PSYCHOPHARMACOLOGY – PSYCHIATRY QUESTIONS AND ANSWERS

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Psychopharmacology – Psychiatry Questions and Answers

Psychopharmacology – Psychiatry Questions and Answers
Psychopharmacology – Psychiatry Questions and Answers
1. Tricyclic antidepressants are contraindicated in:
A. Glaucoma
B. Brain tumour
C. Bronchial asthma
D. Essential hypertension
 
2. Which of the antipsychotic drugs has a prolonged action?
A. Trifluperazine
B. Thioridazine
C. Penfluridol
 
D. Fluphenazine
3. The congenital anomaly produced by lithium therapy is:
A. Limb shortening
B. Anencephaly
C. Heart block
D. Renal agenesis
About 10 percent of newborns exposed in 1st tri­mester of pregnancy had major congenital malforma­tions. The most common is Epstein’s anomaly of the tricuspid valves. Lithium is not indicated in a lactating woman. Signs of is toxicity in infants include lethargy, cyanosis, abnormal reflexes, rarely hepatomegaly.
4. All the following are side-effects of Fluoxetine, except:
A. Weight gain
B. Sweating
C. Urinary retention
D. Diarrhea
 
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5. Akathisia is treated by all the following, except:
A. Trihexyphenidyl
B. Diazepam
C. Haloperidol
D. Promethazine
6. Prophylactic maintenance of serum level of lithium is:
A. 0.2-0.8 mEq/L
B. 0.7-1.2 mEq/L
C. 1.2-2.0 mEq/L
D. 2.0-2.5 mEq/L
7. The treatment of choice in depression with suicidal ten­dencies is:
A. Tricyclic antidepressants
B. MAO inhibitors
C. Fluoxetine
D. Electroconvulsive therapy
The first and most important indication for ECT is depression with suicidal tendencies.
8. The drug not used for prophylaxis of MDP is:
A. Carbamazepine
B. Sodium valproate
C. Chlorpromazine
D. Lithium
Antipsychotics are used as adjuvant in the treatment of mood disorders.
9. All the following are true about clozapine, except:
A. Used in schizophrenia
B. Precipitates seizures
C. Agranulocytosis
D. Extra pyramidal side-effects
The only FDA approved indication for clozapine is as a therapy for treatment resistant schizophrenia. Clozapine suppresses the abnormal movements of TD (Tardive dyskinesia) as does treatment with conventional antipsychotics.
Other indication: Clozapine may treat the movement disorder. Clozapine is more potent on Dl, D3, D4, and 5HT2 receptors in comparison to other typical antipsychotic which are more potent over D2 receptors. Animal models show that clozapine is more active over meso-limbic pathway than nigro- striatal pathway because of which we notice less EPS.
10. Which of the following is not an antidepressant?
A. Trazodone
B. Amitriptyline
C. Fluoxetine
D. Pimozide
11. Carbamazepine is used in all the following except:
A. Mania
B. Alcohol withdrawal
C. Schizophrenia
D. Trigeminal neuralgia
But recent data indicates that CB2 can be used in schizophrenia and Schizo-affective disorders. Other indications are:
Recurrent depressive disorder
Impulse control disorder v
PTSD (post-traumatic stress disorder)
Alcohol /benzodiazepine withdrawal
Severe blood dyscrasias occur in about 1 in 125,000 pts treated with Carbamazepine.
12. A patient of schizophrenia treated for 5 years, developed abnormal movement. The patient has:
A. Tardive dyskinesia
B. Muscular dystonia
C. Akathisia
D. Malignant neuroleptic syndrome
TD delayed effects of antipsychotic caused by dopamine receptor super sensitivity in basal ganglia. Serotonin – dopamine antagonists may be used in pts with TD.
13. The mechanism of action of Fluoxetine is:
A. Serotonin reuptake inhibitor
B. MAO-B inhibitor
C. Nor adrenaline reuptake inhibitor
D. Benzodiazepine antagonist Other SSRI are:
Fluvoxamine Sertraline
Paroxetine
Citalopram
Escitalopram
Serotonin norepinephrine reuptake
Inhibitors:
1. Venlafaxine
2. Sibutramine
Atypical antipsychotics: (serotonin dopamine antagonists)
Risperidone
Olanzapine
Quetiapin
Sertindole
Ziprasidone
Clozapine (dibenzodiazepine)
