Psychiatric and Neurological Drugs Mock Test

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Psychiatric and Neurological Drugs

MOCK TEST
1) PK is a 80 year-old woman with osteoporosis, osteoarthritis,

chronic UTIs, essential tremor, and mild cognitive impairment,
who has recently been diagnosed with depression with anxious
features. PKs appetite has significantly diminished and skipping
several meals of the day. He is currently sleeping only for 1 hour.
Current medications include calcium with D 500 mg/400 IU tid,
alendronate 70 mg weekly, and prn acetaminophen extra
strength. Which of the following is a most likely antidepressant
to give PK?
a. Citalopram or sertraline
b. Sertraline or Paroxetine
c. Paroxetine or Fluoxetine
d. Venlafaxine or Duloxetine
e. Amitriptyline or bupropion
Ans; A
Tips: Fluoxetine and paroxetine are not good choices in senior
due to a propensity to cause excessive stimulation, sleep
disturbance, and agitation; a long half-life (fluoxetine); and
clinically relevant anticholinergic properties (paroxetine).
2) When assessing response of antidepressants, which of the

following symptoms response onset is approximately in 2
weeks?
A) neurovegetative symptoms such as appetite and sleep.
B) mood symptoms
C) cognitive symptoms
D) anxiety symptoms
Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 1

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E) psychosis symptoms
Ans.A
Tips: appetite and sleep may improve in 2 weeks. However
mood improved in 3 weeks. The optimal effect is seen 4 to 6
weeks.
3) Which of the following SSRIs side effects require dose

reduction or switching of antidepressant?
A) Nausea, diarrhea
B) Sleep disturbances
C) Headache
D) Increased sweating
E) Insomnia
Ans.
Tips:
Nausea, diarrhea – one week
Sleep disturbances – first week or two
Headache – first week or two
Side effects that require dosage reduction, treatment or

switching of antidepressant:
• Tremor or akathisia
• Sexual dysfunction

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• Increased sweating
• Nausea (through CNS stimulation)
3) SD is a 59 year old retired person. Frequently visit to his

family doctor for difficulty in sleep. Which of the following
patient assessment is LEAST important for insomnia? Patient
denies taking alcohol, smoking and watching TV.
A- Total sleep time
B) Sleep latency
C) Early and/or frequent awakening
D- Alcohol consumption
E- Daytime impact of sleeping problem
Ans. D
TC page 136, 6th ed. Sleep diary. Is it ok to have 15 min brisk
walk before bedtime.
4) SDs doctor considering to prescribe medication for insomnia.

Which of the following medication have fast onset of action and
least hangover?
A)Zopiclone B) Lorazepam C) Oxazepam
D) Diazepam E) Clonazepam
Ans: A
Tips: Zopiclone is short acting and have least hangover effect.
Triazolam 0.125 mg to 0.250 mg has faster onset of action. Have
No hangover effect. However it has retrograde amnesia.
rebound insomnia, and have day time anxiety. This SEs make
limited use in initiating sleep.
Oxazepam have NO hangover effect TC page 137.

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5) MJ is a 41 years old a chronic alcoholic male, no known

allergies, past medical history: Anxiety, difficulty sleeping.
Current medications: triazolam 0.5 mg qhs x 3 years and
acetaminophen/caffeine/codeine (Tylenol #1) – ii prn headache.
You notice that this patient has been coming in early for refills
for triazolam and has received extra prescriptions for this
medication from many walk-in clinics. Patient approaches you
and states that he is concerned about his triazolam usage, so he
stopped using it 24 hours ago. He asks you what the most
common withdrawal symptoms will be:
A) Diarrhea, shakes and chills
B. Insomnia, muscle spasms and irritability
C. Increased headache, fatigue and nausea
D. Seizures, delirium, and hallucinations
Ans: B
6) KD is a 65 yr female patient of osteoarthritis on

acetaminophen 650 mg qid ask for 120 tab of Tylenol # 1
recommended by the doctor she already on increase dose so
what is the main concern of the pharmacist. Her lifestyle include
daily drinks 2 to 3 wine.
I) Overdose of acetaminophen
II) Constipation
III) Narcotic regulations
A-I only B-III only C-I and II only D-II and III only E-I,II, III
Ans-C

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7)Factors contributing to acetaminophen overdose and liver
toxicity include?
I) ingesting more than the maximum recommended total daily
dose (4 g in 24 hours),
II) taking multiple acetaminophen formulations for different
conditions or symptoms.
III) consuming three or more alcoholic drinks per day while
taking acetaminophen.
A-I only B-III only C-I and II only D-II and III only E-I,II, III
Ans: E
8) If IBs doctor considering to prescribe diclofenax gel (Voltaren

gel) what risk factors you consider? except
A) Age > 65 yo
B) GI bleeding
C) Renal disease < CrCl 30 ml/min
D)if already using oral NSAIDs
Ans: A
TC page 1028, 6th ed. Table 1: Risk factors for developing upper
GI adverse effects with NSAIDs
9) A patient has been taking an opioid analgesic for the past

three months for back pain resulting from a workplace injury. All
of the following behaviors could be indicators of a developing
addiction disorder, EXCEPT:

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a) incidents of lost prescriptions.
b) frequent requests for early refills.
c) prescriptions from multiple family physicians.
d) patient concerns regarding side effects.
e) patient concerns regarding lack of efficacy.
Answer: D
FG is a 65-year-old war veteran with a 40-year history of

paranoid schizophrenia. His symptoms include poor personal
hygiene, blunted affect, and delusions, accompanied by
auditory and visual hallucinations. His delusional symptoms
relate to his wartime experiences. His visual hallucinations
involve enemy soldiers from the war who he believes are
stalking him. FG's auditory hallucinations include the sounds
of war, accompanied by enemy soldiers threatening to end his
life if he does not keep his guard up. FG has been unable to
maintain a job or adequate housing for many years. He
currently lives under a bridge "in case he needs to make a
getaway down the river."
When workers from the free clinic are able to locate him, they
attempt to provide medical care and evaluate his
schizophrenia. If sample medications are available, they
provide him with them. According to their records, FG was
given haloperidol 15 mg 3 times daily and benztropine 1 mg 3
times daily when they last evaluated him. He was given enough
medication for a few weeks so that they could evaluate the
effectiveness and any adverse effects. During previous trials
with other neuroleptic agents, extrapyramidal side effects have
limited the dose FG could tolerate.
The physician on the team would like to discontinue the
haloperidol and initiate an agent with fewer extrapyramidal

