage throughout the day and eliminate the need for in-school dosing.
• C. They have a faster onset of action.
• D. They have no side effects.

Answer: B. They provide smoother coverage throughout the day and eliminate the need for in-school dosing.

18. What is a common side effect of alpha-2 adrenergic agonists like guanfacine?

• A. Insomnia
• B. Appetite suppression
• C. Sedation and hypotension
• D. Tachycardia

Answer: C. Sedation and hypotension

19. The “Transcending Concept” of Patient-Reported Outcomes (PROs) is relevant to migraine management because it involves:

• A. Only measuring blood levels of the drug.
• B. Assessing treatment success based on what the patient reports, such as a reduction in headache days or improved ability to function.
• C. The physician’s report only.
• D. The cost of the medication.

Answer: B. Assessing treatment success based on what the patient reports, such as a reduction in headache days or improved ability to function.

20. A pharmacist’s legal and ethical responsibility in dispensing stimulant medications for ADHD includes:

• A. Ignoring the prescription if it seems unusual.
• B. Ensuring the prescription is legitimate and monitoring for signs of misuse or diversion.
• C. Selling the medication to anyone who asks for it.
• D. Recommending the patient take more than prescribed.

Answer: B. Ensuring the prescription is legitimate and monitoring for signs of misuse or diversion.

21. A patient reports that their sumatriptan injection causes flushing and a feeling of chest tightness. The pharmacist should:

• A. Tell the patient this is a sign of a heart attack and to go to the ER immediately.
• B. Counsel the patient that these are known, often transient side effects of triptans, but to seek medical attention if they experience severe chest pain.
• C. Advise the patient to double the next dose.
• D. Dismiss the patient’s concerns.

Answer: B. Counsel the patient that these are known, often transient side effects of triptans, but to seek medical attention if they experience severe chest pain.

22. Which non-stimulant medication for ADHD has a black box warning for an increased risk of suicidal ideation in children and adolescents?

• A. Guanfacine
• B. Clonidine
• C. Atomoxetine
• D. Methylphenidate

Answer: C. Atomoxetine

23. Prophylactic therapy for migraine should be considered when:

• A. A patient has one mild migraine per year.
• B. A patient’s migraines are frequent or severe enough to cause significant disability.
• C. A patient does not want to use any abortive medications.
• D. A patient has their first migraine ever.

Answer: B. A patient’s migraines are frequent or severe enough to cause significant disability.

24. The metabolism of atomoxetine is highly dependent on which CYP450 enzyme, making it subject to pharmacogenomic variability?

• A. CYP3A4
• B. CYP1A2
• C. CYP2D6
• D. CYP2C9

Answer: C. CYP2D6

25. Butalbital-containing products (e.g., Fioricet, Fiorinal) are used for some headache types but carry a high risk of:

• A. Medication-overuse headache and dependence.
• B. Hypertension.
• C. Severe nausea.
• D. Alopecia.

Answer: A. Medication-overuse headache and dependence.

26. The PHA5789C syllabus includes a lecture on “Interprofessional Team Conflicts.” This is relevant to the management of ADHD because:

• A. There is often only one correct way to manage ADHD.
• B. Disagreements may arise between providers, parents, and teachers about the role of medication, requiring good communication to resolve.
• C. Pharmacists should never speak to teachers.
• D. Conflicts do not happen in healthcare.

Answer: B. Disagreements may arise between providers, parents, and teachers about the role of medication, requiring good communication to resolve.

27. What is a key difference between migraine with aura and migraine without aura?

• A. Migraine with aura is less severe.
• B. Migraine with aura is preceded or accompanied by transient neurological symptoms, such as visual disturbances.
• C. Only migraine without aura responds to triptans.
• D. Migraine with aura does not involve a headache.

Answer: B. Migraine with aura is preceded or accompanied by transient neurological symptoms, such as visual disturbances.

28. A patient using a sumatriptan nasal spray for the first time should be counseled that:

• A. They should spray both nostrils with one dose.
• B. The onset of action is slower than the tablet.
• C. A single dose is one spray into one nostril.
• D. The spray can be used daily to prevent migraines.

Answer: C. A single dose is one spray into one nostril.

29. The management of ADHD often requires monitoring of which vital signs?

• A. Temperature and respiratory rate.
• B. Blood pressure and heart rate.
• C. Oxygen saturation.
• D. All of the above.

Answer: B. Blood pressure and heart rate.

30. Combining a triptan with an SSRI or SNRI carries a theoretical risk of what adverse event, requiring patient counseling on the symptoms?

• A. Hypertensive crisis
• B. Serotonin syndrome
• C. Agranulocytosis
• D. Severe sedation

Answer: B. Serotonin syndrome

31. The “Plan” step of the PPCP for a patient with frequent migraines would involve:

• A. Collecting a headache history.
• B. Assessing for medication overuse.
• C. Establishing patient-centered goals and selecting an appropriate prophylactic agent.
• D. Dispensing an acute medication.

Answer: C. Establishing patient-centered goals and selecting an appropriate prophylactic agent.

32. The mechanism of action of ergots (e.g., dihydroergotamine) in migraine is complex and involves:

• A. Only CGRP antagonism.
• B. Non-selective agonism at serotonin receptors, as well as activity at dopamine and adrenergic receptors.
• C. Only inhibition of COX enzymes.
• D. Selective agonism at 5-HT1B/1D receptors only.

Answer: B. Non-selective agonism at serotonin receptors, as well as activity at dopamine and adrenergic receptors.

