NURS 6630 Week 6 FINAL EXAM

LATEST 2022 RETAKE WINTER

QTR

Course NURS-6630N,Approaches to
Treatment.2022 Winter Qtr
QUIZ 1
What is the strongest established risk factor for bipolar disorder? Family History

Selected answer: “The strongest established risk factor for BPD is a family history of BPD.”

 QUIZ 2
Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)?

i. Nortriptyline
ii. Citalopram
iii. Duloxetine
iv. Fluoxetine
v. Venlafaxine

 QUIZ 3
Which disease state of a non-adherent patient is at greater risk for substance use, violence, and
victimization as well as worse overall quality of life? Schizophrenia

Selected “Moreover, non-adherent patients with schizophrenia are at greater risk for substance
answer: use, violence, and victimization as well as worse overall quality of life.”

 QUIZ 4
Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a
new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant
would you recommend as first-line? Atomoxetine
 Selected (Options C & D are both TCA antidepressants and, based on the patient’s age and
answer: comorbid conditions, a TCA would likely result in more side effects, such as increased fall
risk due to potential for orthostatic hypotension and anticholinergic-related side effects.
In addition, patient has a history for cardiac abnormalities due to A. fib diagnosis - TCAs
result in electrocardiographic changes in susceptible individuals, therefore, would likely
avoid. Choice B is used more for ADHD purposes than as an antidepressant)
Page numbers used: Page 39 for TCA side-effect profile

 QUIZ 5
Which of the following is an appropriate strategy for managing treatment-resistant depression?

Use both SSRI and SNRI

 QUIZ 6
Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and
why?

Selected “As noted previously, antidepressants may contribute to an increase in mood

answer: episode frequency.”

 QUIZ 7
With second-generation antipsychotics, what is the main side effect that requires frequent monitoring?

Selected table 7-6 & page 80, table 7-7; Page 78: “However, attention over the past decade has
answer: focused on effect of second-generation antipsychotics on glucose metabolism and lipids
and associated metabolic syndrome.”

 QUIZ 8
Which amino acid is involved in the synthesis of both norepinephrine and dopamine?

 QUIZ 9
An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and
constipation. He has a past medical history significant for hypertension, heart failure, and depression. Of
the following medications, which one is likely contributing to these side effects?

Selected Only TCA is listed with most anticholinergic effects; Page 39 for TCA side effect profile:
answer: “dry mouth, blurred vision, constipation, urinary hesitancy, tachycardia, memory
difficulties, and ejaculatory difficulties”

 QUIZ 10
Which medication has been studied and recommended in patients with a social anxiety disorder who also
suffer from an alcohol use disorder?
 Selected “Suggested that treatment with the SSRI paroxetine decreased the anxiety and may
answer: have reduced the alcohol use as well”

 QUIZ 11
M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is needed. Which of the
following would be a first-line treatment option for M. B.?

I. Duloxetine
II. Quetiapine
III. Diazepam
IV. Escitalopram

Selected “As is true for panic and the other anxiety disorders, the SSRIs and SNRIS are generally
answer: considered first-line agents for the treatment of GAD because of their favorable side
effect profile….”

 QUIZ 12
The serotonin system is involved in many processes in psychiatry, including, most prominently, mood,
sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized?

Selected answer: under serotonin subheading and figure 1-18 on page 16:
Locus Coeruleus: Norepinephrine
Nucleus basalis: cholinergic neurons
Substantia Nigra: dopamine Ventral
Tegmental area: dopamine

 QUIZ 13
Which of the following symptoms is NOT part of the diagnostic features for bipolar disorder?

Selected “Psychosis is not represented in the diagnostic features for BPD.”

answer: - “Psychosis typically resolves along with the mood symptoms, though diagnostic
criteria acknowledge that psychotic symptoms may linger beyond the end of the
episode.”

 QUIZ 14
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?

Selected under selective serotonin re-uptake inhibitors discontinuation syndrome subtitle: “The
answer: 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.”

