ASPPB Psychopharmacology 3

Question 1

Which of the following benzodiazepines is most appropriate for a patient with severe hepatic impairment?

Accepted Answer

Lorazepam

Answer

Lorazepam (along with oxazepam and temazepam) undergoes direct glucuronidation rather than hepatic oxidation, making it safer in liver disease.

Question 2

A patient on carbamazepine experiences double vision and ataxia after a new medication is added. The new drug most likely inhibited CYP3A4, causing:

Accepted Answer

Elevated carbamazepine levels producing toxicity

Answer

Carbamazepine is a CYP3A4 substrate; CYP3A4 inhibition raises its plasma concentration and produces dose-dependent toxicity.

Question 3

The discontinuation syndrome most associated with paroxetine, characterized by dizziness, 'brain zaps,' and flu-like symptoms, is attributable primarily to:

Accepted Answer

Rapid decrease in synaptic serotonin following abrupt cessation

Answer

Abrupt SSRI withdrawal rapidly drops serotonin availability at synapses, producing a characteristic discontinuation syndrome; paroxetine's short half-life worsens this.

Question 4

Which mood stabilizer is first-line for acute bipolar mania and also has the strongest evidence for suicide prevention in bipolar disorder?

Accepted Answer

Lithium

Answer

Lithium has robust evidence for both acute mania and long-term suicide risk reduction in bipolar disorder.

Question 5

Tardive dyskinesia risk is highest with which class of antipsychotics?

Accepted Answer

First-generation high-potency D2 blockers such as haloperidol

Answer

High-potency first-generation antipsychotics (e.g., haloperidol) produce sustained nigrostriatal D2 blockade, the mechanism underlying tardive dyskinesia.

(ASPPB) Association of State and Provincial Psychology Boards Practice Test

(ASPPB) Association of State and Provincial Psychology Boards Practice Test

ASPPB Psychopharmacology 3