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side effects. He searches the medication supply and finds that
he has samples of olanzapine, quetiapine, aripiprazole, and
risperidone, ziprasidone
10) Which agent is least likely to cause extra pyramidal side

effects?
A) olanzapine
B) quetiapine
C)Aripaprazole
D) Risperidone
E) Ziprasidone
Ans.B
Tips:
EPS Symptoms from least to high Clozapine>quetiapine>
Risperidone> Olanzapine.
Risperidone is the agent least likely to cause extrapyramidal

side effects. At doses ≤6 mg per day, the side effect rate with
risperidone is similar to that with placebo. With increased doses,
the risk of extrapyramidal side effects increases. The most
common side effects with low-dose risperidone are asthenia and
sedation.
11) Which agent is most likely to cause QT prolongation side

effects?
A) olanzapine
B) quetiapine
C)Aripaprazole
D) Risperidone

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E) Ziprasidone
Ans: E
Tips: Ziprasidone is contraindicated in QT prolongation.

Risperidone, quatiapine, olanzapine have QT prolongation SEs.
Clozapine has myocardititis SEs.
12) Which agent cause highest weight gain side effects?

A) Olanzapine
B) Quetiapine
C)Aripaprazole
D) Risperidone
E) ziprasidone
Ans:
Tips: Olanzapine and clozapine have the highest weight of all
antipsychotics.
13) MP was recently diagnosed with schizophrenia and was just

discharged from hospital. He is currently taking risperidone 3 mg
twice daily. He tells you that he no longer has delusions or
hallucinations and is feeling more motivated, but he’s been
having trouble with symptoms that he describes as “wanting to
crawl out of his skin” and a hand tremor. What is appropriate
reasoning to tell MP?
I) the symptoms he is describing are normal side effects of
risperidone; because his symptoms of schizophrenia are well
controlled, there is nothing that can be done
II) sometimes the risperidone can cause the symptoms he is
describing; with his permission, you will call his psychiatrist to
discuss reducing his dosage.

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III) sometimes the risperidone can cause the symptoms he is
describing; with his permission, you will call his psychiatrist to
discuss switching risperidone with clozapine because it is
associated with fewer extra pyramidal symptoms
Ans: D
14) What receptor likely has the largest impact on risk of

sedation?
a) histamine H1 receptors
b) dopamine D2 receptors
c) histamine H2 receptors
d) alpha-1 receptors
e) alpha 2 receptors
Ans:
Tips: sedation is antihistaminic effects caused by blockade of H1
receptors.
15) Which agent must be taken with meals?

A) olanzapine
B) quetiapine
C)Aripaprazole
D) Risperidone
E) ziprasidone
Ans: E
16) What is not monitored for risperidone?

A) blood pressure and pulse on dose titration

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B) Body mass index (BMI)
C) Liver function test at base line and Q6m
D) Lipids and triglyceride levels
E) Cardiomyopathy like chest pain
Tips:E
Bp/pulse BG LFT BMI WBC TG/TC others
Clozapine + + + + + + Cardiotoxicity
Risperidone + + + + + Akithisia
Olanzapine + + + +
Quetiapine + + + +
Ziprasidone
Paliperidone
Aripiprazole
17) After starting antipsychotics therapy. When symptoms of

schizophrenia will start to resolve?
A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks
E) one month
Ans. A
Tips: start resolving in 2 weeks and maximum takes 8 weeks.
20) The doctor prescribes a combination treatment of SSRI +

benzodiazepines for which there is a risk for a pharmacokinetic
interaction. Which of the following is the best course of action?

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A) Recommend avoiding the combination due to the narrow
safety margin of SSRI
B) Recommend avoiding the combination due to narrow safety
of margin of benzodiazepines
C) Dispense the combination and monitor for increased side
effects of SSRI
D) Dispense the combination and monitor for increased side
effects of benzodiazepines
Ans: D
21) A 30 yo maniac patient on lithium 600 mg q8h admitted to

hospital with hallucination and disorientation. What is the
better explanation or drug related problem?
A) non adherence
B) taking too much medication
C) Taking too little dose
D) toxicity of lithium
E) Need additional drug therapy
Ans: E
Tips: Lithium min dose 900 mg to 2100 mg daily. Over dose
symptoms can occur if lithium serum levels are over 2 mEq/L.
Hallucination, and disorientation need additional therapies like
mood stabilizers.
22) A 25 year old student is taking paroxetine daily for the

treatment of depression for the past 3 months. Currently doctor
diagnosed patient as maniac. What is appropriate to do?
A) Continue paroxetine and start lithium
B) Discontinue paroxetine and start lithium
C) Continue paroxetine and add haloperidol and lithium
D) Discontinue paroxetine and add haloperidol

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E) Increase dose of lithium
Ans: B
23) A patient with neuropathic pain was prescribed

carbamazepine by his doctor, with some relief of his signs and
symptoms but with more side effects that are bothering the
patient. Which of the following symptoms are not dose
dependent?
A-Rash
B-Dizziness
C-visual disturbances
D-GI upset
Ans-A
Tips: Carbamazepine idiosyncratic ADR is rash, require to
discontinue and talk to doctor. A patient with allergic
amitriptyline should not take carbamazepine because these two
drugs are structurally same class.
24) A 10 years child with ADHD. His doctor diagnosed his

condition and prescribed methylphenidate CR capsule 10 mg
twice daily. Best thing the pharmacist should do is
A-Call the doctor to switch the patient to methylphenidate CR
tab 20 mg/dose since the later is given in divided doses.
B-Call the doctor to ensure him that methylphenidate CR is given
once daily and not twice daily
C-Dispense the prescription as it is
D-Call the doctor to prescribe him methylphenidate since the
capsule can be opened and sprinkled on soft foods
E-None of the above