 QUIZ 15
 It is appropriate to start lamotrigine in combination with another atypical antipsychotic in treatment of
an acute manic episode in bipolar disorder.

Selected answer: “Lamotrigine has also been extensively studied in bipolar depression as well….”

 QUIZ 16
Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar disorder?

. Depakote
i. Lamotrigine
ii. Topiramate
iii. Carbamazepine
iv. Gabapentin

Selected All the others listed except for lamotrigine are not used in treatment of bipolar
answer: disorder.

 QUIZ 17
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?

Selected “In 2004, the FDA asked manufacturers of almost all the new antidepressant drugs to
answer: 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."

 QUIZ 18
Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotonin-
norepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder?

Selected “Because the SSRI/SNRIs have the potential to cause initial restlessness, insomnia, and
answer: increased anxiety, and because the patients are commonly sensitive to somatic
sensations, the starting doses should be low, typically half (or less) of the usual starting
dose….”

 QUIZ 19
Which of the following statements below is NOT considered an appropriate treatment strategy for
treatment-resistant depression?

Selected “Combination of an SSRI OR an SNRI with a norepinephrine-dopamine re-uptake

answer: inhibitor (bupropion) or a serotonin-norepinephrine antagonist (mirtazapine or
mianserin) is a commonly used combination”

 QUIZ 20
Which atypical antipsychotic(s) require a meal for better absorption?

. Quetiapine
 i. Ziprasidone
ii. Asenapine
iii. Olanzapine
iv. Lurasidone

Selected - Ziprasidone – best with a fatty meal

answer: - Lurasidone – best with a meal of at least 350 calories (no effect of fat
composition)

 QUIZ 21
Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY.

Selected under pharmacokinetics and pharmacodynamics subtitle

answer: - “NSAIDs or other COX-2 inhibitors may decrease renal blood flow and thereby
increase lithium levels by up to 25%.”
- “Therefore, thiazide diuretics, which act distally, will tend to increase lithium levels by
up to 50% while those that act more proximally generally have less of an effect on
lithium levels.”

 QUIZ 22
Which of the following are NOT primary target(s) symptom for antipsychotic agents in schizophrenia?

. Depression, anxiety, demoralization, suicidality, excitability, and agitation

i. Delusions, hallucinations, disorganized thoughts
ii. Affective flattening, alogia, avolition, anhedonia, social withdrawal
iii. Attention, memory, and executive functions

Selected “For schizophrenia, the primary target symptoms for antipsychotic agents fall into three
answer: 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.”

 QUIZ 23
Of the following antipsychotic medications listed below, which one has a Black Box Warning for seizure,
agranulocytosis, and seizures?

Selected answer: Box 7-5 * indicated clozapine-specific black box warnings

 QUIZ 24
Which neurotransmitter is considered the major inhibitory neurotransmitter?

 QUIZ 25
A 27-year-old female presents to your emergency room today with a rash that started about 1 week ago
and has now spread to her whole body. She has a past medical history significant for type 2 diabetes,
 hypertension, and bipolar disorder. The patient reports, “The only thing that is different is that I’ve been
on this new medication for my bipolar for a few weeks.” Of the following medications, which one is likely
to be causing this severe rash?

 QUIZ 26
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?

 QUIZ 27
Which of the following medications used for treatment of bipolar disorder may increase stroke risk
among older patients, particularly those with dementia?

Selected “Notably, pharmacovigilance studies suggest that atypical antipsychotics may increase
answer: stroke risk among older patients, particularly those with dementia, so use of SGA
requires more caution in this group.”

 QUIZ 28
Which of the following receptors below would likely result in extra-pyramidal symptoms, tardive
dyskinesia, and hyperprolactinemia?

Selected first generation antipsychotics all share the common property of D2 blockade, which
answer: can produce EPS, TD, and hyperprolactinemia

 QUIZ 29
Which anticonvulsant below induces its own metabolism over time?

