MRCPsych Pharmacology Fundamentals 3

Question 1

Which antipsychotic is most associated with QTc prolongation and carries the highest risk of torsades de pointes?

Accepted Answer

Thioridazine

Answer

Aripiprazole

Answer

Quetiapine

Answer

Amisulpride

Question 2

The Maudsley Prescribing Guidelines recommend plasma level monitoring for which drug primarily to assess adherence and toxicity?

Accepted Answer

Clozapine

Answer

Sertraline

Answer

Quetiapine

Answer

Aripiprazole

Question 3

A patient develops rigidity, hyperthermia, autonomic instability, and elevated CK after starting haloperidol. What is the most likely diagnosis?

Accepted Answer

Neuroleptic malignant syndrome

Answer

Serotonin syndrome

Answer

Anticholinergic toxicity

Answer

Malignant hyperthermia

Question 4

Which of the following best describes the concept of 'receptor occupancy' in antipsychotic prescribing?

Accepted Answer

The percentage of target receptors bound by a drug at a given plasma level

Answer

The proportion of drug absorbed from the GI tract

Answer

The ratio of drug in plasma to drug in tissue

Answer

The time for 50% of the drug to be eliminated

Question 5

Which SSRI is considered safest in overdose due to its relatively flat dose-response curve and low cardiac toxicity?

Accepted Answer

Fluoxetine

Answer

Citalopram

Answer

Paroxetine

Answer

Fluvoxamine

Question 6

Which mechanism explains the use of propranolol for lithium-induced tremor?

Accepted Answer

Beta-adrenergic blockade reducing peripheral tremor amplitude

Answer

Alpha-1 adrenergic blockade reducing peripheral vasoconstriction

Answer

Inhibition of lithium renal reabsorption

Answer

GABA-B agonism in the cerebellum

Question 7

Which pharmacodynamic interaction explains why combining SSRIs with tramadol increases the risk of serotonin syndrome?

Accepted Answer

Tramadol inhibits serotonin reuptake AND is a weak mu-opioid agonist, with SSRIs adding additive serotonergic load

Answer

Both inhibit monoamine oxidase

Answer

SSRIs increase tramadol bioavailability via CYP2D6 inhibition

Answer

Both block 5-HT3 receptors