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Ans:B: methylphenidate CR is given as 20 mg/dose 8 hours apart
and controlled release as a single dose
25) What is monitored in 10-year-old using methylphenidate,

except?
A-Weight loss
B-Insomnia
C-Constipation
D-Reduce hyperactivity
E-Attention in his studies
F-Suicidal plans
Ans-C
26)The child mother is concerned about addiction of ADHD

medications, What to tell her? except
A) Giving ADHD therapy now will reduce the abuse further in life
B) Drug has addiction. However it is safe to use as prescribed by
doctor.
C) Improve in social interactions
D) Improve in athletic performance
E)Improve academic performance
Ans: D

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27) Which of the following antidepressants is most effective in
the treatment of post herpetic neuralgia, and diabetic
neuropathic pain?
a. Amitriptyline
b. Fluoxetine
c. Paroxetine
d. Citalopram
Ans: A
TC page 143
Tips: Amitriptyline is used in post herpetic, diabetic neuropathic
pains, however it not used in trigeminal neuralgia pain
Amitriptyline dose 10 to 25 mg QHS daily at weekly intervals
until pain relief or side effects.
28)Which of the following DOES NOT have any value in the

treatment of symptoms of trigeminal neuralgia.
I) Carbamazepine
II) Capsaicin
III) Meloxicam
A-I only
B-III only
C-I and II only
D-II and III only
E-I, II, III
Ans: B
TC page 139. NSAIDs, and acetaminophen are NOT effective for
the treatment of neuralgia.
29) A parent of ADHD child call your pharmacy to ask her

concern on her child medication. After initiated
methylphenidate bid 10 mg takes 7 am SR tabs and 3 pm IR tabs.
She is concerned about her child loosed his appetite and going to

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bed late in nights wakes up late in the morning. What is the
appropriate to do?
A) ask her to contact doctor
B) ask her to check weight
C) ask her to give medication 7 am SR tab and 12 noon IR tabs
D) ask her increase diet.
E) ask her to check his school performance
Ans: C
Tips: Give medication with meals, high calories meals, when
stimulants effects are low specially breakfast and bedtime and
supplemental boost ensure and also engage child in meal prep
and shopping for favourite food. Ref: Rx files. To increase
appetite cyproheptadine can be used.
30) Which of the following is indicator or fraudulent

prescription?
A) Prescription is washed with acetone to remove original
handwriting
B) Prescription altered for number of tablets like 10 altered to
100. In verbal prescription ask prescriber to spell out quantity
C) Fictitious patient and stolen pad, computer generated pad
D) Adding other control substances to existing prescription
E) All of the above
Ans: E
31) If pharmacist suspect prescription forged?

I) inform physician/prescriber
II) Report to local law enforcement

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III) Inform other local pharmacies or update in narcotic
monitoring system
Ans: E
32) Pharmacist suspect forged prescription. Patient is agitated

because patient know he has been caught. Patient demand of
return the prescription. What is appropriate to do?
A) do not return prescription and call your local police
B) return prescription and call your local police
C) calm down patient and reassure that you will return
prescription and call police
D) Just return prescription and never call police
E) none of the above
Ans: C
33) MK is 32 year women has been customer at your pharmacy

for some time. Currently she is using citalopram 40 mg daily for
the past 6 months. She came to pick up her refill. She was little
concern about her therapy. Recently she was reading health
Canada warning and advisories on Citalopram > 40 mg have QT
prolongation side effects. What is your appropriate response?
A) advise patient to discontinue citalopram and contact the
doctor.
B) advise patient to reduce the dose to half
C) advise patient to continue her therapy until consult her
doctor.
D) Tell that she can use until the drug is withdrawn from market.

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E) Advise patient to get a new prescription
Ans: C
34) MK asks pharmacist if she is concern that she gets any heart
problem from citalopram use? What is appropriate response?
A) some people may get the side effects of the drug
B) Since already you are taking this medication for the past 6
months, so you may NOT get the side effects.
C) Side effects of SSRIs occurs within first 1 to 2 weeks of drug
initiation.
D) If you notice any symptoms of palpitation or heart rhythm
changes please contact your doctor.
E) QT prolongation only occur if used more than 40 mg of
citalopram.
Ans: D
35) A physician prescribed alprazolam 0.5 mg SL 3 tab. Repeat 5

times. What is correct?
A) Prescription is NOT valid
B) Prescriptions is forged
C) Prescription should not contain repeats
D) prescription is valid
E) the prescription is NOT allowed
Ans: D
Tips: Benzodiazepine can be refilled. Benzodiazepine refills do
not require intervals to be specified. Control substance part 1
doctor has to specify intervals of repeats and repeats allowed
only for written prescriptions.

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36) The pharmacist fills a prescription for sumatriptan 100 mg
tablets for a patient with migraine. Appropriate information to
provide to the patient includes which of the following?
a) If the sumatriptan does not relieve the headache within four

hours, ergotamine may be used.
b) If no relief is achieved in two hours, sumatriptan may be
repeated.
c) If the headache is relieved but another headache occurs eight
hours later, sumatriptan may be used for the second headache.
d) The maximum dosage in any 24 hour period is six tablets.
e) If relief is not achieved, no other medication can be used for
24 hours.
Ans: C
37) A 30-year-old patient, is currently on antidepressant

treatment, wants to stop taking fluoxetine because she
continues to have trouble sleeping and does not wish to use a
sedative. Which is the best option to improve sleep?
a) Add lorazepam at bedtime
b) Switch to bupropion
c) Switch to moclobemide
d) Switch to mirtazapine
Ans: D
38) MD is a 40-year-old woman who has recently been

diagnosed with panic disorder. She describes to you the very
frightening episodes she has experienced over the last six
months. She was convinced she had a serious heart problem,
but has been assured by her doctor that she is physically
healthy. She is obviously very anxious, fidgeting with her