 QUIZ 30
K. B. is a 28-year-old male who was started on Venlafaxine 75 mg about 2 weeks ago and is now calling
you asking how long it should take for this medication to begin to work. He is concerned his girlfriend will
leave him if he doesn’t get better quickly. What is the appropriate amount of time to allot to see a
therapeutic response?

Selected “It has been consistently observed and reported that remission of depression often
answer: requires 4 weeks of treatment or more;” Page 33: “Use of antidepressant for at least 6–
12 weeks to determine whether it is helping or not”

 QUIZ 31
Selection of an antipsychotic agent is usually guided by the side-effect profile and by available
formulations.
 Selected Which drug below has an interaction with cigarette smoking and should be adjusted
answer: based on patient’s tobacco use/non-use?

 QUIZ 32
K. B. never felt relief from his depressive symptoms, even after appropriate time and dose titration of
Venlafaxine. He was switched to Bupropion 150 mg about 2 months ago and is following up with you
today. He reported feeling “great” and that his relationship with his girlfriend is “better than ever now.”
Because he is feeling so well at this time, he is wondering when he can stop taking Bupropion. How long
must the patient be symptom-free before he may begin a trial to taper off the antidepressant therapy?

Selected “Therefore, in treatment-responders, most experts favor a continuation of

answer: antidepressant therapy for a minimum of 6 months following the achievement of
remission.”

 QUIZ 33
Close-ended QUIZs will help identify when patients are taking medications incorrectly.

 QUIZ 34
K. T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about 4 weeks ago.
She was prescribed Clonazepam 2 mg at bedtime but was referred to you to determine chronic treatment.
K. T. states the new medication has been helping a lot but worries about all the side effects that come with
it. She wants to discontinue the medication. What is the appropriate next step to help K. T.?

Selected “The regular use of benzodiazepines for more than 2 to 3 weeks may be associated with
answer: physiological dependence and the potential for significant withdrawal symptoms with
discontinuation. Discontinuation of benzodiazepines is best done with a gradual taper to
minimize withdrawal symptoms.”
- Answer choice A: Honor the patient’s request of discontinuing the medication.
- Answer Choice C: An abrupt stop of a benzodiazepine will likely send the patient into
having withdrawal symptoms.
- Answer D: Patient will likely experience withdrawal symptoms due to how often the
patient uses it OR patient will experience withdrawal symptoms after missing one dose,
thus the therapy wouldn’t have changed at all from how she has been taking it.

 QUIZ 35
Which answer choice includes all the components of patient-focused interventions to enhance adherence?

. Education
I. Motivation
II. Skills
III. Logistics

 QUIZ 36
Of the following medications, which ones are considered first-line in treatment of an acute manic episode
of bipolar disorder (assuming monotherapy)?

. Lithium
 I. Fluoxetine
II. Aripiprazole
III. Risperidone
IV. Ziprasidone
V. Venlafaxine
VI. Quetiapine
VII. Valproate
V

 QUIZ 37
Which drug below has an interaction with cigarette smoking and should be adjusted based on patient’s
tobacco use/non-use?

Selected “Clozapine blood levels are significantly lowered by cigarette smoking and by other
answer: hepatic enzyme-inducers.”

 QUIZ 38
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?

 QUIZ 39
When initiating lithium, how long should you wait before checking a lithium level? What is the
therapeutic goal level of lithium?

 QUIZ 40
Choose the appropriate pair regarding acetylcholine receptors.

Selected “There are two classes of ACh receptors: muscarinic and nicotinic. While muscarinic
answer: receptors are G-protein-coupled, nicotinic receptors are ion channels, which allows for
rapid influx of NA+ and Ca2+ into the post-synaptic neuron.”

 QUIZ 41
Patient is a 59-year-old male with a past medical history significant for bipolar disorder I, hypertension,
and COPD. He calls your clinic today complaining of extreme fatigue and a new tremor in his hand. He
reports starting lithium 600 mg at bedtime about 5 days ago and thinks that may be the cause. What is the
appropriate next step for this patient?

Selected “Other bothersome adverse effects” Patient is likely experiencing lithium toxicity and
answer: labs should be verified first before continuing with other treatments for the tremor.

