• Question 1
Which drug below has an interaction with cigarette smoking and should be adjusted
based on patient’s tobacco use/non-use?
Response “Clozapine blood levels are significantly lowered by cigarette
Feedback: smoking and by other hepatic enzyme-inducers.”
• Question 2
Which of the following medications is best to AVOID in maintenance treatment of bipolar
disorder and why?
Response “As noted previously, antidepressants may contribute to an
Feedback: increase in mood episode frequency.”
• Question 3
Glia cells play a supportive role in the neuron. A few of the functions of the glial cells
include providing nutrition, maintaining homeostasis, stabilizing synapses, and
myelinating axons. The glial cells are categorized as microglia or macroglia. Of the
macroglia cells, which one plays a role in myelinating axons, which may contribute to
mood disorders if altered?
• Question 4
Which of the following are NOT primary target(s) symptom for antipsychotic agents in
schizophrenia?
i. Depression, anxiety, demoralization, suicidality, excitability, and agitation
ii. Delusions, hallucinations, disorganized thoughts
iii. Affective flattening, alogia, avolition, anhedonia, social withdrawal
iv. Attention, memory, and executive functions
Response
“For schizophrenia, the primary target symptoms for antipsychotic
Feedback: agents fall into three categories: psychotic symptoms (e.g.,
hallucinations, delusions, disorganization); agitation (e.g., distractibility,
affective lability, tension, increased motor activity); and negative
symptoms (e.g. apathy, diminished affect, social withdrawal, poverty
of speech.” AND “Although cognitive deficits are an important
contributor to disability in schizophrenia, cognitive deficits usually are
not considered a target for antipsychotic agents because they are not
very responsible to current agents.”
• Question 5
A 32-year-old males calls you complaining of decreased libido since starting Paroxetine
20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now
experiencing extreme irritability and nervousness. He wishes to stop this medication due
to side effects. What do you recommend?
Response under selective serotonin re-uptake inhibitors discontinuation syndrome
Feedback: subtitle: “The risk of such adverse events occurring seems to be
, inversely related to the half-life of the SSRI, with fluoxetine reported
as having a significantly lower risk than paroxetine in two studies. For
more severe discontinuation-related adverse events, re-institution of
the SSRI and slow taper may be necessary to alleviate these
symptoms.”
• Question 6
With second-generation antipsychotics, what is the main side effect that requires
frequent monitoring?
Response table 7-6 & page 80, table 7-7; Page 78: “However, attention over
Feedback: the past decade has focused on effect of second-generation
antipsychotics on glucose metabolism and lipids and associated
metabolic syndrome.”
• Question 7
A 23-year-old female was just diagnosed with major depressive disorder and is being
started on escitalopram 10 mg daily. The patient should be counseled about which Black
Box warning?
Response “In 2004, the FDA asked manufacturers of almost all the new
Feedback: antidepressant drugs to include in their labeling a warning statement
that recommends close observation of adult and pediatric patients
treated with these drugs for worsening depression or the emergence of
suicidality."
• Question 8
Which anticonvulsant below induces its own metabolism over time?
• Question 9
In order for the NMDA receptor to fully open and allow an influx of calcium, both
glutamate and glycine must bind to cause a depolarization of the cell that will ultimately
displace which ion? Is the NMDA receptor an ionotropic or metabotropic receptor?
• Question 10
Which of the following medications are known as selective serotonin re-uptake inhibitors
(SSRIs)?
i. Nortriptyline
ii. Citalopram
iii. Duloxetine
iv. Fluoxetine
v. Venlafaxine
• Question 11
Which disease state of a non-adherent patient is at greater risk for substance use,
Which drug below has an interaction with cigarette smoking and should be adjusted
based on patient’s tobacco use/non-use?
Response “Clozapine blood levels are significantly lowered by cigarette
Feedback: smoking and by other hepatic enzyme-inducers.”
• Question 2
Which of the following medications is best to AVOID in maintenance treatment of bipolar
disorder and why?
Response “As noted previously, antidepressants may contribute to an
Feedback: increase in mood episode frequency.”
• Question 3
Glia cells play a supportive role in the neuron. A few of the functions of the glial cells
include providing nutrition, maintaining homeostasis, stabilizing synapses, and
myelinating axons. The glial cells are categorized as microglia or macroglia. Of the
macroglia cells, which one plays a role in myelinating axons, which may contribute to
mood disorders if altered?
• Question 4
Which of the following are NOT primary target(s) symptom for antipsychotic agents in
schizophrenia?
i. Depression, anxiety, demoralization, suicidality, excitability, and agitation
ii. Delusions, hallucinations, disorganized thoughts
iii. Affective flattening, alogia, avolition, anhedonia, social withdrawal
iv. Attention, memory, and executive functions
Response
“For schizophrenia, the primary target symptoms for antipsychotic
Feedback: agents fall into three categories: psychotic symptoms (e.g.,
hallucinations, delusions, disorganization); agitation (e.g., distractibility,
affective lability, tension, increased motor activity); and negative
symptoms (e.g. apathy, diminished affect, social withdrawal, poverty
of speech.” AND “Although cognitive deficits are an important
contributor to disability in schizophrenia, cognitive deficits usually are
not considered a target for antipsychotic agents because they are not
very responsible to current agents.”
• Question 5
A 32-year-old males calls you complaining of decreased libido since starting Paroxetine
20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is now
experiencing extreme irritability and nervousness. He wishes to stop this medication due
to side effects. What do you recommend?
Response under selective serotonin re-uptake inhibitors discontinuation syndrome
Feedback: subtitle: “The risk of such adverse events occurring seems to be
, inversely related to the half-life of the SSRI, with fluoxetine reported
as having a significantly lower risk than paroxetine in two studies. For
more severe discontinuation-related adverse events, re-institution of
the SSRI and slow taper may be necessary to alleviate these
symptoms.”
• Question 6
With second-generation antipsychotics, what is the main side effect that requires
frequent monitoring?
Response table 7-6 & page 80, table 7-7; Page 78: “However, attention over
Feedback: the past decade has focused on effect of second-generation
antipsychotics on glucose metabolism and lipids and associated
metabolic syndrome.”
• Question 7
A 23-year-old female was just diagnosed with major depressive disorder and is being
started on escitalopram 10 mg daily. The patient should be counseled about which Black
Box warning?
Response “In 2004, the FDA asked manufacturers of almost all the new
Feedback: antidepressant drugs to include in their labeling a warning statement
that recommends close observation of adult and pediatric patients
treated with these drugs for worsening depression or the emergence of
suicidality."
• Question 8
Which anticonvulsant below induces its own metabolism over time?
• Question 9
In order for the NMDA receptor to fully open and allow an influx of calcium, both
glutamate and glycine must bind to cause a depolarization of the cell that will ultimately
displace which ion? Is the NMDA receptor an ionotropic or metabotropic receptor?
• Question 10
Which of the following medications are known as selective serotonin re-uptake inhibitors
(SSRIs)?
i. Nortriptyline
ii. Citalopram
iii. Duloxetine
iv. Fluoxetine
v. Venlafaxine
• Question 11
Which disease state of a non-adherent patient is at greater risk for substance use,
