American Board of Psychiatry and Neurology ABPN Neuropharmacology and Psychopharmacology 3

Question 1

A patient on phenelzine (MAOI) eats aged cheese and develops a hypertensive crisis. Which mechanism explains this reaction?

Accepted Answer

Tyramine displaces norepinephrine causing massive sympathetic discharge

Answer

MAOIs prevent gut and hepatic MAO from metabolizing tyramine in aged foods, allowing tyramine to enter systemic circulation and displace norepinephrine from vesicles.

Question 2

Which mood stabilizer is MOST teratogenic and requires mandatory REMS enrollment due to risk of major congenital malformations?

Accepted Answer

Valproate

Answer

Valproate carries the highest teratogenic risk among mood stabilizers, causing neural tube defects and cognitive impairment, and requires the FDA's Valproate REMS program.

Question 3

Which receptor does memantine target for the treatment of moderate-to-severe Alzheimer's disease?

Accepted Answer

NMDA glutamate receptor

Answer

Memantine is a non-competitive NMDA receptor antagonist that reduces glutamate excitotoxicity implicated in Alzheimer's disease neurodegeneration.

Question 4

A patient experiences neuroleptic malignant syndrome (NMS). Which combination of features is MOST characteristic?

Accepted Answer

Fever, muscle rigidity, altered consciousness, autonomic instability

Answer

NMS is characterized by the tetrad of hyperthermia, severe muscle rigidity, altered consciousness, and autonomic instability following dopamine antagonist exposure.

Question 5

Which antiepileptic drug requires monitoring of serum levels and is known to cause Steven-Johnson syndrome, particularly in patients with HLA-B*1502 allele?

Accepted Answer

Carbamazepine

Answer

Carbamazepine is associated with Stevens-Johnson syndrome, and the risk is significantly higher in patients of Asian descent carrying the HLA-B*1502 allele.

American Board of Psychiatry and Neurology Practice Test

American Board of Psychiatry and Neurology Practice Test

American Board of Psychiatry and Neurology ABPN Neuropharmacology and Psychopharmacology 3