 QUIZ 42
Choose the appropriate statement regarding lamotrigine dosing.
 Selected Carbamazepine induced metabolism of lamotrigine – increase dose of lamotrigine;
answer: Valproate may inhibit clearance of lamotrigine, so dose reduction of lamotrigine is
needed

 QUIZ 43
Choose the correct option regarding the major classes of GABA receptors and the ions involved in
inhibition of the neurotransmitter pathway

Selected “GABAB receptors, akin to the metabotropic glutamate receptors, are G-protein-coupled
answer: receptors rather than ion channels. Activation of GABAB causes downstream changes in
potassium (K+) and Ca+2 channels, largely via G-protein-mediated inhiation of cAMP.”

 QUIZ 44
A 25-year-old female comes into your clinic today informing you she is ready to have a baby and wishes to
discontinue her birth control at this time. After reviewing her chart, you notice she has a history of bipolar
disorder and was previously prescribed valproic acid by another doctor. What is your concern with this
medication in this specific patient?

Selected answer: “Valproic acid may produce teratogenic effects.”

 QUIZ 45
How do you manage a patient who develops neuroleptic malignant syndrome while on an atypical
antipsychotic?

 QUIZ 46
The following patient case is considered an example of treatment-resistant depression.

B. B. is a 26-year old-female at your clinic today with the diagnosis, “treatment-resistant depression.” She
is currently on Bupropion 300 mg daily and has been at this dose for 6 weeks with no alleviation in
depressive symptoms.

She has trialed the following medications in the past with treatment duration listed:

- Paroxetine 40 mg daily for 4 weeks

- Citalopram 20 mg daily for 2 weeks

Selected “At least one trial with an antidepressant with established efficacy in MDD (with
answer: sufficient duration and doses) is considered to be adequate antidepressant treatment.”

 QUIZ 47
What is the therapeutic plasma level of carbamazepine?

 QUIZ 48
 Of the following medications used in the treatment of social anxiety disorder, which one would you
AVOID in a patient who has uncontrolled hypertension?

Selected Phenelzine reported to have hypertensive reactions as a limitation/primary side

answer: effect

 QUIZ 49
M. M. is 27-year-old female student pharmacist who presents to the ER after experiencing extreme
lightheadedness during her fourth-year seminar presentation. Her vitals are as follows: BP (107/65) and
HR of 45. What medication below is likely the cause of these symptoms?

Selected “The use of beta-blockers may be associated with orthostatic hypotension,

answer: lightheadedness, bradycardia, and nausea.”

 QUIZ 50
Which drug below differs from other atypical antipsychotics in causing persistent hyperprolactinemia?

Selected “Risperidone differs from other second-generation antipsychotics in causing

answer: persistent hyperprolactinemia.”

 QUIZ 51
When completing this exam, did you comply with Walden University’s Code of Conduct including the
expectations for academic integrity?
My answers to some of the QUIZs – Some Right some wrong

What is the strongest established risk factor for bipolar disorder?

Female > Male

A.
Family history of bipolar disorder
B.
Male > female
C.

D. Being diagnosed with Major Depressive Disorder

Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)?

i. Nortriptyline
ii. Citalopram
iii. Duloxetine
iv. Fluoxetine
v. Venlafaxine
i, iii, and v only
A.
B. iii and v only
i only
C.
D. ii and iv only
E. i, ii, iii, iv, and v
Which disease state of a non-adherent patient is at greater risk for substance use, violence, and victimization
as well as worse overall quality of life?

a. Parkinson’s Disease
b. Multiple Sclerosis
c. Schizophrenia
d. Major depressive disorder

Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new
diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you
recommend as first-line?

A. Fluoxetine
 B. Atomoxetine
C. Nortriptyline
D. Imipramine

With second-generation antipsychotics, what is the main side effect that requires frequent monitoring?

A. Metabolic Syndrome
B. Extra-pyramidal symptoms
C. Parkinsonism
D. Dystonia

Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and why?