33. In the management of pediatric ADHD, monitoring what growth parameter is essential?

• A. Head circumference
• B. Height and weight
• C. Shoe size
• D. Arm span

Answer: B. Height and weight

34. A patient reports that their migraines are often triggered by certain foods. A key part of non-pharmacological management would be:

• A. Trying an elimination diet of all possible triggers.
• B. Keeping a headache diary to identify and avoid personal, consistent triggers.
• C. Ignoring the triggers as they are not real.
• D. Taking a triptan before eating a trigger food.

Answer: B. Keeping a headache diary to identify and avoid personal, consistent triggers.

35. Lisdexamfetamine is a prodrug of what active stimulant medication?

• A. Methylphenidate
• B. Dextroamphetamine
• C. Atomoxetine
• D. Modafinil

Answer: B. Dextroamphetamine

36. A patient should not use a second dose of a triptan within 24 hours if they have already taken:

• A. An NSAID.
• B. A different triptan or an ergot derivative.
• C. A beta-blocker.
• D. A vitamin supplement.

Answer: B. A different triptan or an ergot derivative.

37. Which of the following is a non-pharmacological strategy for managing ADHD?

• A. Avoiding all structure and routines.
• B. Behavioral therapy and creating structured environments.
• C. Increasing screen time and video games.
• D. A high-sugar diet.

Answer: B. Behavioral therapy and creating structured environments.

38. The use of Patient-Reported Outcomes (PROs) in clinical trials for migraine medications is an example of what “transcending concept”?

• A. Evidence-Based Practice
• B. Health & Wellness
• C. Interprofessional Communication
• D. Law & Ethics

Answer: A. Evidence-Based Practice

39. Before dispensing a stimulant, the pharmacist should screen for a history of:

• A. Allergic rhinitis.
• B. Cardiovascular disease and substance abuse.
• C. Migraines.
• D. Acid reflux.

Answer: B. Cardiovascular disease and substance abuse.

40. The management of menstrual migraine may involve:

• A. A short-term prophylactic course of an NSAID or triptan around the time of menses.
• B. Discontinuing all medications during menses.
• C. Using a high-dose opioid.
• D. Daily use of an abortive agent.

Answer: A. A short-term prophylactic course of an NSAID or triptan around the time of menses.

41. The primary difference between an amphetamine and a methylphenidate product is their:

• A. Legal classification.
• B. Core chemical structure and primary mechanism (amphetamine also promotes dopamine release).
• C. Efficacy, with one being clearly superior.
• D. Side effect profile, with one having no side effects.

Answer: B. Core chemical structure and primary mechanism (amphetamine also promotes dopamine release).

42. A patient with migraine with aura may have a slightly increased risk of what, making it important to manage other cardiovascular risk factors?

• A. Kidney stones
• B. Ischemic stroke
• C. Liver failure
• D. Gout

Answer: B. Ischemic stroke

43. A pharmacist counseling a parent on a long-acting methylphenidate capsule (that can be opened) should explain that the beads inside:

• A. Can be crushed or chewed for faster onset.
• B. Should be sprinkled on a small amount of soft food and swallowed immediately without chewing.
• C. Should be dissolved in a large glass of water.
• D. Are for decoration and should be discarded.

Answer: B. Should be sprinkled on a small amount of soft food and swallowed immediately without chewing.

44. Which of the following is an appropriate goal for prophylactic migraine therapy?

• A. To completely eliminate all future migraines.
• B. To reduce the frequency, severity, and/or duration of migraine attacks by at least 50%.
• C. To allow for the unlimited use of acute medications.
• D. To replace the need for any acute medications.

Answer: B. To reduce the frequency, severity, and/or duration of migraine attacks by at least 50%.

45. The “Follow-up” step of the PPCP for a patient on a new ADHD medication would involve assessing for:

• A. Only symptom improvement.
• B. Only side effects.
• C. Both symptom improvement (e.g., using rating scales) and adverse effects (e.g., appetite, sleep, vital signs).
• D. Only the cost of the medication.

Answer: C. Both symptom improvement (e.g., using rating scales) and adverse effects (e.g., appetite, sleep, vital signs).

46. Which anti-seizure medication is also commonly used for migraine prophylaxis?

• A. Phenytoin
• B. Carbamazepine
• C. Topiramate
• D. Levetiracetam

Answer: C. Topiramate

47. The management of ADHD is a collaborative effort between the patient, family, prescriber, pharmacist, and often:

• A. Law enforcement.
• B. The patient’s employer.
• C. The patient’s teachers or school personnel.
• D. The local news station.

Answer: C. The patient’s teachers or school personnel.

48. Why is it important to differentiate a migraine from a tension-type headache?

• A. It is not important; the treatments are the same.
• B. Because specific abortive therapies like triptans are effective for migraine but not for tension-type headache.
• C. Tension-type headaches are more severe.
• D. Only migraines can be treated with NSAIDs.

Answer: B. Because specific abortive therapies like triptans are effective for migraine but not for tension-type headache.

49. A key counseling point for a patient starting atomoxetine is that:

• A. It provides immediate symptom relief like a stimulant.
• B. It must be taken daily, and it may take several weeks to see the full effect.
• C. It is a controlled substance.
• D. It does not have a black box warning.

Answer: B. It must be taken daily, and it may take several weeks to see the full effect.

50. The comprehensive management of “Other Neuropsychiatric Disorders” like ADHD and migraine requires the pharmacist to be an expert in:

• A. Only acute treatment.
• B. Only prophylactic treatment.
• C. Both acute and prophylactic treatment strategies, as well as non-pharmacological and counseling interventions.
• D. Only non-pharmacological interventions.

Answer: C. Both acute and prophylactic treatment strategies, as well as non-pharmacological and counseling interventions.