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purse, looking around to see who may also be in the pharmacy.
Upon questioning, you found out that she has been having
trouble concentrating and sleeping and that she is very worried
about having another attack.
Which of the following medications would be the best choice,
as a single agent, for immediate relief of MD’s symptoms?
a. Buspirone
b. Desipramine
c. Alprazolam
d. Fluoxetine
Ans: C
TIPS: As alprazolam is related to BDZs it’s the best choice.
39) JK is 53-year-old lady came to the pharmacy with a

prescription for Wellbutrin 150 mg SR. Her profile shows that
she was on Wellbutrin 150mg XL. The pharmacist asked the
patient whether she is aware of any changes that her doctor
made for her therapy, and she replied that nothing her doctor
told her about that. The best action the pharmacist should do
is:
A. Dispense Wellbutrin 150mg SR since there is no difference
between the two
B. Dispense Wellbutrin XL as in her profile
C. Call the doctor to see if he has intended to change XL to SR
D. Give the generic bupropion SR
E. None of the above
Ans: (C)
Tips: Wellbutrin XL is once a day and Wellbutrin SR is twice
a day but could be given once a day, so the best option is to call
the doctor that the.
40) JKs doctor call pharmacy to change prescription to

Wellbutrin SR 150 mg bid. However technician prints

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prescription label. Wellbutrin SR 150 mg take two tablet daily.
What is pharmacist changes you recommend?
A) Wellbutrin SR 150 maximum single dose should not exceed
150 mg
B) Wellbutrin SR 150 mg should not exceed 300 mg daily
C) Wellbutrin SR 150 mg single dose 150 mg and doses 8 hr
apart
D) Wellbutrin SR 150 mg is once a day
E) Wellbutrin XL 150 mg is twice daily
42) You were told by the same patient that she once was on
antidepressant that caused her limbs to jerk at night. Which
antidepressant is most likely to cause this problem?
a) Mirtazapine
b) venlafaxine
c) bupropion
d) moclobemide
Ans: D
43) Venlafaxine was omitted for 10 days for a 78 year old

patient. The order was inadvertently crossed off from
medication administration records and subsequently not
transcribed on transfer to chronic care. Patient experienced all
of the following, except?
A) nausea and vomiting

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B)Delirium
C) Flu like symptoms
D)Insomnia
E)Tremors
Ans: E
Tips: SSRI or SNRI withdrawal or discontinued symptoms: flu like
symptoms. However no tremors and cognitive symptoms.
44) A nurse had an order to administer a 200 mg depot injection

of zuclopenthixol decanoate. She had no previous experience
with the drug and misunderstood the vial’s label. Instead of
giving the patient his usual dose of 1ml of a 200mg/ml solution,
she interpreted
the entire vial to contain 200mg. Five times the normal dose was
given (the vial was only half full). The patient may experienced
the following?
A) unpleasant extra pyramidal symptoms
B) suicidal symptoms
C) disorientation
D) Insomnia
E)none of the above
ANS: A
45) Which of the following can be crushed and chewed?

A) Dutasteride
B) Ibandronate
C)Duloxetine
D) Divalproex
E) ASA 80 mg
ANS:E

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46) JM is 75 year old diagnosed with Alzheimer’s disease and

diastolic dysfunction, his current medication include donepezil
10mg QD, furosemide 40mg QD, verapamil SR QD. Jims father
and mother both have had suffered Alzheimer in their old age.
Symptoms of Alzheimer’s disease, all EXCEPT:
a) Slurred speech
B)Delay cognitive functions detritions
C)Fatigue
D)Dementia
E) Loss of memory
Ans: C
Tips: Fatigue and reversing cognitive functions are NOT a goal of
therapy for dementia.
SAPF = Stress, Anxiety, Psychosis and Fatigue are except for
dementia symptoms.
47) All of the following are the risk factor of Alzheimer’s disease,
EXCEPT
a) Female gender
B)Family history
C)Age
D)Emotional stress
E)None of the above
Ans: D

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48) The doctor prescribes a combination treatment of SSRI +
benzodiazepines for which there is a risk for a pharmacokinetic
interaction. Which of the following is the best course of action?
A) Recommend avoiding the combination due to the narrow
safety margin of SSRI
B) Recommend avoiding the combination due to narrow safety
of margin of benzodiazepines
C) Dispense the combination and monitor for increased side
effects of SSRI
D) Dispense the combination and monitor for increased side
effects of benzodiazepines
Ans: D
**************
49) A 25 year old student is taking paroxetine daily for the
treatment of depression for the past 3 months. Currently doctor
diagnosed patient as maniac. What is appropriate to do?
A) Continue paroxetine and start lithium
B) Discontinue paroxetine and start lithium
C) Continue paroxetine and add haloperidol and lithium
D) Discontinue paroxetine and add haloperidol
E) Increase dose of lithium
Ans: B

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50) KP is a 27 year old man using salbutamol and fluticasone

inhalers for asthma. Having dry cough. He asks pharmacist, why
all OTC cough suppressants like dextromethorphan (DM) should
be avoided?
A) DM may hide early symptoms of asthma attack
B) DM interact with corticosteroids making both ineffective
C)all people asthma should consult with physician as soon as
respiratory symptoms develops
D) codeine is more safe and effective for people with asthma
Ans: A