Valproate, because it is only used in the treatment of acute manic episodes.

A.
Lithium, because it is only used in the treatment of acute manic episodes.
B.
Venlafaxine, because it can possibly increase frequency of mood episodes.
C.
Lamotrigine, because it is only used in initial treatment of bipolar depression, but not maintenance.
D.

Which of the following is an appropriate strategy for managing treatment-resistant depression?

A. Switch from one SSRI to another SSRI

B. Switch from one SSRI to a SNRI
C. Combine two antidepressants with different mechanisms of action
D. Augment with lithium
Any of the above would be an appropriate strategy
E.

Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a new
diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant would you
recommend as first-line?

A. Fluoxetine
 B. Atomoxetine
C. Nortriptyline
D. Imipramine

Which amino acid is involved in the synthesis of both norepinephrine and dopamine?

a. Tyrosine
Glutamic acid
b.
c. Tryptophan
d. Phenylalanine

An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and constipation.
He has a past medical history significant for hypertension, heart failure, and depression. Of the following
medications, which one is likely contributing to these side effects?

A. Escitalopram
B. Duloxetine
C. Bupropion
D. Nortriptylin

Which medication has been studied and recommended in patients with a social anxiety disorder who also
suffer from an alcohol use disorder?

A. Citalopram
B. Paroxetine
C. Sertraline
D. Sertraline

The serotonin system is involved in many processes in psychiatry, including, most prominently, mood, sleep,
and psychosis. Of the following neurons listed, from where is serotonin synthesized?
 a. Locus Coeruleus
b. Raphe Nuclei
c. Nucleus Basalis
d. Substantia Nigra
e. Ventral Tegmental Area

Which antiepileptic drugs should we avoid in pregnant women in the treatment of bipolar disorder?

i. Depakote
ii. Lamotrigine
iii. Topiramate
iv. Carbamazepine
v. Gabapentin
i and ii
A.
B. ii and iv
C. i and iv
D. iii and v

Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotonin-
norepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder?
Symptom remission is expected within 1 week.
A.
B. Symptoms may worsen initially with SSRI treatment.
C. They are considered second-line therapy.
D. Start at the usual starting dose that is consistent with depression treatment.

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?

Myocarditis
A.
Sexual dysfunction
B.
Decreased seizure threshold
C.

D. Suicidal thinking and behavior

Which of the following statements below is NOT considered an appropriate treatment strategy for treatment-
resistant depression?

Sertraline + Bupropion
A.
Fluoxetine + Venlafaxine
B.
Desvenlafaxine + Bupropion
C.
D. Fluoxetine + Mirtazapine

Which statement is TRUE regarding the use of selective serotonin reuptake inhibitors (SSRI)/serotonin-
norepinephrine reuptake inhibitors (SNRI) in patients with Generalized Anxiety Disorder?
Symptom remission is expected within 1 week.
A.
B. Symptoms may worsen initially with SSRI treatment.
C. They are considered second-line therapy.
D. Start at the usual starting dose that is consistent with depression treatment.

Which atypical antipsychotic(s) require a meal for better absorption?

i. Quetiapine
ii. Ziprasidone
iii. Asenapine
iv. Olanzapine
v. Lurasidone
I and V
A.
B. II and V
C. III and V
V only
D.

Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY.

Ibuprofen – decrease lithium levels

A.
Hydrochlorothiazide – decrease lithium levels
B.
Naproxen – increase lithium levels
C.

D. Chlorthalidone – increase lithium levels

Of the following antipsychotic medications listed below, which one has a Black Box Warning for seizure,
agranulocytosis, and seizures?

Quetiapine
A.
Clozapine
B.
Olanzapine
C.
Lurasidone
D.

Which neurotransmitter is considered the major inhibitory neurotransmitter?

Glutamate
a.
Glycine
b.
GABA
c.

d. Acetylcholine

A 27-year-old female presents to your emergency room today with a rash that started about 1 week ago and
has now spread to her whole body. She has a past medical history significant for type 2 diabetes,
hypertension, and bipolar disorder. The patient reports, “The only thing that is different is that I’ve been on
this new medication for my bipolar for a few weeks.” Of the following medications, which one is likely to be
causing this severe rash?

