BCACP Mental Health and Substance Use Disorders 5 — Questions and Answers
Question 1: A patient with alcohol use disorder (AUD) is started on acamprosate. Which patient population is acamprosate CONTRAINDICATED in?
- Patients with liver cirrhosis
- Patients with severe renal impairment (CrCl < 30 mL/min) (Correct answer)
- Patients currently drinking alcohol
- Patients on opioid therapy
Correct answer: Patients with severe renal impairment (CrCl < 30 mL/min)
Acamprosate is renally eliminated and is contraindicated in patients with severe renal impairment (CrCl < 30 mL/min), unlike naltrexone which is contraindicated in hepatic failure.
Question 2: A patient with PTSD is not responding to sertraline. Which medication is the ONLY other FDA-approved pharmacotherapy specifically indicated for PTSD?
- Venlafaxine
- Paroxetine (Correct answer)
- Prazosin
- Mirtazapine
Correct answer: Paroxetine
Paroxetine (Paxil) is the only other FDA-approved medication for PTSD besides sertraline; venlafaxine and prazosin are used off-label.
Question 3: Which stimulant medication for ADHD is classified as Schedule II and requires a new written prescription for each fill with NO refills permitted?
- Atomoxetine (Strattera)
- Methylphenidate (Ritalin) (Correct answer)
- Viloxazine (Qelbree)
- Guanfacine extended-release (Intuniv)
Correct answer: Methylphenidate (Ritalin)
Methylphenidate is a Schedule II controlled substance; federal law prohibits refills, and a new prescription is required for each 30-day supply.
Question 4: A patient with bipolar depression is initiated on quetiapine. What is the FDA-approved dose range for quetiapine in bipolar depression?
- 25–100 mg/day
- 300–600 mg/day (Correct answer)
- 50–300 mg/day
- 600–800 mg/day
Correct answer: 300–600 mg/day
The FDA-approved dose for quetiapine in bipolar depression is 300–600 mg/day, typically titrated over several days.
Question 5: A patient taking phenelzine (an MAOI) for treatment-resistant depression requests tramadol for pain. What is the MOST serious risk of this combination?
- Hypertensive crisis
- Serotonin syndrome (Correct answer)
- Prolonged QTc interval
- Excessive sedation only
Correct answer: Serotonin syndrome
Tramadol inhibits serotonin reuptake and combined with an MAOI creates a potentially life-threatening serotonin syndrome.
Question 6: A pharmacist reviews a prescription for fluoxetine 60 mg/day for a 14-year-old with MDD. Which black box warning must be communicated to the patient and family?
- Risk of diabetes mellitus
- Increased risk of suicidal thinking and behavior in pediatric patients (Correct answer)
- Risk of tardive dyskinesia
- Risk of QT prolongation and sudden cardiac death
Correct answer: Increased risk of suicidal thinking and behavior in pediatric patients
All antidepressants carry an FDA black box warning for increased risk of suicidal thinking and behavior in children, adolescents, and young adults up to age 24.
Question 7: A patient with schizophrenia on haloperidol develops sustained muscle contractions of the neck and back. Which agent is FIRST-LINE to rapidly reverse this acute dystonia?
- Bromocriptine
- Benztropine (Cogentin) IM (Correct answer)
- Propranolol
- Dantrolene IV
Correct answer: Benztropine (Cogentin) IM
Acute dystonia from antipsychotics is treated with anticholinergic agents such as benztropine or diphenhydramine given IM or IV for rapid reversal.
BCACP Mental Health and Substance Use Disorders 5
A patient with alcohol use disorder (AUD) is started on acamprosate.
Which patient population is acamprosate CONTRAINDICATED in?