Central presynaptic 2 – adrenergic receptor antagonist – clonidine
Mirtazapine (tetracyclic antidepressant)
14. An irritable urge to move about with inner restlessness is called:
A. Akathisia
B. Akinesia
C. Hyperkinesia
D. Dyskinesia
15. The drug of choice for rapid cycle MDP is:
A. Lithium
B. Carbamazepine
C. Sodium Valproate
D. Haloperidol
16. A 35-year-old female on chlorpromazine for 10 years schizophrenia complains of hearing voices. The loud­ness of the voices of taking chlorpromazine but not stop completely. The best treatment is:
A. Clozapine
B. Haloperidol
C. Tianeptine
D. Sulpiride
Clozapine, the only FDA approved drug for treatment resistant schizophrenia.
17. Tianeptine is a:
A. Selective serotonin reuptake enhancer »
B. Selective serotonin reuptake inhibitor.
C. Selective norepinephrine reuptake inhibitor
D. Norepinephrine agonist
Tianeptine – Norepinephrine serotonin selective reuptake enhancers
Venlafaxine – Norepinephrine serotonin reuptake inhibitor
MAOI-Hydroxide – a. Phenelezine b. isocarboxazide Norhydroxide – a. tranylcypromine Reversible selective
MAOls
MAOI – B – Selegiline
MAOI – A – Moclobamide
Broforamine Irreversible selective MAOI: clorgyline
Sympathomimetic stimulants:
1. Dextroamphetamine
2. Methylphenidate
Mood Stabilizers:
1. Lithium
2. Carbamazepine
3. Sodium valproate
4. Topiramate
5. Lamotrigine
6. Clonazepam
18. A 50-year-old man has presented with pain in back, lack of interest in recreational activities, low mood, lethargy, decreased sleep, and appetite for 2 months. There is no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no family history of psychiatric illness. Routine investi­gations including hierogram, renal function tests, elec­trocardiogram, did not reveal any abnormality. This pa­tient should be treated with:
A. Haloperidol
B. Sertraline
C. Alprazolam
D. Olanzapine
(The only antidepressant in this group)
Clinical history suggests that the patient is depressed.
19. Carbamazepine was first used in:
A. Depression
B. MDP
C. Anxiety
D. All of the above
Carbamazepine is an antimonies and mood stabilizing agent. It is a tricyclic compound synthesized in 1953 by Schindler.
20. The treatment of choice for acute or abrupt onset de­pression includes:
A. Lithium
B. Tricyclic antidepressants
C. MAO inhibitors
D. Electroconvulsive therapy
21. In acute mania, the therapeutic serum level of lithium includes:
A. 0.2 – 0.5 mEg/L
B. 0.8-1.5 mEq/L
C. 1-2 mEq/L
D. 2-5 mEQ/L
22. Antipsychotic drug to be avoided especially in first tri­mester of pregnancy:
A. Chlorpromazine
B. Haloperidol
C. Carbamazepine
D. Lithium
i. Neurological – Tremor, muscle weakness, cogwheel rigidity, seizures, neurotoxicity.
ii. Renal – Polyuria, polydipsia, tubular changes nephrogenic diabetes insipid nephritic syndrome.
iii. CVS – Hypokalemia, T wave depression.
iv. Endocrine – Goiter, hypothyroidism, abnormal thyroid function, weight gain.
v. GIT – Nausea, vomiting, diarrhea, abdominal pain, metallic taste.
vi. Dermatological-Acne form eruptions, popular eruptions, exacerbation of psoriasis.
vii. During pregnancy of lactation-teratogenic, increased incidence of Ebstein’s anomaly also created in milk with 30 to 100 percent of maternal blood hi level. Cause toxicity in infant. Contraindications of lithium we are cardio renal, thyroid, neurological dys­function blood dyscrasias, during first traumata of pregnancy and lactation, concomitant administration of theorize diuretics, tetracycline, or anesthetics.
23. Lithium is used in psychiatry to treat:
A. Hysteria
B. Phobia
C. Mood disorders
D. Acute organic brain syndrome Indications of lithium in psychiatry:
Acute mania
Prophylaxis of bipolar mood disorders
Schizoaffective disorder
Impulsive aggression.
24. Clozapine is a:
A. Atypical antipsychotic
B. Anti-anxiety drug
C. Used in dementia
D. Also known as disulfiram
Other atypical antipsychotics – Risperidone, olanzapine, ziprasidone.
