MRCPsych Pharmacology Fundamentals 4

Question 1

Which antidepressant acts as a noradrenaline and dopamine reuptake inhibitor (NDRI) with no direct serotonergic activity?

Accepted Answer

Bupropion

Answer

Venlafaxine

Answer

Duloxetine

Answer

Mirtazapine

Question 2

The therapeutic drug monitoring target range for lithium in acute mania treatment is:

Accepted Answer

0.8–1.0 mmol/L

Answer

0.2–0.4 mmol/L

Answer

0.4–0.6 mmol/L

Answer

1.2–1.5 mmol/L

Question 3

Which pharmacological property of clozapine is thought to contribute most to its superior efficacy in treatment-resistant schizophrenia?

Accepted Answer

Low D2 affinity combined with 5-HT2A antagonism and multi-receptor actions

Answer

High D2 receptor affinity with slow dissociation

Answer

Partial agonism at D3 receptors

Answer

Selective blockade of D4 receptors

Question 4

Which enzyme does acetylcholinesterase inhibitors (e.g., donepezil) target, and what is the net effect?

Accepted Answer

Inhibit acetylcholinesterase, increasing acetylcholine at the synapse

Answer

Inhibit COMT, increasing dopamine levels

Answer

Inhibit MAO-B, increasing serotonin levels

Answer

Inhibit choline acetyltransferase, decreasing ACh synthesis

Question 5

Which adverse effect is most associated with long-term use of antipsychotics and is characterised by involuntary orofacial movements?

Accepted Answer

Tardive dyskinesia

Answer

Akathisia

Answer

Parkinsonism

Answer

Acute dystonia

Question 6

A 35-year-old woman with bipolar disorder is prescribed carbamazepine. She is also taking the oral contraceptive pill. What is the key concern?

Accepted Answer

Carbamazepine is a CYP3A4 inducer, reducing OCP efficacy and risking unintended pregnancy

Answer

Carbamazepine increases oestrogen levels, causing thrombosis risk

Answer

Combined use causes serotonin syndrome

Answer

QTc prolongation with combined therapy

Question 7

Which of the following best describes 'pharmacodynamic tolerance'?

Accepted Answer

Diminished response to a drug due to receptor downregulation or desensitisation

Answer

Reduced plasma drug levels due to increased hepatic metabolism

Answer

Increased drug absorption over time due to gut adaptation

Answer

Rapid elimination of a drug due to autoinduction