ACT Pharmacology & Medication Management 2 — Questions and Answers
Question 1: A client taking an SSRI for depression asks about starting St. John's Wort to boost the effect. What is the primary concern?
- Increased sedation
- Serotonin syndrome risk (Correct answer)
- Reduced SSRI absorption
- Hypertensive crisis
Correct answer: Serotonin syndrome risk
Combining SSRIs with St. John's Wort can cause serotonin syndrome due to additive serotonergic effects.
Question 2: Which class of medications is most commonly associated with discontinuation syndrome if stopped abruptly?
- Benzodiazepines only
- SSRIs and SNRIs (Correct answer)
- Atypical antipsychotics
- Mood stabilizers
Correct answer: SSRIs and SNRIs
SSRIs and SNRIs frequently cause discontinuation syndrome (dizziness, flu-like symptoms, 'brain zaps') when stopped abruptly.
Question 3: A client on lithium therapy reports nausea, tremor, and polyuria. The therapist's most appropriate action is to:
- Encourage the client to drink more water
- Refer to the prescribing physician immediately (Correct answer)
- Suggest the client reduce their dose temporarily
- Document symptoms and monitor for one week
Correct answer: Refer to the prescribing physician immediately
These symptoms may indicate lithium toxicity, requiring immediate medical evaluation as the window between therapeutic and toxic levels is narrow.
Question 4: In ACT-integrated care, the therapist's role regarding a client's psychiatric medication is best described as:
- Recommending dosage adjustments based on symptom reports
- Collaborating with prescribers while maintaining scope of practice (Correct answer)
- Discouraging medication use to promote psychological flexibility
- Prescribing adjunct supplements when needed
Correct answer: Collaborating with prescribers while maintaining scope of practice
ACT therapists coordinate with prescribers as part of integrated care while remaining within their non-prescribing scope of practice.
Question 5: A client expresses that their antidepressant 'numbs' their emotions and they want to stop. The ACT-consistent response prioritizes:
- Validating concerns and immediately supporting discontinuation
- Exploring the client's values and facilitating a conversation with their prescriber (Correct answer)
- Explaining that emotional numbing is a necessary side effect
- Increasing session frequency to compensate for medication reduction
Correct answer: Exploring the client's values and facilitating a conversation with their prescriber
ACT supports client autonomy and values-based decision-making while encouraging coordination with the prescribing physician.
Question 6: Which medication used in ADHD treatment has the highest potential for abuse and requires a DEA Schedule II prescription?
- Atomoxetine (Strattera)
- Amphetamine salts (Adderall) (Correct answer)
- Bupropion (Wellbutrin)
- Guanfacine (Intuniv)
Correct answer: Amphetamine salts (Adderall)
Amphetamine salts are Schedule II controlled substances due to their high potential for abuse and dependence.
Question 7: A client taking an MAOI asks if they can eat aged cheese at a dinner party. The therapist should advise:
- Small amounts are safe if taken with water
- Aged cheese is contraindicated due to tyramine content (Correct answer)
- Only soft cheeses are restricted
- Food restrictions only apply in the first month of MAOI use
Correct answer: Aged cheese is contraindicated due to tyramine content
MAOIs combined with tyramine-rich foods like aged cheese can cause a hypertensive crisis.
ACT Pharmacology & Medication Management 2
A client taking an SSRI for depression asks about starting St.
John's Wort to boost the effect.
What is the primary concern?