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******
51) KK, is a 43-year-old male, presents to your pharmacy
requesting something for his “ulcer.” On questioning him, you
learn that: 1) he has had “stomach pains: that have been getting
progressively worse over the month; 2) he does not take any
NSAIDs/ASA; 3) his pain does not rise towards the neck
(heartburn); 4) he has not alarm features; and 5) he never has
been diagnosed with an ulcer. He smokes 3 to 4 cigarettes a day
and usually has 2 glasses of wine with dinner. Based on the
evidence, what would be an appropriate next step to manage
KK?
a) Stop the cigarettes and the wine
b) Try an alginate-containing product
c) Suggest he see his family doctor for possible H. pylori testing.
d) Go to the Emergency room to be assessed for a possible
peptic ulcer
Ans: C
52) PKis a 58-year-old female with moderate persistent low back

pain. She is currently taking acetaminophen 300 mg/codeine 30
mg, 4 to 6 tablets per day and senna, 2 tablets per day for
constipation. Her pain score is 6/10. She doesn’t like the
inconvenience of taking so many pills and would like to reduce
her pill burden. Her physician would like to switch her to a pain
patch for more consistent pain control.
10. Which of the following would be the most
appropriate
for PK?
I) Buprenorphine transdermal system
II) Fentanyl transdermal system
III) acetaminophen+codeine+caffeine PRN
Ans: E

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53) Which of the following is/are appropriate counselling

point(s) for transdermal administration of opioids?
I) Advise patients to avoid exposure to external heat sources as
they can increase the release of buprenorphine or fentanyl and
may result in an overdose.
II) Advise patients to avoid strenuous exercises as they may
increase absorption of buprenorphine or fentanyl and may result
in an overdose
III) Advise patients to contact their physician or pharmacist if
they develop a high fever as fever can increase release of
buprenorphine or fentanyl and may result in an overdose
Ans: A
54) MP is a 50 year old male participating in your pharmacy

cardiovascular risk assessment clinic. He has history of
hypertension or diabetes and has never smoked. He has no
recent blood work on file. A fasting lipid panel is ordered to
assess his cardiovascular risk. Which of the following lab tests
should be completed at baseline in the event the patient is
started on a statin?
I) AST/ALT
II) Creatine kinase
III) Electrolytes
Ans: A
55) MP is a 22-year-old woman, otherwise healthy, presents

with a 6-month history of episodes of unresponsiveness

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accompanied by lip smacking lasting 1 to 2 minutes and
occurring 2 to 3 times per month. She takes no medications She
is in a monogamous relationship with a male sexual partner
and only occasionally uses contraception. A routine EEG
shows left temporal epileptiform activity and MRI of the brain
shows left mesial temporal sclerosis. Which of the following
drugs have decrease the effectiveness of oral contraceptive
pills?
i. Gabapentin
ii. Lamotrigine
iii. Topiramate
a) I only
b) III only
c) I and II
d) II and III
e) I, II III
Ans-B
56) Which of the following drugs are associated with

hirsutism side effects?
A) Phenytoin
B) Carbamazepine
C) valproic acid
D) Topiramate
E) Lamotrigine
Ans: A
Answer: B: Hirsutism is a common side effect of phenytoin

and is not correlated with serum phenytoin concentration.
Ataxia and sedation are concentration-dependent side
effects.
Drugs that cause hirsutism include: phenytoin, androgen,
finasteride, OCP, prednisone.

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57) After her phenytoin therapy has been optimized, MP
returns to the clinic just before her wedding and requests
an oral contraceptive. Which of the following statements
regarding oral contraceptives and phenytoin is most
correct?
A. There is no potential drug-drug interaction
B. Phenytoin inhibits the metabolism of phenytoin and may
increase their side effects.
C. Oral contraceptives inhibit the metabolism of phenytoin
and may increase its side effects.
D. Phenytoin induces the metabolism of oral contraceptives
and may decrease their efficacy.
E. Oral contraceptives induce the metabolism of phenytoin
and may decrease its efficacy.
Answer: D: Phenytoin is an enzyme inducer. It may
increase the metabolism of oral contraceptives and reduce
their efficacy. Patients should be advised to consider
alternative methods of contraception to avoid unplanned
pregnancy.
58) Doctor doubled dose of phenytoin, when to measure

steady state concentration?
A) After 1 day
B) After 1 week
C) After 1 month
D) After 2 week
E) After 3 week
Ans: B
Tips: On average at phenytoin dose of:
300 mg/day takes approx. 5 to 7 days to Css

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Example. Patient receiving phenytoin 300 mg capsule daily.
The Css is 9.2 mcg/ml. If doctor increased dose to 400 mg
daily. What will be Css.
Cnew = (Dnew/Dold) x Cold then increase 15 to 33%
Cnew = (400 mg/300 mg) x 9.2 mcg

= 12.3 mcg/ml
For 15% is 1.15 x 12.5 = 14.1 mcg/ml
For 33% = 16.4 mcg/ml
Then range is 14.1 mcg/mL to 16.4 mcg/mL
59) A 21-year-old obese woman who is otherwise healthy

reports a 5-year history of Generalized-onset seizures are most
effectively treated with broad-spectrum antiepileptic drugs. Her
current medications include Alesse 28, 1 tablet daily as directed
(has not had this filled regularly), vitamin C 500 mg po od, and
vitamin B complex 50 1 tab po daily.
What is the drug of choice for generalized onset seizures?
A) Lamotrigine
B) valproic acid
C-Carbamazepine
D-Phenytoin
E-Topiramate
Ans: B
60) All of the following drug have least drug interactions with
Alesse 28?
I) Valproic acid II) Gabapentin III) Lamotrigine

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A) I only B-III only C-I and II D) II and III
E) I, II, III
Ans: E
61) Which of the following laboratory test is monitored for

valporoic acid?
A) Renal function tests
B) Liver function tests
C) Fabrile seizure
D) Neuroleptic malignant syndrome
Ans: B
62) A patient brings a prescription of divalproex 250 mg bid. In

the patient profile patient was using valproic acid for the past 3
years. What is appropriate to do?
A) this could be drug non compliance
B) call doctor to confirm if dr want to change medication
C) valproic acid and divalproex are drug with same indication so
dispense
D)Check dosage if it is same as divalproex than can be dispensed
E) ask patient if he is aware his medication has been changed
and what did the doctor tell you about this
Ans: E
63) A 60 yo person on Li2CO3 600 mg q8h for maniac depression,

have continuous vomiting and watery diarrhea for a last 1 week?