A. Ziprasidone
B. Quetiapine
C. Risperidone
D. Lamotrigine

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?
 a. Astrocytes
b. Oligodendrocytes
c. Schwann cells
d. Ependymal cells
Which of the following medications used for treatment of bipolar disorder may increase stroke risk among
older patients, particularly those with dementia?

Carbamazepine
A.
Lithium
B.
Bupropion
C.

D. Olanzapine

K. B. is a 28-year-old male who was started on Venlafaxine 75 mg about 2 weeks ago and is now calling you
asking how long it should take for this medication to begin to work. He is concerned his girlfriend will leave
him if he doesn’t get better quickly. What is the appropriate amount of time to allot to see a therapeutic
response?

A. 2–4 weeks
B. 4–12 weeks
C. ≥ 6 months
D. ≤ 1 week

Selection of an antipsychotic agent is usually guided by the side-effect profile and by available formulations.

A. True
B. False
K. B. never felt relief from his depressive symptoms, even after appropriate time and dose titration of
Venlafaxine. He was switched to Bupropion 150 mg about 2 months ago and is following up with you today.
He reported feeling “great” and that his relationship with his girlfriend is “better than ever now.” Because he
is feeling so well at this time, he is wondering when he can stop taking Bupropion. How long must the patient
be symptom-free before he may begin a trial to taper off the antidepressant therapy?

A. ≥ 12 months
B. 3 months
C. ≥ 6 months
 4–12 weeks
D.
Close-ended QUIZs will help identify when patients are taking medications incorrectly.

True
a.

b. False

K. T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about 4 weeks ago. She
was prescribed Clonazepam 2 mg at bedtime but was referred to you to determine chronic treatment. K. T.
states the new medication has been helping a lot but worries about all the side effects that come with it. She
wants to discontinue the medication. What is the appropriate next step to help K. T.?

A. Inform her that the therapy is working and there is no need to discontinue.
Begin a slow taper of clonazepam and talk about alternative medications to help with her new
diagnosis.
B.

C. Discontinue clonazepam at this visit and begin Escitalopram 5 mg daily.

D. Change her scheduled dosing to as needed to help with anxiety symptoms.

Which answer choice includes all the components of patient-focused interventions to enhance adherence?

I. Education
II. Motivation
III. Skills
IV. Logistics
I, II, and III only
a.
I, II, III, and IV
b.
II and III only
c.
I and IV only
d.
When ini tiating lithium, how long should you wait before checking a lithium level? What is the therapeutic
goal level of lithium?

5 days; 0.6 to 0.8 mEq/L

A.
4–6 weeks; 0.6 to 0.8 mEq/L
B.
3 days; 0.8 – 1.2 mEq/L
C.

D. No need to check until patient experiences symptoms of lithium toxicity

Which of the following receptors below would likely result in extra-pyramidal symptoms, tardive dyskinesia,
and hyperprolactinemia?

A. 5-HT2 agonism
B. D2 agonism
C. D2 antagonism
D. 5-HT2 antagonism

Hello, I have identified the correct answers in bold. Kindly look at them, I hope they will be
of help to you

Explanation:
Which of the following is an appropriate strategy for managing treatment-resistant
depression?
A. Switch from one SSRI to another SSRI
B. Switch from one SSRI to a SNRI
C. Combine two antidepressants with different mechanisms of action
D. Augment with lithium
E. Any of the above would be an appropriate strategy

Which of the following medications is best to AVOID in maintenance treatment of bipolar

disorder and why?
A.Valproate, because it is only used in the treatment of acute manic episodes.
B.Lithium, because it is only used in the treatment of acute manic episodes.
C.Venlafaxine, because it can possibly increase frequency of mood episodes.
D.Lamotrigine, because it is only used in initial treatment of bipolar depression, but not
maintenance.

