Pharmacology Midterm Exam with Answers (51 Solved Questions)

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Question 1Which drug below has an interaction with cigarette smoking and should be adjustedbased on patient’s tobacco use/non-use?ResponseFeedback:“Clozapine blood levels are significantly lowered by cigarettesmoking and by other hepatic enzyme-inducers.”Question 2Which of the following medications is best to AVOID in maintenance treatment of bipolardisorder and why?ResponseFeedback:“As noted previously, antidepressants may contribute to anincrease in mood episode frequency.”Question 3Glia cells play a supportive role in the neuron. A few of the functions of the glial cellsinclude providing nutrition, maintaining homeostasis, stabilizing synapses, andmyelinating axons. The glial cells are categorized as microglia or macroglia. Of themacroglia cells, which one plays a role in myelinating axons, which may contribute tomood disorders if altered?Question 4Which of the following are NOT primary target(s) symptom for antipsychotic agents inschizophrenia?i.Depression, anxiety, demoralization, suicidality, excitability, and agitationii.Delusions, hallucinations, disorganized thoughtsiii.Affective flattening, alogia, avolition, anhedonia, social withdrawaliv.Attention, memory, and executive functionsResponseFeedback:“For schizophrenia, the primary target symptoms for antipsychoticagents fall into three categories: psychotic symptoms (e.g.,hallucinations, delusions, disorganization); agitation (e.g., distractibility,affective lability, tension, increased motor activity); and negativesymptoms (e.g. apathy, diminished affect, social withdrawal, poverty ofspeech.” AND “Although cognitive deficits are an important contributorto disability in schizophrenia, cognitive deficits usually are notconsidered a target for antipsychotic agents because they are not veryresponsible to current agents.”Question 5A 32-year-old males calls you complaining of decreased libido since starting Paroxetine20 mg 2 weeks ago. He reported stopping the medication 1 day ago and is nowexperiencing extreme irritability and nervousness. He wishes to stop this medication dueto side effects. What do you recommend?ResponseFeedback:under selective serotonin re-uptake inhibitors discontinuation syndromesubtitle: “The risk of such adverse events occurring seems to be

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inversely related to the half-life of the SSRI, with fluoxetine reported ashaving a significantly lower risk than paroxetine in two studies. Formore severe discontinuation-related adverse events, re-institution ofthe SSRI and slow taper may be necessary to alleviate thesesymptoms.”Question 6With second-generation antipsychotics, what is the main side effect that requiresfrequent monitoring?ResponseFeedback:table 7-6 & page 80, table 7-7; Page 78: “However, attention over thepast decade has focused on effect of second-generationantipsychotics on glucose metabolism and lipids and associatedmetabolic syndrome.”Question 7A 23-year-old female was just diagnosed with major depressive disorder and is beingstarted on escitalopram 10 mg daily. The patient should be counseled about which BlackBox warning?ResponseFeedback:“In 2004, the FDA asked manufacturers of almost all the newantidepressant drugs to include in their labeling a warning statementthat recommends close observation of adult and pediatric patientstreated with these drugs for worsening depression or the emergence ofsuicidality."Question 8Which anticonvulsant below induces its own metabolism over time?Question 9In order for the NMDA receptor to fully open and allow an influx of calcium, bothglutamate and glycine must bind to cause a depolarization of the cell that will ultimatelydisplace which ion? Is the NMDA receptor an ionotropic or metabotropic receptor?Question 10Which of the following medications are known as selective serotonin re-uptake inhibitors(SSRIs)?i.Nortriptylineii.Citalopramiii.Duloxetineiv.Fluoxetinev.VenlafaxineQuestion 11Which disease state of a non-adherent patient is at greater risk for substance use,

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violence, and victimization as well as worse overall quality of life?ResponseFeedback:“Moreover, non-adherent patients with schizophrenia are at greaterrisk for substance use, violence, and victimization as well as worseoverall quality of life.”Question 12An 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, heartfailure, and depression. Of the following medications, which one is likely contributing tothese side effects?ResponseFeedback:Only TCA is listed with most anticholinergic effects; Page 39 for TCAside effect profile: “dry mouth, blurred vision, constipation, urinaryhesitancy, tachycardia, memory difficulties, and ejaculatorydifficulties”Question 13Choose the appropriate statement regarding lamotrigine dosing.ResponseFeedback:Carbamazepine induced metabolism of lamotrigine – increase dose oflamotrigine; Valproate may inhibit clearance of lamotrigine, so dosereduction of lamotrigine is neededQuestion 14Of the following medications used in the treatment of social anxiety disorder, which onewould you AVOID in a patient who has uncontrolled hypertension?ResponseFeedback:Phenelzine reported to have hypertensive reactions as alimitation/primary side effectQuestion 15What is the therapeutic plasma level of carbamazepine?Question 16Which of the following statements below is NOT considered an appropriate treatmentstrategy for treatment-resistant depression?ResponseFeedback:“Combination of an SSRI OR an SNRI with a norepinephrine-dopaminere-uptake inhibitor (bupropion) or a serotonin-norepinephrineantagonist (mirtazapine or mianserin) is a commonly usedcombination”Question 17Choose the correct statement(s) regarding lithium levels. SELECT ALL THAT APPLY.

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