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Looking for some OTC antidiarrheal? If patient is taking
mistakenly every 1 h, what is the serious symptoms is observed?
A) bradycardia
B) sweating
C) confusion
D) diarrhea
E) course tremors
Ans: E
64) A resident of a long term care facility was admitted to

hospital with behavioral challenges. The patient condition
stabilized on olanzapine 10 mg qid. After discharge from
hospital, the resident required readmission a short time later
because of over sedation and falls. What is reason for second
time admission?
A) due to side effect of olanzapine
B)neuroleptic malignant syndrome
C)overdose of olanzapine
D)because patient is old
E)not sure what is going on
Ans: C
65) An elderly patient had a prescription of lorazepam 1 mg as

needed for escalation of aggressive, agitated behavior. About 30
min after administration of a dose of the lorazepam, the patient
was given clonazepam. Which of the following should be
monitored? except?
A) Disorientation
B) difficulty in walking
C) fall
D) insomnia

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E) sedation
Ans: D
66) A.M. is an 18-year old male who was admitted to the

hospital after having his first psychotic break. A.M.’s parents
has noticed that he was acting strangely for the last few
months. His grades in school had dropped; he was not
interested in hanging out with his friends anymore; and he had
been fired from his part-time job. Most of A.M.’s time was
spent alone in the basement staring blankly at the TV. When it
appeared that A.M. was not responding to external stimuli, his
parents brought him to the emergency department worried
that something is wrong with their son. A.M.’s social
withdrawal, as well as his loss of academic and occupational
functioning is most consistent with:
a) prodromal phase of schizophrenia
b) depression
c) acute phase of schizophrenia
d) residual phase of schizophrenia
Ans: A
67) As part of the initial screening of the above patient, it would

be important to include :
a. complete blood count and electrolytes
b. urine drug screen
c. urine culture
d. thyroid function test
Ans: A
Tips: CBC, electrolytes, routine urine analysis if clinically
indicated.

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68)The most appropriate choice of medication treatment for

A.M would be:
a. clozapine
b. olanzapine
c. perphenazine
d. chlorpromazine
Ans: B
69) Second-generation anti-psychotics as a class offer the

following advantage:
a. high D2 blockade
b. dopamine blockade specific to the nigrostriatal and
mesocortical areas
c. low ratio of D2:5HT2 blockade
d. rapid dissociation from the serotonin receptor
Ans: C
70) The efficacy of second-generation antipsychotics as

compared to conventional antipsychotics can be summarized as:
a. equally effective for positive symptoms and negative
symptoms, less effective for cognitive symptoms and mood
symptoms
b. equally effective for positive, negative, cognitive and mood
symptoms

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c.equally effective for positive symptoms, more effective for
mood and cognitive symptoms and less effective for negative
symptoms
d. equally effective for positive symptoms, more effective for
negative, cognitive and mood symptoms
Ans: D
71) Which of the following second-generation agents is most

likely to cause prolactin elevation?
a. Risperidone
b. olanzapine
c. Quetiapine
d. clozapine
Ans: A
72) The propensity of second generation agents to cause weight

gain can be ordered as follows:
a. clozapine>Risperidone>Quetiapine>olanzapine
b. olanzapine>clozapine>Risperidone>Quetiapine
c.risperidone>Quetiapine>olanzapine>clozapine
d.clozapine>Olanzapine>Quetiapine>Risperidone
Ans: D
73) RJ a 34 year old patient who has been getting his

prescriptions filled at your pharmacy for a long time. He has
been taking paroxetine 40 mg per day for two years for the
treatment of obsessive-compulsive disorder, with good results.
He used to have obsessions of doubt, leading to compulsive
checking, which virtually incapacitated him. He wasn’t able to
leave the house for fear that the stove has been left on, or that
the door wasn’t locked. He has talked to his psychiatrist about
stopping the medication and he asks for your opinion.

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Which of the following is correct?
a. he will not relapse after discontinuation since he took the
medication for two years
b. he must stay on medication for at least five years to reduce
the risk of relapse
c. he has been on medication too long already
d. he may or may not relapse if the medication is stopped.
Ans: D
74) RJ after a discussion with his physician, decides to stop the

paroxetine. Which of the following would represent the best
advice for him?
a. taper down the dose of paroxetine slowly
b. stop the paroxetine at once and take prn doses of diazepam if
required
c. stop the paroxetine at once and monitor symptoms
d. substitute paroxetine with fluoxetine for two weeks then stop
Ans: A
75) One year after stopping the paroxetine, RJ notices the return
of some of his symptoms. He is reluctant to take medication
again because he does not want to have to take medications for
the rest of his life.
Which of the following statements is correct with respect to
treatment of OCD?
a) cognitive-behavioral therapy has not been shown to be
effective
b) cognitive-behavioral therapy is as effective as
pharmacotherapy
c) pharmacotherapy is much more effective than cognitive-
behavioural therapy
d) cognitive-behavioral therapy should be tried before
pharmacotherapy is offered

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Ans: D
***************
76) JDs doctor would like to start her on combination

pharmacotherapy with an anxiolytic and an antidepressant.
Which of the following SSRIs would be most likely to have a
pharmacokinetic interaction with a benzodiazepine?
a) citalopram
b) Fluvoxamine
c) paroxetine
d) sertraline
Ans:B
************
77) You implement a plan to monitor the therapeutic outcomes

of Ms L’s pharmacotherapy. Which of the following best
describes the goals of treatment for panic disorder?
a. reduce the number of panic attacks and the degree of
anticipatory anxiety
b. reduce the number of symptoms experienced during a panic
attack
c. reduce the time it takes for symptoms to peak during a panic
attack
d. reduce the number of panic attacks
Ans: A
***********
78) A 44 year old patient with epilepsy, he is using valproic acid
500mg TID, for past 6 months He has good response however he