With second-generation antipsychotics, what is the main side effect that requires frequent
monitoring?
A.Metabolic Syndrome
B.Extra-pyramidal symptoms
C.Parkinsonism
D.Dystonia

Which amino acid is involved in the synthesis of both norepinephrine and dopamine?
a.Tyrosine
b.Glutamic acid
c.Tryptophan
d.Phenylalanine
Which drug below differs from other atypical antipsychotics in causing persistent
hyperprolactinemia?
A.Clozapine
B.Risperidone
C.Aripiprazole
D.Olanzapine

M. M. is a 27-year-old female student pharmacist who presents to the ER after experiencing

extreme lightheadedness during her fourth-year seminar presentation. Her vitals are as
follows: BP (107/65) and HR of 45. What medication below is likely the cause of these
symptoms?
A. Tranylcypromine
B.Clonazepam
C.Propranolol
D.Fluoxetine

Of the following medications used in the treatment of social anxiety disorder, which one
would you AVOID in a patient who has uncontrolled hypertension?
A.Citalopram
B.Lorazepam
C.Phenelzine
D.Atenolol

What is the therapeutic plasma level of carbamazepine?

A.4 to 12 µg/mL
B.4 to 12 mg/mL
C.0.8-1.2 mEq/mL
D.0.6 to 0.8 mEq/L

The following patient case is considered an example of treatment-resistant depression.

B. B. is a 26-year old-female at your clinic today with the diagnosis, "treatment-resistant
depression." She is currently on Bupropion 300 mg daily and has been at this dose for 6
weeks with no alleviation in depressive symptoms.
She has trialed the following medications in the past with treatment duration listed:
- Paroxetine 40 mg daily for 4 weeks
- Citalopram 20 mg daily for 2 weeks
A. True
B. False

How do you manage a patient who develops neuroleptic malignant syndrome while on an
atypical antipsychotic?
A. Stop offending agent
B. Initiate Dantrolene
C. Both A & B
D. None of the above
A 25-year-old female comes into your clinic today informing you she is ready to have a baby
and wishes to discontinue her birth control at this time. After reviewing her chart, you notice
she has a history of bipolar disorder and was previously prescribed valproic acid by another
doctor. What is your concern with this medication in this specific patient?
A. The drug causes weight gain, therefore, I would likely not want patient on it for her
disease state.
B. This drug is safe to use by this patient.
C. This drug is used more for seizures than bipolar disorder, therefore, I would want
to look at other options first.
D. This drug is a teratogen, therefore, I would need to counsel on avoidance of this
medication while trying for a baby, and to follow-up with the doctor who prescribed it.

Choose the correct option regarding the major classes of GABA receptors and the ions
involved in inhibition of the neurotransmitter pathway
a. GABAA - ionotropic - calcium and potassium
b. GABAB - ionotropic - chloride
c. GABAB - metabotropic - Calcium and potassium
d. GABAA - metabotropic - chloride

Choose the appropriate statement regarding lamotrigine dosing.

A.If adding carbamazepine decrease lamotrigine dose
B. If adding valproic acid decrease lamotrigine dose
C. If adding carbamazepine no dose change is needed
D. If adding valproic acid no dose change is neeed

Patient is a 59-year-old male with a past medical history significant for bipolar disorder I,
hypertension, and COPD. He calls your clinic today complaining of extreme fatigue and a
new tremor in his hand. He reports starting lithium 600 mg at bedtime about 5 days ago and
thinks that may be the cause. What is the appropriate next step for this patient?
A. Start propranolol for the tremor.
B. Tell patient to cut dose in half to stop the tremor.
C. Verify labs to determine appropriate lithium level.
D. Tell patient to discontinue the medication all together due to lithium toxicity.