Also remember – Clozapine is the drug of choice in treatment-resistant schizophrenia.
25. Paroxetine is a:
A. Antipsychotic drug
B. Used in opiate poisoning
C. Tricyclic antidepressant
D. Selective serotonin reuptake inhibitor
Others SSRI’s
Paroxetine, fluvoxamine, fluoxetine, sertraline, citalopram
Also remember –
SSRI with longest half-life-fluoxetine
SSRI with shortest half-life-fluvoxamine
26. Imipramine is mainly used as a:
A. Sedative
B. Tranquilizer
C. Antidepressant
D. All of the above
Remember – imipramine is the first antidepressant to be introduced.
27. Nausea is a troublesome side effect of the following an­tidepressant:
A. Doxepine
B. Fluoxetine
C. Trazodone
D. Mianserin
Other side effects: Insomnia, akathisia, loss of appetite, sexual dysfunction.
28. Which antidepressant found to be associated with tar­dive dyskinesia and narcoleptic malignant syndrome?
A. Amoxapine
B. Trazodone
C. Fluoxetine
D. Amineptin
This is because of blockade of dopamine receptors in the striatum.
29. Blood levels of neuroleptics are useful to check the fol­lowing:
A. Toxicability
B. Therapeutic levels
C. Resistance
D. All of the above
Clozapine and haloperidol levels are important to monitor toxicities.
30. The drug of first choice in weight reduction programme is:
A. Amphetamine
B. Phenylethlamine
C. Fenfluramine
D. Diethyl propion
31. Therapeutic range of lithium is:
A. 0.5 to 1 mmol/1
B. 0.8 to 1.4 mmol/1
C. 1.4 to 2.5 mmol/1
D. 1.0-2.6 mmol/1
Remember toxicity – if level > 2.0 mEq/1
Life threatening intoxication – > 3.5 mEq/1
32. Akathisiais:
A. Neurotic disease
B. Seen in schizophrenia
C. Side effect of lithium
D. Side effect of antipsychotic drugs.
Akathisia manifests as motor restlessness. It is due to blockade of dopamine type-2 receptors in striatum.
33. Neuroleptic malignant syndrome is characterized:
A. Bradycardia
B. Labile hypertension
C. Hypotonia
D. Hypothermia
Feature of NMS – fever, elevated, EPS, catatonic symptoms, autonomic dysfunction
34. Akathisia is treated by:
A. Haloperidol
B. Fluoxetine
C. Propranolol
D. Lithium
Drug of choice – Propranolol. Benzodiazepines are useful.
35. Feature of akathisia is:
A. Cogwheel rigidity
B. Oculogyric crisis
C. Restlessness
D. Periodic movements
Motor restlessness is the key feature of akathesia Cogwheel rigidity occurs in parkinsonism Oculogyric crises is an acute dystonia Perioral movements could be rabbit syndrome or Tardier dyskinesia.
36. Malignant neuroleptic syndrome is treated by:
A. Dantrolene
B. Diazepam
C. Haloperidol
D. Chlorpromazine Bromocriptine can also be used.
37. Side effect of clozapine is:
A. Within one week – neutropenia
B. Dl- ve, D2 +ve
C. Agranulocytosis
D. Excitement
Clozapine must be stopped immediately.
38. The drug of choice for obsessive-compulsive disorder is:
A. Haloperidol
B. Clomipramine
C. Amitryptilline
D. Diazepam
Dose of Clomipramine – 75 to 300 mg 1 day.
39. Lithium is used in all except:
A. Endogenous depression
B. Recurrent attacks of mania
C. Schizoaffective psychosis
D. Paranoid psychosis
40. Side effect of chlorpromazine for which anti cholinergic is used:
A. Blurred vision
B. Oculogyric crises
C. Hypotension
D. Dry mouth
41. Newer nonsedative, nonhypnotic anxiolytic is:
A. Alprazolam
B. Buspirone
C. Lorazepam
D. Diazepam
Buspirone acts as a partial against at 5HTIA receptor. It doesn’t have anticonvulsant and muscle relaxant properties.
42. The drug of choice for panic disorders is:
A. Imipramine
B. Nitrazepam
C. Clonidine
D. Diazepam
Small doses of antidepressants are used (imipramine and fluoxetine).
136 Psychiatry Question Bank for PG Entrance Exams
43. In drug induced parkinsonism, benzhexol has got no role in:
A. Sialorrhea
B. Tremor
C. Akathisia
D. Rigidity
Akathisia is treated with P blockers and benzodiazepines (propranolol).
44. In fluoxetine and imipramine, the main difference is in: –
A. Less side effects
B. Onset of action
C. Effect of OCD
D. Duration of action
 
