LPCC Pharmacology Fundamentals 2 — Questions and Answers
Question 1: A client on lithium reports tremors, nausea, and blurred vision. The serum lithium level is 1.8 mEq/L. What is the clinical priority?
- Reassure the client that these are expected side effects
- Hold the next dose and contact the prescribing physician immediately (Correct answer)
- Administer an antiemetic to manage the nausea
- Increase fluid intake and continue lithium as prescribed
Correct answer: Hold the next dose and contact the prescribing physician immediately
A lithium level of 1.8 mEq/L exceeds the therapeutic range (0.6–1.2 mEq/L) and indicates early toxicity requiring immediate medical consultation.
Question 2: Which neurotransmitter is primarily targeted by SSRIs to reduce symptoms of depression?
- Dopamine
- Norepinephrine
- Serotonin (Correct answer)
- GABA
Correct answer: Serotonin
SSRIs block the reuptake of serotonin at the presynaptic neuron, increasing serotonin availability in the synaptic cleft.
Question 3: A client taking a monoamine oxidase inhibitor (MAOI) consumes aged cheese at dinner. What reaction is most likely to occur?
- Sedation and respiratory depression
- Hypertensive crisis (Correct answer)
- Serotonin syndrome
- QT prolongation
Correct answer: Hypertensive crisis
Tyramine in aged cheese cannot be metabolized when MAO is inhibited, causing a dangerous release of norepinephrine and a hypertensive crisis.
Question 4: Which class of medications is most commonly associated with the risk of developing tardive dyskinesia with long-term use?
- Benzodiazepines
- First-generation antipsychotics (Correct answer)
- SSRIs
- Mood stabilizers
Correct answer: First-generation antipsychotics
First-generation (typical) antipsychotics block D2 dopamine receptors and carry the highest risk of tardive dyskinesia with prolonged use.
Question 5: A prescriber orders clonazepam for a client with panic disorder. Under what schedule does this substance fall under the DEA?
- Schedule I
- Schedule II
- Schedule III
- Schedule IV (Correct answer)
Correct answer: Schedule IV
Clonazepam, like other benzodiazepines, is classified as a Schedule IV controlled substance due to its lower but existing potential for abuse and dependence.
Question 6: Which metabolic enzyme is responsible for metabolizing the majority of psychiatric medications in the liver?
- CYP1A2 only
- The CYP450 enzyme system (Correct answer)
- Monoamine oxidase exclusively
- Glucuronyl transferase
Correct answer: The CYP450 enzyme system
The cytochrome P450 (CYP450) system is the primary hepatic enzyme family responsible for metabolizing most psychiatric drugs.
Question 7: A client suddenly stops taking a high-dose SSRI after 2 years of use. Which discontinuation syndrome symptom is most distinctive for SSRIs?
- Rebound psychosis
- FINISH symptoms including flu-like symptoms and electric shock sensations (Correct answer)
- Severe withdrawal seizures
- Opioid-like cravings
Correct answer: FINISH symptoms including flu-like symptoms and electric shock sensations
SSRI discontinuation syndrome is characterized by FINISH symptoms: Flu-like symptoms, Insomnia, Nausea, Imbalance, Sensory disturbances, and Hyperarousal.
LPCC Pharmacology Fundamentals 2
A client on lithium reports tremors, nausea, and blurred vision.
The serum lithium level is 1.8 mEq/L.
What is the clinical priority?