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is experiencing some side effect like stomach upset. The
pharmacist should advise the patient:
I ) Talk to doctor to reduce the dose
II) Talk to doctor to switch him to liquid form
III) Talk to doctor to give him another medication in the same
class (divalproex)
A-I only B-III only C) I and II D) II and III E) I, II, III
Ans: B
TIPS: Changing the dosage form will not reduce the side effect.
However usually, if there is a good response to any medication
with side effect, it is better to keep within the same class.
79) Folic acid deficiency will affect which of the following

antiepileptic drugs?
I) carbamazepine
II) valproic acid
III) phenytoin
A) I only B) III only C) I and II D) II and III E) I, II, III
Ans: B
TIPS: Drugs that cause macrocytosis and altered folate
metabolism including (antineoplastic and zidovudine, phenytoin,
primidone, MTX, triamterene, trimethoprim, and oral
contraceptives) REF. (TC, 4th edition, 838).
80) A patient came to emergence poisoned with

diphenhydramine, amitriptyline, imipramine. What are the
symptoms?
a. dry mouth
b. tinnitus
c. constipation
d. sedation
e. all of the above

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Ans: E
TIPS:TCAs SEs are antcholenergic, anthitamenergic, orthostatic
hypotension, lowered seizure threshold, and sexual dysfunction.
REF (TC, 4th edition, 49).
81) A woman phoned the pharmacist and told him that her
husband has swallowed 30 tabs of acetaminophen 325 mg. What
is the proper advice?
a. he will be ok
b. induce emesis-using ipecac
c. call the poison center to ask for advice
d. take him to the emergency department
Ans: C
TIPS: In adults hepatotoxicity may occur after ingestion of a
single oral dose more than 7.5 g. For treatment consider
consultation with a toxic poison center. REF (CPS,2003,
acetaminophen).
**********
82) A patient came to his family physician experiencing severe

Elbow pain after severe contact with anther soccer player. There
is swelling also in his ankle. He treated his ankle at the time of
incidence with ice packs, for 24 hrs, however the pain is still
persistent. patient has peptic ulcer. What will you recommend
I cold compress
II NSAIDs rubs
III Ibuprofen
A) I only B-III only C-I and II only D) II and III only E)I, II, III
Ans : C

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83) Which of the following agents is preferred when used to

heal an NSAID-induced ulcer if the NSAID must be
continued.
a. sucralfate
b. misoprostol
c. proton pump inhibitor
d. H2 receptor antagonist
Ans C
TIPS: At risk patients for peptic ulcer from NSAIDs therapy may
be offered gastric protective therapy with standard doses of PPI.
REF(TC,4th edition,502).
*************
84) MP is a 78 year old female who had difficulty sleeping

over the past several days and some leg cramping and
rigidity in the early of hours of morning. Her medical
history include angina, chronic constipation and
Parkinson's disease. Currently she is using
levodopa/carbidopa 100/25 1 tablets 8 am 12 noon 4 pm
and 8 pm. Amantadine 100 mg qd, ASA 81 mg, Nitrodur
0.6 mg qam, bisacodyl PRN.
Which of the following most likely explanation for MP
symptoms?
A) anticholinergic side effects of amantadine
B) On-off fluctuation
C) wearing off effect
D) Extrapyramidal side effects
E) levodopa induced urinary incontinence
Ans: C

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85) Which of the following you suggest to improve MP

symptoms?
A) Decrease the dose of levodopa/carbidopa
B) Switch to controlled release levodopa/carbidopa
C) Switch to amantadine
D) decrease the frequency of levodopa/carbidopa
E)Discontinue levodopa and add entacapone
Ans: B
KM is a 66-year-old female who visits your pharmacy. She arrives at your pharmacy to
refill her prescriptions. She is currently taking levodopa/carbidopa 100/25 five times
daily, bromocriptine 5 mg qid, and selegiline 5 mg q 12 h. KM tells you that she has
been well, except for some difficulty sleeping.
86) What should you recommend to KM?

a) Ensure that selegiline is taken early in the day
b) Ensure that the last dose of levodopa is taken to no later than 6 pm
c) Suggest that you could recommend that her physician switch from bromocriptine to
ropinirole
d) Ensure that she avoids foods with high tyramine content, such as red wine and
smoked meats.
Ans-A
87) KM turns one month later with a new complaint. She tells you that she has noticed
that she is often light-headed when she arises from sitting or lying down. What might be
causing this problem for KM?
a) Progression of PD
b) Levodopa therapy
c) Bromocriptine therapy
d) All of the above
Ans-D
88) Which of the following is a reasonable strategy for dealing with KM’s problem?
a) The use of a salt substitute
b) Fluid restriction
c) Fludrocortisone therapy
d) All of the above
Ans-A

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89) Which of the following medications is/are approved for postherpetic neuralgia
(PHN)?
a. Gabapentin
b. Amitriptyline
c. Lidocaine patch 5%
d. All of the above
Ans : D
TC page 141, Lidocaine 5% topical gel and transdermal patch
90). Which of the following agents is indicated for the treatment of trigeminal neuralgia?
a. Topiramate
b. Gabapentin
c. Carbamazepine
d. Phenytoin
Ans. C
TC page 139
91) Which of the following antidepressants is most effective in the treatment of

neuropathic pain?
a. Amitriptyline
b. Fluoxetine
c. Paroxetine
d. citalopram
Ans: A
TC page 143
Tips: Amitriptyline is used in postherpetic, diabetic neuropathic pains, however it not
used in trigeminal neuroglia pain Amitriptyline dose 10-25 mg QHS daily at weekly
intervals until pain relief or side effects.
92) A patient using phenytoin for the six months, reports had swollen gum, which of the
following is the appropriate recommendation.
A-Mouth hygiene
B) Refer to dentist
C) Recommend oral mouth hygiene
D-Recommend toothpaste
93) Mr DL is 69 year old male who is being treated for chronic cancer pain with 15 mg of
SR morphine at 6 AM and 6 PM. He is complaining significant break through pain which
wakes him up at about 4 AM and another pain 3 PM which requires rescue doses of
immediate release morphine. His pain is well controlled throughout the rest of the day.
How should morphine regimen should change:
A-Reduce the dose interval of SR morphine to q 8 h
B-No need to change, as rescue doses continue to be taken as needed
C-Increase the dose of immediate release morphine
D-Increase dose of SR morphine to 30 mg q 12 hours.
11-D

