American Board of Psychiatry and Neurology ABPN Neuropharmacology and Psychopharmacology 2 — Questions and Answers
Question 1: Which mechanism best describes how benzodiazepines produce their sedative-anxiolytic effects?
- Block NMDA glutamate receptors
- Potentiate GABA-A chloride channel opening (Correct answer)
- Inhibit dopamine reuptake
- Block serotonin 5-HT3 receptors
Correct answer: Potentiate GABA-A chloride channel opening
Benzodiazepines bind to GABA-A receptors and increase the frequency of chloride channel opening in response to GABA, enhancing inhibitory neurotransmission.
Question 2: Which antidepressant is CONTRAINDICATED in patients with a seizure disorder or eating disorders due to lowered seizure threshold?
- Sertraline
- Bupropion (Correct answer)
- Mirtazapine
- Escitalopram
Correct answer: Bupropion
Bupropion dose-dependently lowers the seizure threshold and is contraindicated in patients with seizure disorders or active eating disorders.
Question 3: A patient stabilized on olanzapine gains 25 pounds over 6 months and develops hyperglycemia. This best exemplifies which pharmacological mechanism?
- D2 receptor blockade
- H1 histamine receptor antagonism and 5-HT2C blockade (Correct answer)
- Muscarinic M1 receptor blockade
- Alpha-2 adrenergic agonism
Correct answer: H1 histamine receptor antagonism and 5-HT2C blockade
Olanzapine's metabolic side effects are primarily attributed to H1 and 5-HT2C receptor blockade, which increase appetite and impair glucose regulation.
Question 4: Which drug interaction is MOST clinically significant in a patient taking valproate who starts carbamazepine?
- Carbamazepine increases valproate levels causing toxicity
- Carbamazepine induces CYP enzymes, decreasing valproate levels (Correct answer)
- Valproate inhibits carbamazepine metabolism causing toxicity
- No significant interaction occurs between these agents
Correct answer: Carbamazepine induces CYP enzymes, decreasing valproate levels
Carbamazepine is a potent CYP3A4 inducer that significantly reduces valproate serum levels, potentially causing loss of seizure control.
Question 5: What is the mechanism by which acetylcholinesterase inhibitors improve symptoms in Alzheimer's disease?
- They increase dopamine in the prefrontal cortex
- They prevent amyloid beta aggregation
- They increase acetylcholine availability at synapses (Correct answer)
- They block glutamate NMDA receptor excitotoxicity
Correct answer: They increase acetylcholine availability at synapses
Acetylcholinesterase inhibitors (e.g., donepezil, rivastigmine) prevent the breakdown of acetylcholine, compensating for the cholinergic deficit in Alzheimer's disease.
Question 6: Which medication is FDA-approved for the treatment of alcohol use disorder by blocking opioid reward pathways?
- Disulfiram
- Naltrexone (Correct answer)
- Acamprosate
- Topiramate
Correct answer: Naltrexone
Naltrexone is an opioid receptor antagonist that reduces alcohol craving and pleasure by blocking the endogenous opioid reward pathway activated by alcohol.
American Board of Psychiatry and Neurology ABPN Neuropharmacology and Psychopharmacology 2
Which mechanism best describes how benzodiazepines produce their sedative-anxiolytic effects?