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45. Which of the following drug has the minimum extra py­ramidal side effect?
A. Clozapine
B. Metoclopramide
C. Reserpine
D. Trifluperazine
46. Which of the following drugs produce rapid induction of sleep with least influence of sleep architecture?
A. Zaleplon
B. Diazepam
C. Chlorpromazine
D. Haloperidol
Dosage of zaleplon 5 to 10 mg
As it has a half-life of one hour it is useful in initial insomnia
47. All of the following are antidepressants, except:
A. Imipramine
B. Amitryptilline
C. Risperidone
D. Citalopram
Imipramine and amitryptilline are tricyclic anti­depressants; citalopram is a SSRI risperidone is an atypical antipsychotic.
48. Which of the following side effects of chlorpromazine are ameliorated by anticholinergic antiparkinson medi­cation?
A. Confusion
B. Hypotension
C. Blurred vision
D. Oculogyric crisis
49. Lithium is used to treat:
A. Hysteria
B. Phobia
C. Mood disorders
D. Acute organic brain syndrome
50. Lithium is used in:
A. Acute mania
B. Depression
C. Hyperkinetic disorder
D. All of the above.
51. The least affected organ in lithium toxicity is:
A. Liver
B. Heart
C. Kidney
D. Brain
There is no hepatic metabolism for lithium in body.
52. Treatment of Panic attack includes the use of:
A. Diazepam
B. Imipramine
C. Fluoxetine
D. Clonazepam
E. Bothb + c
Both imipramine and fluoxetine in small doses are useful in treating panic disorder
53. All the following are anxiolytic except:
A. Fluoxetine
B. Buspirone
C. Diazepam
D. Nitrazepam
Fluoxetine is an antidepressant. It acts by selecting serotonin reuptake inhibition
54. Lithium is treatment of choice for:
A. Unipolar MDP prophylaxis
B. Bipolar MDP
C. Schizophrenia
D. Acute mania
Lithium is indicated in prophylaxis of bipolar MAP and acute mania.
55. The most useful drug in enuresis is:
A. Haloperidol
B. Diazepam
C. Imipramine
D. Chlorpromazine
Imipramine is the drug of choice in nonorganic enuresis usual dose range is 25 to 75 mg 1 day.
56. The least extra pyramidal effect is seen with:
A. Haloperidol
B. Thioridazine
C. Clozapine
D. Chlorpromazine
Drugs with minimal EPS are clozapine, quetipin sulpiride and ziprasidone.
Drugs useful in Heroin withdrawal are clonidine, methadone, buprenorphin, LAAM, and dextropropoxyphene.
57. Long-term therapy of lithium causes:
A. Neutropenia
B. Hypothyroidism
C. Hepatotoxicity
D. Bone narrow depression
Long-term lithium use causes renal side-effects also.
58. All of the following are selective serotonin (5HT) reuptake inhibitors, except:
A. Fluvoxamine
B. Fluoxetine
C. Paroxetine
D. Olanzapine
SSRI’s are fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram.
59. A psychiatric patient on tricyclic antidepressants presents with bradycardia, hypotension, decreased sweating, and retention of urine. The most likely drug used is:
A. Amitryptilline
B. Fluoxetine
C. Selegiline
D. Lithium
Decreased sweating, retention of urine, bradycardia are anticholinergic side effects of amitryptilline, hypotension is due to Ll-adrenergic blockade.
60. A 63-year-old man who is taking amitryptilline suddenly develops confusion, urinary retention and blurring of vi­sion. The cause is:
A. Anticholinergic side-effects
B. Reactive depression
C. Emergence of negative symptoms
D. CVA
61. A patient was found stuporous and he did not eat or sleep the whole day. On examination, he was found to be con­scious. The treatment should be: (AIIMS-2000)
A. ECT
B. Antipsychotics
C. Antidepressants
D. Neuroleptic
62. 30-year-old Bano Begum was brought to the casualty is a state of altered sensorium. She was on lithium treat­ment for the affective disorder and suffered an attack of epileptic fits. On examination she has tremors, increased deep tension reflexives, and insentience of urine. She also had undergone an episode of severe gash enteritis 2 days ago. Lithium level in the serum is 1.95 mEq/l. The most likely cause is:
A. lithium toxicity
B. severe dehydration
C. Manic stupor
D. Epileptic fits
63. The most common cardiac abnormality associated with use of lithium in 1st trimester of pregnancy:
A. Deacon’s syndrome
B. Epstein’s anomaly of tricuspid valve
C. PDA
D. Coarctation of aorta
In Epstein’s anomaly there is a distortion and down ward displacement of tricuspid valve. Use of lithium is contraindicated in the 1st trimester of pregnancy.
64. Vasanti, 45-year-old, was brought to casualty with ab­normal movements which included persistent deviation of the meek to the right side. One day earlier, she had been prescribed haloperidol 5mg three times daily by the psychiatrist. She also had an altercation with her bush and recently. Which of the following is the most likely cause for her symptoms?
A. Acute drug dystonia
B. Conversion reaction
C. Acute psychosis
D. Cerebrovascular accident.
Acute dystonia is an acute extra pyramidal symptom caused by antipsychotic medication. In this case, the neck muscles are affected by dystonia.
65. Contraindications to lithium administration include:
A. An administration in combination with chlorpromazine
B. The presence of renal disease
C. Any occurrence of the symptoms of schizophrenia
D. The presence of depression
E. An administration in combination with imipramine.
 
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