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Comments: use immediate release product with SR formulation for break through pains.
The opioid potency or dose can be increased if pain continues or becomes moderate to
severe. Doses should be prescribed on schedule basis rather than PRN to prevent
reoccurrence of pain. An agent with quick onset of action should also be prescribed as
needed for breakthrough pain.
TC p 132
95) Which of the following counselling is important when a patient who

has been given opioid for the first time:
A-Double of dose if needed
B-Do not drink alcohol while taking this medication
C-Take medication with full glass of water
D-Do not takes this medication with any other medication
12-B
96) Which of the following is most accurate description of breakthrough pain;

A-pain that is not responsive to medications
B-Pain that interrupts sleep
C-Pain that spikes upward in intensity
D-Pain experienced by cancer patients
13-C
97) JP is a 59-year-old male who is taking levodopa/benserazide 100/25 qid, selegiline

2.5 mg daily He has taken this medication at this dose for 3 months and has had little
rigidity and posture.
Which of the following is true?
a) Levodopa/carbidopa is more effective than levodopa/benserazide, so JP should be
switched to levodopa/carbidopa
b) Benserazide is administered with levodopa for the purpose of reducing the adverse
effects of levodopa and decreasing levodopa
c) The lack of response to this agent means that JP does not have PD
d) None of the above
Ans-B
98) Which of the following is not a consequence of autonomic dysfunction in PD?

a) Urinary incontinence
b) Excessive sweating
c) Sleep disturbances
d) Sexual dysfunction
Ans-C
99) JP return to pharmacy with new prescription of citalopram 50 mg daily for the
treatment of depression symptoms. What is the pharmacist concern?
A) drug and drug interaction
B) drug and food interaction
C) Age of patient

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D) QT prolongation concern
E) no concern
100) JP reports excessive sweating, and hypertension is occurring from the past few
days? What is the reason?
A) hypertension crisis
B) serotonin syndrome
C) Neuroleptic malignance
D) Drug side effects
E) Parkinson's disease symptoms
18) KM is a 75 yo women, frequently forgets daily activities such

housekeeping, names of relative and friends... Doctor diagnosed
Alzheimer's. What is goal of therapy?
A) Delay the time to transfer nursing home facility
B) Decrease mortality
C) Decrease cognitive functions damage
D) Decrease the time for pharmacotherapy
E) Increase medication compliance
Ans: C
Tips: Decrease cognitive functions damage this delays
progression of disease and prevent getting into severe form of
dementia. Lab test to confirm cognitive MME, MoCA.
19) MJ is 70 year old man. Has been on anti-Parkinson's

medications levodopa/carbidopa tid. and Furosemide for the
treatment of hypertension. He also uses arthritis medications
Acetaminophen 650 mg q6h and vitamin B12 injections. Recently
he has been diagnosed for urinary incontinence. What is the
cause of urinary incontinence?
A) Levodopa/carbidopa
B) Furosemide
C) Acetaminophen
D) Vitamin B12 injection
Ans: A

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TC page 879 6th ed. Drugs that may cause or aggravate urinary
retention should be avoided in urinary incontinence.

Psychiatric and Neurological Drugs Mock Test

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Psychiatric and Neurological Drugs Mock Test

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PharmacyPREP.

Psychiatric and Neurological Drugs

1) PK is a 80 year-old woman with osteoporosis, osteoarthritis,

2) When assessing response of antidepressants, which of the

Tips Inc Copyright 2000-2012 Prevent Piracy & Report Piracy 1

3) Which of the following SSRIs side effects require dose

Side effects that require dosage reduction, treatment or

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3) SD is a 59 year old retired person. Frequently visit to his

4) SDs doctor considering to prescribe medication for insomnia.

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5) MJ is a 41 years old a chronic alcoholic male, no known

6) KD is a 65 yr female patient of osteoarthritis on

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8) If IBs doctor considering to prescribe diclofenax gel (Voltaren

9) A patient has been taking an opioid analgesic for the past

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FG is a 65-year-old war veteran with a 40-year history of

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10) Which agent is least likely to cause extra pyramidal side

Risperidone is the agent least likely to cause extrapyramidal

11) Which agent is most likely to cause QT prolongation side

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Tips: Ziprasidone is contraindicated in QT prolongation.

12) Which agent cause highest weight gain side effects?

13) MP was recently diagnosed with schizophrenia and was just

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14) What receptor likely has the largest impact on risk of

15) Which agent must be taken with meals?

16) What is not monitored for risperidone?

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17) After starting antipsychotics therapy. When symptoms of

20) The doctor prescribes a combination treatment of SSRI +

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21) A 30 yo maniac patient on lithium 600 mg q8h admitted to

22) A 25 year old student is taking paroxetine daily for the

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23) A patient with neuropathic pain was prescribed

24) A 10 years child with ADHD. His doctor diagnosed his

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25) What is monitored in 10-year-old using methylphenidate,

26)The child mother is concerned about addiction of ADHD

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28)Which of the following DOES NOT have any value in the

29) A parent of ADHD child call your pharmacy to ask her

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30) Which of the following is indicator or fraudulent

31) If pharmacist suspect prescription forged?

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32) Pharmacist suspect forged prescription. Patient is agitated

33) MK is 32 year women has been customer at your pharmacy

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35) A physician prescribed alprazolam 0.5 mg SL 3 tab. Repeat 5

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a) If the sumatriptan does not relieve the headache within four

37) A 30-year-old patient, is currently on antidepressant

38) MD is a 40-year-old woman who has recently been

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39) JK is 53-year-old lady came to the pharmacy with a

40) JKs doctor call pharmacy to change prescription to

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43) Venlafaxine was omitted for 10 days for a 78 year old

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