American Board of Psychiatry and Neurology ABPN Neuropharmacology and Psychopharmacology 1 — Questions and Answers
Question 1: Which neurotransmitter system is the PRIMARY target of typical antipsychotic medications?
- Serotonin (5-HT2A)
- Dopamine (D2) (Correct answer)
- GABA-A
- Norepinephrine (alpha-1)
Correct answer: Dopamine (D2)
Typical antipsychotics primarily block dopamine D2 receptors, which accounts for both their antipsychotic efficacy and extrapyramidal side effects.
Question 2: A patient on lithium develops tremor, polyuria, and polydipsia. What is the MOST appropriate next step?
- Immediately discontinue lithium
- Check serum lithium level (Correct answer)
- Add propranolol for tremor
- Switch to valproate
Correct answer: Check serum lithium level
Checking the serum lithium level is essential to determine if symptoms reflect toxicity or are side effects at therapeutic levels.
Question 3: Which antidepressant is MOST associated with serotonin syndrome when combined with an MAOI?
- Bupropion
- Mirtazapine
- Fluoxetine (Correct answer)
- Trazodone
Correct answer: Fluoxetine
Fluoxetine, a potent SSRI with a long half-life, carries the highest risk of serotonin syndrome when combined with or shortly after an MAOI.
Question 4: Tardive dyskinesia is MOST commonly caused by long-term use of which class of drugs?
- Benzodiazepines
- Mood stabilizers
- Dopamine receptor antagonists (Correct answer)
- Anticholinergics
Correct answer: Dopamine receptor antagonists
Tardive dyskinesia results from chronic blockade of dopamine receptors, causing receptor supersensitivity and abnormal involuntary movements.
Question 5: Which anticonvulsant is considered FIRST-LINE for trigeminal neuralgia?
- Valproate
- Carbamazepine (Correct answer)
- Lamotrigine
- Levetiracetam
Correct answer: Carbamazepine
Carbamazepine is first-line for trigeminal neuralgia due to its efficacy in blocking sodium channels and reducing ectopic neuronal firing.
Question 6: A patient taking clozapine develops fever, sore throat, and an absolute neutrophil count of 400/μL. What is the MOST appropriate action?
- Continue clozapine and recheck CBC in 1 week
- Reduce clozapine dose by 50%
- Immediately discontinue clozapine (Correct answer)
- Add G-CSF and continue clozapine
Correct answer: Immediately discontinue clozapine
Severe agranulocytosis (ANC < 500/μL) requires immediate discontinuation of clozapine to prevent life-threatening infection.
American Board of Psychiatry and Neurology ABPN Neuropharmacology and Psychopharmacology 1
Which neurotransmitter system is the PRIMARY target of typical antipsychotic medications?