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

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1) 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

2. 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.

3. 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

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

a.Tyrosine

b.Glutamic acid

c.Tryptophan

d.Phenylalanine

5. Which drug below differs from other atypical antipsychotics in causing persistent hyperprolactinemia?

A.Clozapine

B.Risperidone

C.Aripiprazole

D.Olanzapine

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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.

12. 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

13. 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

14. 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.

15. 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