BHP Pharmacology & Medication Management 3 — Questions and Answers
Question 1: A BHP observes that a client prescribed risperidone has developed breast enlargement and galactorrhea. This is most likely due to:
- Hypothyroidism induced by the medication
- Elevated prolactin from dopamine D2 blockade (Correct answer)
- Weight gain causing hormonal imbalance
- Serotonin receptor activation in mammary tissue
Correct answer: Elevated prolactin from dopamine D2 blockade
Risperidone's strong D2 blockade raises prolactin levels by removing dopamine's inhibitory effect on prolactin secretion.
Question 2: Which benzodiazepine property makes lorazepam preferred over diazepam for clients with liver impairment?
- Lorazepam has a shorter half-life
- Lorazepam undergoes glucuronidation rather than oxidative hepatic metabolism (Correct answer)
- Lorazepam does not cross the blood-brain barrier
- Lorazepam has no active metabolites and is renally cleared
Correct answer: Lorazepam undergoes glucuronidation rather than oxidative hepatic metabolism
Lorazepam is conjugated via glucuronidation, a pathway preserved in liver disease, unlike diazepam's oxidative metabolism.
Question 3: A client on valproate for bipolar disorder becomes pregnant. The BHP's most important immediate action is to:
- Reassure the client that valproate is safe during the first trimester
- Alert the prescriber immediately due to high teratogenicity risk (Correct answer)
- Advise the client to halve the dose on their own
- Schedule a follow-up appointment in 4 weeks
Correct answer: Alert the prescriber immediately due to high teratogenicity risk
Valproate carries a high risk of neural tube defects and other fetal harm, requiring urgent prescriber consultation for medication review.
Question 4: Methylphenidate (Ritalin) works primarily by:
- Blocking reuptake of dopamine and norepinephrine (Correct answer)
- Directly stimulating dopamine receptors in the prefrontal cortex
- Inhibiting monoamine oxidase B selectively
- Increasing GABA transmission in the limbic system
Correct answer: Blocking reuptake of dopamine and norepinephrine
Methylphenidate blocks dopamine and norepinephrine transporters, increasing their synaptic availability in the prefrontal cortex.
Question 5: A client is prescribed disulfiram (Antabuse) for alcohol use disorder. They must be warned to avoid:
- Grapefruit juice only
- All alcohol-containing products including mouthwash and cough syrups (Correct answer)
- Foods high in tyramine
- NSAIDs and aspirin
Correct answer: All alcohol-containing products including mouthwash and cough syrups
Disulfiram blocks aldehyde dehydrogenase, and even small amounts of alcohol from mouthwash or medication can trigger a severe reaction.
Question 6: Which symptom cluster is most characteristic of serotonin syndrome?
- Bradycardia, hypothermia, and miosis
- Hyperthermia, agitation, clonus, and diaphoresis (Correct answer)
- Dry skin, urinary retention, and confusion
- Sedation, respiratory depression, and pinpoint pupils
Correct answer: Hyperthermia, agitation, clonus, and diaphoresis
Serotonin syndrome presents with the triad of neuromuscular abnormalities (clonus), autonomic instability, and altered mental status including agitation.
Question 7: When a client asks why their psychiatrist prescribed an atypical antipsychotic instead of a typical one, the most accurate explanation is:
- Atypicals are always cheaper and equally effective
- Atypicals have a lower risk of extrapyramidal side effects due to serotonin-dopamine antagonism (Correct answer)
- Atypicals work faster and require no blood monitoring
- Atypicals are only used for depression, not psychosis
Correct answer: Atypicals have a lower risk of extrapyramidal side effects due to serotonin-dopamine antagonism
Atypical antipsychotics block both D2 and 5-HT2A receptors, reducing the risk of extrapyramidal side effects compared to typical antipsychotics.
BHP Pharmacology & Medication Management 3
A BHP observes that a client prescribed risperidone has developed breast enlargement and galactorrhea.
This is most likely due to: