Psychotropic drugs: depression, psychosis and mania therapies MCQs With Answer

Introduction: This quiz collection on Psychotropic Drugs — focusing on therapies for depression, psychosis and mania — is tailored for M.Pharm students studying Advanced Pharmacology-I. It emphasizes mechanisms, therapeutic uses, adverse effects, pharmacokinetics and clinically relevant drug interactions. Questions are designed to test deeper understanding beyond memorization: receptor pharmacology, monitoring parameters, management of toxicities, rationale for drug selection in special populations, and contemporary agents like ketamine and clozapine. Use these MCQs to consolidate knowledge, prepare for examinations and clinical decision-making. Explanatory study after answering will strengthen ability to choose evidence-based pharmacotherapy in complex psychiatric scenarios.

Q1. Which of the following antidepressants primarily inhibits both serotonin and norepinephrine reuptake and is commonly used for neuropathic pain as well as depression?

• Fluoxetine
• Venlafaxine
• Imipramine
• Bupropion

Correct Answer: Venlafaxine

Q2. Which adverse effect is most characteristic of tricyclic antidepressant overdose and guides urgent management?

• Hepatic necrosis
• Prolonged QT and wide QRS due to sodium channel blockade
• Aplastic anemia
• Serotonin syndrome

Correct Answer: Prolonged QT and wide QRS due to sodium channel blockade

Q3. Which antipsychotic is considered the most effective for treatment-resistant schizophrenia and requires regular absolute neutrophil count (ANC) monitoring?

• Risperidone
• Clozapine
• Haloperidol
• Olanzapine

Correct Answer: Clozapine

Q4. Lithium’s primary route of elimination and a key modality for preventing toxicity involves monitoring which organ function?

• Hepatic function (LFTs)
• Renal function (serum creatinine and eGFR)
• Pulmonary function (spirometry)
• Thyroid autoantibodies

Correct Answer: Renal function (serum creatinine and eGFR)

Q5. Which mechanism best describes the rapid antidepressant action of intravenous ketamine in treatment-resistant depression?

• Selective serotonin reuptake inhibition
• Dopamine D2 receptor antagonism
• NMDA receptor antagonism leading to enhanced glutamate-AMPA throughput and synaptogenesis
• Monoamine oxidase inhibition

Correct Answer: NMDA receptor antagonism leading to enhanced glutamate-AMPA throughput and synaptogenesis

Q6. A patient on an SSRI is started on an MAOI. Which serious interaction are they at highest risk for?

• Neuroleptic malignant syndrome
• Hypertensive crisis due to tyramine
• Serotonin syndrome
• Agranulocytosis

Correct Answer: Serotonin syndrome

Q7. For maintenance therapy in bipolar depression to reduce risk of relapse of depressive episodes, which agent is particularly indicated and requires very slow titration due to risk of rash?

• Lithium
• Lamotrigine
• Valproate
• Carbamazepine

Correct Answer: Lamotrigine

Q8. Which adverse effect is most strongly associated with atypical antipsychotics such as olanzapine and clozapine relative to typical antipsychotics?

• Extrapyramidal symptoms (acute dystonia)
• Sexual dysfunction due to hyperprolactinemia
• Severe metabolic syndrome including weight gain, hyperglycemia and dyslipidemia
• Cholinergic crisis

Correct Answer: Severe metabolic syndrome including weight gain, hyperglycemia and dyslipidemia

Q9. Which antidepressant is an NDRI (norepinephrine-dopamine reuptake inhibitor) that is useful when sexual side effects are a concern but is contraindicated in bulimia due to seizure risk?

• Paroxetine
• Bupropion
• Sertraline
• Nortriptyline

Correct Answer: Bupropion

Q10. A patient develops acute oculogyric crisis and neck dystonia after starting an antipsychotic. Which treatment is most appropriate for immediate symptom relief?

• Start an SSRI
• Administer an anticholinergic agent such as benztropine or diphenhydramine
• Begin lithium therapy
• Administer naloxone

Correct Answer: Administer an anticholinergic agent such as benztropine or diphenhydramine

Q11. Which laboratory monitoring is essential when a patient is treated with valproate for acute mania?

• Thyroid function tests every 2 weeks
• Liver function tests and platelet count periodically
• Fasting cortisol levels monthly
• Serum lithium level weekly

Correct Answer: Liver function tests and platelet count periodically

Q12. Which antipsychotic has relatively high propensity to cause hyperprolactinemia due to D2 blockade in the tuberoinfundibular pathway?

• Quetiapine
• Risperidone
• Clozapine
• Ziprasidone

Correct Answer: Risperidone

Q13. Which pharmacological characteristic explains why TCAs have anticholinergic side effects like dry mouth, constipation and urinary retention?

• Inhibition of monoamine oxidase
• Antagonism of muscarinic acetylcholine receptors
• Stimulation of GABA-A receptors
• Activation of opioid receptors

Correct Answer: Antagonism of muscarinic acetylcholine receptors

Q14. A patient with bipolar mania and a history of polycystic ovarian syndrome (PCOS) requires mood stabilization. Which agent is relatively less favorable due to teratogenicity and endocrine effects?

• Lithium
• Valproate
• Lamotrigine
• Oxcarbazepine

Correct Answer: Valproate

Q15. Which sign differentiates neuroleptic malignant syndrome (NMS) from serotonin syndrome in a patient on antipsychotic therapy?

• Hyperreflexia and clonus
• Lead-pipe rigidity with very high CK and slow onset over days
• Mydriasis and hyperactive bowel sounds
• Rapid onset within hours after a serotonergic drug

Correct Answer: Lead-pipe rigidity with very high CK and slow onset over days

Q16. Which antidepressant mechanism is characteristic of mirtazapine and explains its sedative and appetite-stimulating properties?

• Serotonin reuptake inhibition only
• Alpha-2 adrenergic antagonism with H1 histamine receptor antagonism
• MAO-A inhibition
• NMDA receptor antagonism

Correct Answer: Alpha-2 adrenergic antagonism with H1 histamine receptor antagonism

Q17. Which drug interaction significantly increases lithium levels and can precipitate lithium toxicity?

• Concurrent use of rifampicin
• Concurrent use of thiazide diuretics
• Concurrent use of phenytoin
• Concurrent use of carbamazepine

Correct Answer: Concurrent use of thiazide diuretics

Q18. Which antipsychotic is associated with the greatest risk of agranulocytosis and requires enrollment in a REMS program with mandatory blood monitoring?

• Haloperidol
• Clozapine
• Aripiprazole
• Paliperidone

Correct Answer: Clozapine

Q19. Which statement best describes the typical time-course of therapeutic response to standard oral antidepressants?

• Clinical antidepressant effects are evident within hours
• Improvement commonly begins after 2–4 weeks with full effect often by 6–8 weeks
• They produce immediate mood elevation but require lifelong use
• Therapeutic response is typically seen only after 6 months

Correct Answer: Improvement commonly begins after 2–4 weeks with full effect often by 6–8 weeks

Q20. Which antiseizure mood stabilizer induces CYP3A4 and can reduce the plasma concentrations of many co-administered drugs, requiring dose adjustments?

• Valproate
• Carbamazepine
• Lithium
• Lamotrigine

Correct Answer: Carbamazepine

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