ABPN Neuropharmacology and Psychopharmacology Flashcards

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

Answer: Tyramine displaces norepinephrine causing massive sympathetic discharge

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

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

Answer: Valproate

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

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

Answer: NMDA glutamate receptor

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

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

Answer: Fever, muscle rigidity, altered consciousness, autonomic instability

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

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

Answer: Carbamazepine

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

A 35-year-old patient with bipolar I disorder is started on lithium. Which baseline laboratory test is MOST important before initiating therapy?

Answer: Renal function (BMP/creatinine) and thyroid function

Lithium is renally cleared and can cause nephrotoxicity and hypothyroidism, so baseline renal function and thyroid tests are mandatory before initiation.