Choose the appropriate pair regarding acetylcholine receptors.

a.Nicotinic - ion; muscarinic - ion
b.Nicotinic - G-protein; muscarinic - ion
c.Nicotinic - G-protein; muscarinic - G-protein
d.Nicotinic - ion; muscarinic - G-protein
e.None of the above is correct

When initiating lithium, how long should you wait before checking a lithium level? What is
the therapeutic goal level of lithium?
A.5 days; 0.6 to 0.8 mEq/L
B.4-6 weeks; 0.6 to 0.8 mEq/L
C.3 days; 0.8 - 1.2 mEq/L
D.No need to check until patient experiences symptoms of lithiu

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?
a.Sodium - ionotropic
b.Sodium - metabotropic
c.Magnesium - metabotropic
d.Magnesium - ionotropic

Which drug below has an interaction with cigarette smoking and should be adjusted based
on patient's tobacco use/non-use?
A.Risperidone
B.Haloperidol
C.Aripiprazole
D.Clozapine

Of the following medications, which ones are considered first-line in treatment of an acute
manic episode of bipolar disorder (assuming monotherapy)?

1. Lithium
2. Fluoxetine
3. Aripiprazole
4. Risperidone
5. Ziprasidone
6. Venlafaxine
7. Quetiapine
8. Valproate

A. I, III, and VIII only

B. I, III, IV, V, VII, and VIII only
C. I, III, and VI only
D.I only
E.All that are listed are appropriate in treating the acute episode.

Which answer choice includes all the components of patient-focused interventions to

enhance adherence?

1. Education
2. Motivation
3. Skills
4. Logistics

a.I, II, and III only

b.I, II, III, and IV
c.II and III only
d.I and IV only

K. T. is a 35-year-old woman who was diagnosed with Generalized Anxiety Disorder about
4 weeks ago. She was prescribed Clonazepam 2 mg at bedtime but was referred to you to
determine chronic treatment. K. T. states the new medication has been helping a lot but
worries about all the side effects that come with it. She wants to discontinue the medication.
What is the appropriate next step to help K. T.?
A. Inform her that the therapy is working and there is no need to discontinue.
B. Begin a slow taper of clonazepam and talk about alternative medications to help with her
new diagnosis.
C.Discontinue clonazepam at this visit and begin Escitalopram 5 mg daily.
D.Change her scheduled dosing to as needed to help with anxiety symptoms.

Close-ended QUIZs will help identify when patients are taking medications incorrectly.
a.True
b.False

K. B. never felt relief from his depressive symptoms, even after appropriate time and dose
titration of Venlafaxine. He was switched to Bupropion 150 mg about 2 months ago and is
following up with you today. He reported feeling "great" and that his relationship with his
girlfriend is "better than ever now." Because he is feeling so well at this time, he is
wondering when he can stop taking Bupropion. How long must the patient be symptom-free
before he may begin a trial to taper off the antidepressant therapy?
A.≥ 12 months
B.3 months
C.≥ 6 months
D.4-12 weeks

Selection of an antipsychotic agent is usually guided by the side-effect profile and by

available formulations.
A.True
B.False

Answer:1:-
Initiating lithium, how long should you wait before checking a lithium level? What is the
therapeutic goal level of lithium?
A).5 days; 0.6 to 0.8 mEq/L.

Answer:2:-
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.
a). Sodium - ionotropic
Answer:3:-
drug below has an interaction with cigarette smoking and should be adjusted based on
patient's tobacco use/non-use.
d). Clozapine.

Answer:4:-
ones are considered first-line in treatment of an acute manic episode of bipolar disorder
(assuming monotherapy.
B). I, III, IV, V, VII, and VIII only

Answer:5:-
choice includes all the components of patient-focused interventions to enhance adherence.
d). I and IV only

Answer:6:-
Discontinue the medication. What is the appropriate next step to help K. T.
B). Begin a slow taper of clonazepam and talk about alternative medications to help with her
new diagnosis.

Answer:7:-
Close-ended QUIZs will help identify when patients are taking medications incorrectly.
a.True.

Answer:8:-
How long must the patient be symptom-free before he may begin a trial to taper off the
antidepressant therapy:
A). ≥ 12 months

Answer:9:-
Selection of an antipsychotic agent is usually guided by the side-effect profile and by
available formulations.
A.)True